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Advanced bronchoscopic procedures
Published in Don Hayes, Kara D. Meister, Pediatric Bronchoscopy for Clinicians, 2023
Karthik Balakrishnan, R. Paul Boesch
Endobronchial valves are one-way valves deployed within the airway lumen to isolate areas of the lung from airflow. These valves may be helpful in lung volume reduction for treatment of severe emphysema and have been applied in the treatment of bronchopleural fistulae.8,9
Lung volume reduction − old and new approaches
Published in Claudio F. Donner, Nicolino Ambrosino, Roger S. Goldstein, Pulmonary Rehabilitation, 2020
Nathaniel Marchetti, Gerard Criner
The VENT study was also performed in 23 European sites where 111 subjects were randomized to EBV and 60 to medical therapy (47). Although the study was underpowered compared to the U.S. VENT study, the results were similar. At 6 months there were modest improvements in FEV1, quality of life and 6-minute walk distance in the EBV group compared to the control group that were either significant or nearly significant. Once again, those with complete fissures had better results with improvements in FEV1 (16% vs. 2%, p = 0.02) when treated with EBV compared to medical therapy. The median reduction in target lobe volume reduction (TLVR) relative to baseline TLVR was greater in those with complete fissures (−55%) compared to incomplete fissures (−13%) (p < 0.0001) (47). These two studies suggest that if collateral ventilation is absent, then placement of endobronchial valves can improve lung function and quality of life by reducing lung volumes.
Other Treatments for Dyspnea
Published in Donald A. Mahler, Denis E. O’Donnell, Dyspnea, 2014
Given the potential benefits of LVRS juxtaposed with the risks of median sternotomy or VATS, bronchoscopic volume reduction has been introduced as a less invasive procedure to palliate dyspnea refractory to optimal medical therapy in patients with the emphysema phenotype of COPD [76,77]. The objectives are the same as LVRS, that is, to reduce hyperinflated lung volume and thereby improve physiological function and reduce dyspnea. These techniques include placement of unidirectional endobronchial valves that allow exit, but not entry, of air to collapse hyperinflated portions of lung [78–80], placement of coils within the airway, intrabronchial administration of a synthetic polymer that forms a sealant to occlude the airway and prevent air from reaching the target area of emphysema leading to reabsorption of air and lung deflation [81], creation of airway bypass tracts that connect stented pathways between hyperinflated lung and the bronchial tree to allow escape of trapped air [82–84], and thermal vapor ablation [85]. The majority of studies examining bronchoscopic volume reduction have been observational, whereas RCTs evaluating placement of endobronchial valves have shown mixed results on relief of breathlessness [86,87]. Endobronchial valves may not successfully reduce lung volume if there is collateral ventilation by an incomplete lobar fissure. Although bronchoscopic volume reduction procedures offer promise to relieve breathlessness and to improve function in patients with emphysema, current information is not sufficient to recommend their use at the present time [76,77].
Endoscopic approaches for treating emphysema
Published in Expert Review of Respiratory Medicine, 2018
Konstantina Kontogianni, Ralf Eberhardt
The endobronchial valves (EBVs) have the largest series of treated patients so far. They are blocking devices that can be easily removed. Endobronchial valves have the ability to block the entrance of air during inspiration, while allowing air and secretions to escape during expiration (one-way valves). Valves are used to occlude the most emphysematous and hence destroyed lobe of the lung. With every expiration the amount of air in the treated lobe is reduced and this leads to target lobar volume reduction (TLVR), reducing the overall lung volume and ideally inducing a complete lobar atelectasis (Figure 1(a,b)).
Lung volume reduction with endobronchial valves in patients with emphysema
Published in Expert Review of Medical Devices, 2018
Marieke C. Van Der Molen, Karin Klooster, Jorine E. Hartman, Dirk-Jan Slebos
Key findings in the research done so far is that endobronchial valve treatment can result in clinically important improvements in lung function, dyspnea scores, exercise capacity and quality of life in a subgroup of patients with emphysema.