Chemical pleurodesis as a therapeutic option in non-traumatic chylothorax: a scoping review.

BACKGROUND: Non-traumatic chylothorax is a rare condition with heterogeneous etiology and significant morbidity and mortality. Most cases are associated with malignancy, accounting for approximately two-thirds of cases. Management remains challenging due to the lack of evidence-based guidelines. Initial treatment is typically conservative, including nutritional support and pleural drainage; however, failure rates are considerable, and optimal second-line strategies remain unclear. This scoping review aimed to evaluate the available evidence on the effectiveness and safety of chemical pleurodesis in patients with non-traumatic chylothorax. METHODS: A scoping review was conducted following established methodological frameworks and reported in accordance with PRISMA-ScR guidelines to map and synthesize the available evidence on the effectiveness and safety of chemical pleurodesis in patients with non-traumatic chylothorax. A comprehensive search of relevant databases was performed. Study selection was conducted using Rayyan, a web-based platform designed for systematic review screening, allowing independent and blinded assessment of titles and abstracts. RESULTS: Chemical pleurodesis, particularly with talc, appears to be an effective and minimally invasive option for the management of non-traumatic chylothorax. Available evidence suggests high success rates in controlling chylous effusions in selected patients, with a favorable safety profile and low incidence of major complications. Despite these findings, its use remains limited, likely due to the scarcity of high-quality evidence and the lack of standardized criteria for patient selection and timing of intervention. CONCLUSIONS: Chemical pleurodesis, especially talc pleurodesis, represents a viable therapeutic alternative in patients with non-traumatic chylothorax who fail conservative management. It should be considered as part of a multimodal treatment strategy. Further studies are needed to better define its indications, timing, and comparative effectiveness.