Endobronchial Valve Treatment of Tuberculous Cavities in Patients with Multidrug-Resistant Pulmonary Tuberculosis: A Randomized Clinical Study

Abstract

Background: Multidrug-resistant pulmonary tuberculosis (MDR-PTB) has become a major cause of high morbidity and mortality related to TB. Conventional drug regimens are ineffective for the treatment of MDR-PTB patients with cavities. This study aimed to evaluate the clinical efficacy and safety of one-way endobronchial valves (EBVs) for the treatment of cavities in MDR-PTB patients. Methods: MDR-PTB patients with positive sputum cultures, sputum smears, and cavities were treated with EBVs in the drainage bronchus of the pulmonary cavity between November 2013 and March 2018. The participants comprised those who had failed previous anti-tuberculosis therapy, as determined by drug susceptibility testing. Results: Thirty-five MDR-PTB patients were included, three of whom were lost during follow-up. The size of the lung cavity was reduced in all of the patients after EBV implantation, including the three lost to follow-up. In the remaining 32 patients, the sputum culture conversion (SCC) rate reached 100%, and the cavity closure rate was 68.8%. There were no significant differences in the cavity closure rate between patients aged ≤40 and >40 years, between the upper and lower lobes, or between the use and non-use of linezolid groups (p > 0.05). Interestingly, the cavity closure rate was higher in women than in men (p = 0.005). Moreover, the cavity closure rate correlated with the time to SCC (correlation coefficient, 0.8933; p < 0.0001). There were no severe adverse events in the patients treated with EBV implantation. Conclusion: EBV installation is effective and safe for the treatment of cavities in MDR-PTB patients. The efficacy of EBV treatment may not be affected by age, disease course, or the location of the lung lobe in the cavity.

Post Tuberculosis (TB) Bronchiectasis versus Non-TB Bronchiectasis in Northern Pakistan: A single centre retrospective cohort study on frequency, demographics, microbiology, and complications

“…Significant structural lung disease such as destroyed lung syndrome with large lung cavities is challenging, particularly within our resource-poor context where there is limited recourse to cardiothoracic surgery such as Video-Assisted Thoracic Surgery (VATS) due to cost and availability. Here Endobronchial valve insertion may be an option and has already been trialled in patients with tuberculous cavities (26).…”

“…Significant structural lung disease such as destroyed lung syndrome with large lung cavities is challenging, particularly within our resource-poor context where there is limited recourse to cardiothoracic surgery such as Video-Assisted Thoracic Surgery (VATS) due to cost and availability. Here Endobronchial valve insertion may be an option and has already been trialled in patients with tuberculous cavities(26). While early detection and diagnosis remains key to the reduction of Post TB Bronchiectasis and its complications, further research and resources are also necessary to reduce morbidity and mortality in those who have already developed advanced disease.…”

Novel Insights from Clinical Practice Autologous Blood Patch Pleurodesis and Endobronchial Valves for Management of Persistent Air Leaks in Two Cases of Tuberculosis

“…EBV placement has been shown to be efficacious in addressing PALs [20][21][22]. Prior studies have described the use of EBVs in patients with persistent cavitary lesions or bronchocutaneous fistulas in patients with TB [23,24]. To our knowledge, there is only one other case describing the successful use of EBVs for PAL due to pleuropulmonary TB, but EBV may be a viable option especially when ABPP is not successful [25].…”