Efficacy of bronchoscopic lung volume reduction: a meta-analysis

Abstract

BackgroundOver the last several years, the morbidity, mortality, and high costs associated with lung volume reduction (LVR) surgery has fuelled the development of different methods for bronchoscopic LVR (BLVR) in patients with emphysema. In this meta-analysis, we sought to study and compare the efficacy of most of these methods.MethodsEligible studies were retrieved from PubMed and Embase for the following BLVR methods: one-way valves, sealants (BioLVR), LVR coils, airway bypass stents, and bronchial thermal vapor ablation. Primary study outcomes included the mean change post-intervention in the lung function tests, the 6-minute walk distance, and the St George’s Respiratory Questionnaire. Secondary outcomes included treatment-related complications.ResultsExcept for the airway bypass stents, all other methods of BLVR showed efficacy in primary outcomes. However, in comparison, the BioLVR method showed the most significant findings and was the least associated with major treatment-related complications. For the BioLVR method, the mean change in forced expiratory volume (in first second) was 0.18 L (95% confidence interval [CI]: 0.09 to 0.26; P<0.001); in 6-minute walk distance was 23.98 m (95% CI: 12.08 to 35.88; P<0.01); and in St George’s Respiratory Questionnaire was -8.88 points (95% CI: −12.12 to −5.64; P<0.001).ConclusionThe preliminary findings of our meta-analysis signify the importance of most methods of BLVR. The magnitude of the effect on selected primary outcomes shows noninfe-riority, if not equivalence, when compared to what is known for surgical LVR.

The minimal important difference for the St George's Respiratory Questionnaire in patients with severe COPD

“…Another limitation of our study is that all our patients participated in trials investigating a BLVR treatment, which is known to be a highly effective intervention resulting in a large decrease in SGRQ scores after treatment [25]. This could affect the size of the MID estimates.…”

Staged bilateral single-port thoracoscopic lung volume reduction surgery: A report of 11 cases

“…Beckers et al reported that, compared with pulmonary lobe partial resection, lobectomy could better improve the curative effects on the lung function of patients with severe emphysema (17). A meta-analysis by Iftikhar et al indicated that bronchoscopic lung volume reduction (BLVR) was a simple replacement therapy of emphysema (18). Chen et al confirmed the curative effects of lung transplantation and LVRS on treating end-stage emphysema, indicating that compared with LVRS, lung transplantation could better improve lung function of patients, blood gas analysis and quality of life after surgery.…”

Emphysema: Imaging for Endoscopic Lung Volume Reduction

“…The goal is an acute, but "controlled" inflammatory process with subsequent shrinkage of the tissue through scarring or fibrosis. Although a meta-analysis [28] showed the best results for BioLVR, this method is currently no longer available. Thermoablation is still considered to be experimental, since there have been no major studies [29].…”