Endoscopic Lung Volume Reduction: An Expert Panel Recommendation - Update 2017

Abstract

Interest in endoscopic lung volume reduction (ELVR) technologies for emphysema is consistently growing. In the last couple of months, several endoscopic options (e.g., endo- or intrabronchial valves, coil implants, and thermal vapor ablation) that have been evaluated in randomized controlled trials have been reported with the ultimate goal of improving respiratory mechanics and alleviating chronic dyspnea. Patients presenting with severe air trapping and thoracic hyperinflation have the greatest potential to derive benefit from ELVR procedures. Baseline assessment should ideally include cardiological evaluation, high-resolution computed tomography scan and perfusion scintigraphy, full pulmonary function tests, and cardiopulmonary exercise testing. This expert statement updates best practice recommendations regarding patient selection and utilization of these various techniques for the treatment of patients with advanced emphysema.

Endoscopic Lung Volume Reduction: An Expert Panel Recommendation – Update 2019

“…The recommendation for the selection of patients for further evaluation remains unchanged [8]. Potential patients who are candidates for intervention are those who remain highly symptomatic despite receiving optimal medical treatment; i.e., maximal pharmacological therapy with bronchodilators, inhaled corticosteroids in selected candidates, and maintenance with systemic therapies in selected patients.…”

“…The primary assessment should also ensure the absence of significant co-morbidity or abnormalities that require further assessment [15]. If there are unexpected findings such as bronchiectasis, pulmonary nodules, suspected lung cancer, interstitial fibrosis, or severe tracheobronchomalacia that are identified on the screening high-resolution computer tomography, patients should be evaluated and treated based on the abnormality detected if considered clinically important [8]. …”

“…The update was published in 2017 [8]. Since then, additional randomized controlled trials (RCTs) have been published that alter the treatment decisions previously outlined in the original 2016 Expert Panel Report.…”

Bronchoscopic Thermal Vapor Ablation: Best Practice Recommendations from an Expert Panel on Endoscopic Lung Volume Reduction

“…A RV ≥150% of predicted was defined as an inclusion criterion for patient enrolment in the different trials [2, 3, 6]. However, in keeping with our consensus statements we recommend that only patients with a RV ≥175% of predicted should be considered tor BTVA treatment [1]. …”

“…Endoscopic lung volume reduction (ELVR) represents an additional therapeutic option for appropriately selected patients with advanced emphysema and severe hyperinflation [1]. Various ELVR techniques with the goal of improving respiratory mechanics are available that differ in their mechanism of action, reversibility, and complication spectrum.…”