title: Early Trends in Bronchoscopic Lung Volume Reduction: A Systematic Review and Meta-analysis of Efficacy Parameters.
abstract: The goal of our systematic review and meta-analysis is to examine the therapeutic effectiveness of bronchoscopic lung volume reduction (BLVR), and to compare it with medical management and lung volume reduction surgery.
  
  
  
  Variables of interest were absolute change in FEV1, 6MWT, and SGRQ. Meta-analysis was performed for the BLVR modalities with ≥3 trials. Of the 18 shortlisted publications, only valves (four trials; n = 159) and coils (six trials; n = 194) qualified for meta-analysis. To avoid redundant reporting for valves, only the data for intact fissure subjects were analyzed. Outcome data are presented as the mean difference from baseline with 95% confidence interval at 6-months follow-up.
  
  
  
  For BLVR using valves, the pooled mean difference (PMD) for FEV1 was 0.146 L (95% CI 0.111-0.181; p < 0.001), 6MWT was 45.225 meters (95% CI 26.954-63.495; p < 0.001), and SGRQ was -8.825 points (95% CI -14.824 to -2.825; p = 0.004). All the PMDs were statistically significant and higher than their respective minimal clinically important difference (MCID). For BLVR using coils, the PMD for FEV1 was 0.080 L (95% CI 0.057-0.104; p < 0.001), 6MWT was 45.320 meters (95% CI 28.040-62.600; p < 0.001), and SGRQ was -10.570 points (95% CI -13.299 to -7.841; p < 0.001). All three variables showed statistically significant PMDs but that for FEV1 was smaller than the MCID. Data from BLVR modalities with <3 major publications are reviewed in the discussion section.
  
  
  
  BLVR offers early promise in the palliation of advanced emphysema. Better characterization of patients to identify phenotypes that will derive sustained benefit is needed.
authors.affiliation: Mercy Medical Center, Cedar Rapids, IA, USA. medshek@gmail.com.|State University of New York/University at Buffalo, Buffalo, NY, USA. medshek@gmail.com.
authors.forename: Abhishek
authors.initials: A
authors.lastname: Kumar
authors.affiliation: State University of New York/University at Buffalo, Buffalo, NY, USA.
authors.forename: Rajany
authors.initials: R
authors.lastname: Dy
authors.affiliation: University of Massachusetts, Worcester, MA, USA.
authors.forename: Kanwaljit
authors.initials: K
authors.lastname: Singh
authors.affiliation: State University of New York/University at Buffalo, Buffalo, NY, USA.|Western New York Veterans Administration Healthcare System, Buffalo, NY, USA.
authors.forename: M
authors.initials: M
authors.lastname: Jeffery Mador
mesh_terms: D001999:Bronchoscopy / Q000009:adverse effects; D005541:Forced Expiratory Volume; D006801:Humans; D011013:Pneumonectomy / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods* / Q000639:trends; D011656:Pulmonary Emphysema / Q000503:physiopathology* / Q000601:surgery*; D016896:Treatment Outcome; D000070857:Walk Test
keywords: Bronchoscopic lung volume reduction (BLVR); COPD; Emphysema; Endoscopic lung volume reduction; Lung volume reduction