Bronchoscopic lung volume reduction for pulmonary emphysema: preliminary experience with endobronchial occluder.
OBJECTIVE
To describe the self-expanding endobronchial occluder, as utilized in bronchoscopic lung volume reduction, with a 36 month follow-up procedure.


METHODS
Twenty-three subjects with severe emphysema were recruited and underwent flexible bronchoscopic placement of self-expanding endobronchial occluders. Outcomes were assessed at 1 week, 1-month, 3-, 6-, 12-, 24-, and 36-month intervals. Feasibility, safety, and efficacy were analyzed by means of pulmonary function testing, 6-min walk test, dyspnea score, BODE (body mass index, air-flow obstruction, dyspnea, and exercise capacity) index, and St George's Respiratory Questionnaire.


RESULTS
Fifty-eight self-expanding endobronchial occluders were implanted into 23 lobes previously selected. No displacement was found during the follow-up. Five subjects experienced postoperative complications of cough, and 6 subjects had lobar pneumonia, which were not located in any of the blocked segments. The FEV1 in 18 subjects was improved by > 15%, compared with baselines (P < .001), and the mean first efficacy time and maximal efficacy time were 5.65 ± 1.51 months and 6.35 ± 3.08 months, respectively. No significant changes were observed in FVC or the ratio of residual volume to TLC. The 6-min walk distance, dyspnea score, and St George's Respiratory Questionnaire total score were improved in 22 subjects over a 24-month period, and a minority of subjects continued to improve through to the end of the study. Mean baseline BODE index had improved during follow-up, but not at the study's conclusion.


CONCLUSIONS
This preliminary study demonstrates early significant improvements in pulmonary function, 6-min walk distance, dyspnea score, BODE index, and quality of life after placement of the self-expanding endobronchial occluder in bronchoscopic lung volume reduction. Its placement also proved both easy and safe. However, the initial improvements were maintained long-term for only a minority of subjects.
Department of Respiratory Medicine, Xi Jing Hospital, Fourth Military Medical University, Xi'an, China.
Liqiang
L
Song
Feng
F
Zhao
Xinyu
X
Ti
Weiqiang
W
Chen
Gaowen
G
Wang
Changgui
C
Wu
Yan
Y
Li
D000368:Aged; D001999:Bronchoscopy / Q000295:instrumentation*; D005240:Feasibility Studies; D005260:Female; D005541:Forced Expiratory Volume; D006801:Humans; D008297:Male; D008875:Middle Aged; D011013:Pneumonectomy / Q000295:instrumentation / Q000379:methods*; D011446:Prospective Studies; D019736:Prostheses and Implants; D011474:Prosthesis Design; D019919:Prosthesis Implantation / Q000379:methods; D011656:Pulmonary Emphysema / Q000503:physiopathology / Q000601:surgery*; D011788:Quality of Life; D014057:Tomography, X-Ray Computed
bronchoscopic lung volume reduction; emphysema; endobronchial occluder; pulmonary function; safety