title: Efficacy of bronchoscopic lung volume reduction: a meta-analysis.
abstract: BACKGROUND
  Over 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.
  
  
  METHODS
  ELIGIBLE 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.
  
  
  RESULTS
  Except 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).
  
  
  CONCLUSIONS
  The preliminary findings of our meta-analysis signify the importance of most methods of BLVR. The magnitude of the effect on selected primary outcomes shows noninferiority, if not equivalence, when compared to what is known for surgical LVR.
authors.affiliation: Department of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, University of South Carolina, Columbia, SC, USA.
authors.forename: Imran H
authors.initials: IH
authors.lastname: Iftikhar
authors.affiliation: Department of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, University of South Carolina, Columbia, SC, USA.
authors.forename: Franklin R
authors.initials: FR
authors.lastname: McGuire
authors.affiliation: Department of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, National Jewish Health, Denver, CO, USA.
authors.forename: Ali I
authors.initials: AI
authors.lastname: Musani
mesh_terms: D001999:Bronchoscopy / Q000009:adverse effects / Q000295:instrumentation / Q000401:mortality; D005081:Exercise Therapy; D017079:Exercise Tolerance; D005541:Forced Expiratory Volume; D006801:Humans; D008168:Lung / Q000503:physiopathology / Q000601:surgery*; D008176:Lung Volume Measurements; D011013:Pneumonectomy / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods* / Q000401:mortality; D029424:Pulmonary Disease, Chronic Obstructive / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D011656:Pulmonary Emphysema / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D020127:Recovery of Function; D015607:Stents; D011795:Surveys and Questionnaires; D013997:Time Factors; D016896:Treatment Outcome; D016138:Walking
keywords: coils; emphysema; endobronchial valves; sealants; stents