title: Bilateral Endoscopic Lung Volume Reduction in Patients with Severe Emphysema.
abstract: Reducing hyperinflated areas in chronic obstructive pulmonary disease, either surgically or endoscopically, leads to improvement of functional parameters. It is unclear if bilateral treatment with endobronchial valves (EBV) aiming at total lobar occlusion is beneficial. The aim of this study was to assess the results after staged bilateral endoscopic treatment with EBV. This is a retrospective analysis of patients with severe airflow obstruction, who were treated bilaterally with EBV in two stages, aiming at subsequent atelectasis. Pre- and postintervention lung function parameters, the 6-minute walk test (6-MWT), complications, and follow-up were recorded. Sixteen patients were treated bilaterally in two stages. There was an overall improvement in lung function from baseline to second-treatment follow-up with an increase in FEV1 (23.57-29.21% of predicted) and a decrease in residual volume (299.21-240.10% of predicted) and total lung capacity (140.78-128.71% of predicted). The 6-MWT improved up to 54 m. After each procedure, 9 of 16 patients (56.25%) developed an atelectasis of the target lobe. Overall, pneumothorax occurred in 8 of 32 procedures (25%). No patient died. Patients benefitted from the first EBV treatment. The second treatment did not lead to marked improvements compared to the first treatment. Bilateral lung volume reduction with valves is possible; however, the current results seem not to justify bilateral valve treatment as a routine approach.
authors.affiliation: Department of Internal Medicine V - Pneumology, Allergology, and Critical Care Medicine, University Hospital of Saarland, Homburg, Germany.
authors.forename: Franziska C
authors.initials: FC
authors.lastname: Trudzinski
authors.forename: Philipp M
authors.initials: PM
authors.lastname: Lepper
authors.forename: Daniela
authors.initials: D
authors.lastname: Leppert
authors.forename: Frank
authors.initials: F
authors.lastname: Langer
authors.forename: Christian
authors.initials: C
authors.lastname: Lensch
authors.forename: Monika
authors.initials: M
authors.lastname: Flaig
authors.forename: Robert
authors.initials: R
authors.lastname: Bals
authors.forename: Heinrike
authors.initials: H
authors.lastname: Wilkens
authors.forename: Peter
authors.initials: P
authors.lastname: Minko
authors.forename: Sebastian
authors.initials: S
authors.lastname: Fähndrich
mesh_terms: D000368:Aged; D001999:Bronchoscopy / Q000379:methods*; D005260:Female; D005541:Forced Expiratory Volume; D006801:Humans; D008297:Male; D008875:Middle Aged; D011013:Pneumonectomy / Q000379:methods*; D011031:Pneumothorax, Artificial / Q000379:methods*; D019919:Prosthesis Implantation / Q000379:methods*; D011656:Pulmonary Emphysema / Q000503:physiopathology / Q000601:surgery*; D012115:Residual Volume; D012189:Retrospective Studies; D012720:Severity of Illness Index; D014109:Total Lung Capacity; D016896:Treatment Outcome; D014797:Vital Capacity; D000070857:Walk Test