Bronchoscopic Lung Volume Reduction Coil Research Articles

Outcomes of bronchoscopic lung volume reduction coil treatment in patients with severe emphysema

Background: This study aims to evaluate the outcomes of bronchoscopic lung volume reduction coil treatment in patients with severe emphysema. Methods: Between February 2016 and March 2019, a total of 20 severe emphysema patients (19 males, 1 female; mean age: 65.2±5.2 years; range, 52 to 73 years) who underwent bronchoscopic lung volume reduction coil treatment were included. Each patient underwent pre- and post-treatment (6 and 12 months) pulmonary function tests, 6-min walking distance, modified Medical Research Council dyspnea scores, and diffusing capacity of the lung for carbon monoxide tests. Results: An mean number of 12.0±3.8 coils was placed in each lobe. There were significant improvements in the patients' pulmonary function tests and quality of life 12 months after the treatment. There was a significant difference in dyspnea as assessed by the modified Medical Research Council dyspnea scores 12 months after treatment compared to pre-treatment scores (p<0.05). There was no change in the pulmonary function tests six months after treatment, while a significant improvement was seen at 12 months (p<0.05). Conclusion: Bronchoscopic lung volume reduction coil treatment seems to be a promising modality for severe emphysema patients with significant improvements in the pulmonary function test results, modified Medical Research Council dyspnea scores, and 6-min walking distance.

Efficiency and Reliability of Bronchoscopic Lung Volume Reduction Coil Application in Patients with Severe Emphysema.

In the past years, surgery has been used for the non-medical treatment of severe emphysema. However, in recent years, bronchoscopic lung volume reduction (LVR) treatment has become more preferred because it is less invasive. Bronchoscopic coil treatment is the most frequently applied technique among these methods. The aim of the investigation was to determine the efficacy and safety of bronchoscopic volume reduction coil treatment for patients with severe emphysema. The patients who were performed bronchial volume reduction coil treatment between 2015 and 2017 and were followed in our outpatient clinic were retrospectively examined. They were followed for 1 year at quarterly intervals after the procedure. All the safety and efficacy of the patient's records, including the modified Medical Research Council (MRC) dyspnea score, the St. George's Respiratory Questionnaire (SGRQ) quality of life scale, the 6 min walk distance (6-MWT), pulmonary function tests, and adverse events, were evaluated. Sixteen patients were included in the study. The mean of the preoperative mMRC clinic dyspnea score was 3.38, the mean of the 3rd month's mMRC score was 2.62 (p=0.007), and the mean of the 12th month's mMRC was 2.37 (p=0.003). The preoperative SGRQ quality of life parameter was 71.95±15.7, the 3rd month was 66.7±16.2 (p=0.007), and the 12th month was 62.9±16.4 (p=0.003). Preoperative mean of 6-MWT was 247.25±112.36 m, 3rd month 264.25±95 m (p=0.148), and 12th month 317±122.9 m (p=0.034). Patients' preoperative residual volume was 5.28±1.96 L, 3rd month 4.52±1.35 L (p=0.023), and 12th month 4.545±1.83 L (p=0.163). Patients' preoperative forced expiratory volume in one second, respectively, was 0.79±0.29 L, 3rd month 0.79±0.3 L (p=0.917), and 12th month 0.86±0.3 L (p=0.756). It seems that bronchoscopic LVR coil treatment, which is an effective and reliable procedure that reduces shortness of breath rather than respiratory function test parameters and improves the quality of daily life, will become even more widespread.

Bronchoscopic Lung Volume Reduction Coil Treatment for Severe Emphysema: A Systematic Review and Meta-Analysis of Individual Participant Data

Background: Lung volume reduction coil (LVR-coil) treatment provides a minimally invasive treatment option for severe emphysema patients which has been studied in multiple clinical trials. Objectives: The aim of the study was to assess the effect of LVR-coil treatment on pulmonary function, quality of life, and exercise capacity using individual participant data. Method: PubMed, Web of Science, and EMBASE were searched until May 17, 2021. Prospective single-arm and randomized controlled trials that evaluated the effect of LVR-coil treatment on forced expiratory volume in 1 s (FEV₁), residual volume (RV), St. George Respiratory Questionnaire (SGRQ) total score, and/or 6-min walk distance (6MWD) and were registered in an official clinical trial database were eligible for inclusion. Individual patient data were requested, and a linear mixed effects model was used to calculate overall treatment effects. Results: Eight trials were included in the final analysis, representing 680 individual patients. LVR-coil treatment resulted in a significant improvement in FEV1 at 3- (0.09 L [95% confidence interval (95% CI): 0.06–0.12]) and 6-month follow-up (0.07 L [95% CI: 0.03–0.10]), a significant reduction in RV at 3- (−0.45L [95% CI: −0.62 to −0.28]), 6- (−0.33L [95% CI: −0.52 to −0.14]), and 12-month follow-up (−0.36L [95% CI: −0.64 to −0.08]), a significant reduction in SGRQ total score at 3- (−12.3 points [95% CI: −15.8 to −8.8]), 6- (−10.1 points [95% CI: −12.8 to −7.3]), and 12-month follow-up (−9.8 points [95% CI: −15.0 to −4.7]) and a significant increase in 6MWD at 3-month follow-up (38 m [95% CI: 18–58]). Conclusions: LVR-coil treatment in emphysema patients results in sustained improvements in pulmonary function and quality of life and shorter lived improvements in exercise capacity. Since the owner of this LVR-coil has decided to stop the production and newer generations LVR-coils are currently being developed, these results can act as a reference for future studies and clinical guidance.

HRCT characteristics of severe emphysema patients: Interobserver variability among expert readers and comparison with quantitative software

PurposeFor a successful bronchoscopic lung volume reduction coil treatment it is important to place the coils in the most emphysematous lobes. Therefore assessment of the lobe with greatest destruction is essential. Our aims were to investigate the level of agreement among expert reviewers of HRCT-scans in emphysema patients and the comparison with QCT (quantitative computed tomography) software. MethodFive experienced CT-assessors, conducted a visual assessment of the baseline HRCT-scans of emphysema patients who participated in the RENEW bronchoscopic lung volume reduction coil study. On the same HRCT-scans, a QCT analysis was performed. ResultsIn total 134 HRCT-scans were rated by all 5 experts. All 5 CT-assessors agreed on which was the most destructed lobe in 61 % of the left lungs (ƙ:0.459) and 60 % of the right lungs (ƙ:0.370). The consensus of the 5 assessors matched the QCT in the left lung for 77 % of the patients (ƙ:0.425) and in the right lung for 82 % (ƙ:0.524). ConclusionsOur results show that the interobserver agreement between five expert CT-assessors was only fair to moderate when evaluating the most destructed lobe. CT-assessor consensus improved matching with QCT determination of lobar destruction compared to individual assessor determinations. Because some CT-features are associated with treatment outcomes and important for optimal patient selection of bronchoscopic lung volume reduction treatment, we recommend including more than one CT-reviewer and supported by QCT measurements.

Bronchoscopic lung volume reduction using coil therapy: complications and management.

Nonsurgical approaches involving bronchoscopic lung volume reduction (BLVR) have been developed in the last decade. One of these, the BLVR coil procedure, is a treatment option for patients with homogeneous and heterogeneous end-stage emphysema and a forced expiratory volume in 1 second (FEV1) of 15-45%. This treatment decreases hyperinflation and improves lung function, the quality of life, and exercise capacity. It is very important to prepare patients for treatment, premedications, anesthesia applications, intubation, post-procedure follow-up and treatments. Further, it has been observed that various complications can develop during and after the procedure. Generally, the observed and reported complications are chronic obstructive pulmonary disease (COPD) exacerbation, chest pain, mild bleeding, pneumonia, pneumothorax, and respiratory failure. Rarely, aspergillus cavitation (coil-related aspergilloma), bronchopleural fistula and penetration into the pleural space, bronchiectasis, coil-associated inflammatory response and opacities, and hiccups are observed. Common complications are usually mild or moderate, while the rare ones can be life-threatening (except hiccup), so early diagnosis and treatment are necessary. However, patients treated with BLVR have lower mortality rates than untreated patients with similar morbidity. Based on the findings of this review, we can estimate that premedication one day before and just before the procedure may reduce potential complications. Some medical centers apply and recommend 30-day macrolide treatment after the procedure. New generation supraglottic devices may be preferred to avoid complications due to endotracheal intubation. Moreover, further research is needed to identify risk factors, prevent potential complications, and a common consensus is required for routine preventive treatment.

Effects of Bronchoscopic Lung Volume Reduction Coil Treatment on Arterial Blood Gases.

Bronchoscopic lung volume reduction (BLVR) coil treatment is an increasingly used treatment modality for selected severe emphysema patients in recent years. Emphysema causes dynamic hyperinflation, loss of elastic recoil, air trapping, and decreased exercise capacity in advanced stages. This process progresses over time, leading to hypoxic and hypercapnic respiratory failure. The goal of this study is to elucidate the effects of BLVR coil treatment on arterial blood gas parameters in severe emphysema patients with respiratory failure. This is a retrospective study performed at a single pneumology center in Turkey. In total, this study included 39 patients diagnosed with severe emphysema who underwent bilateral BLVR coil treatment according to the general inclusion and exclusion criteria in the literature. The patients baseline and 12-month data were collected from medical records. Twelve months after BLVR coil treatment, significant improvements were observed in patients' pulmonary function tests, an increase in partial pressure of oxygen in arterial blood (PaO2) from 58.05±9.36 to 73.82±13.3 (P<0.000) and decrease in partial pressure of carbon dioxide in arterial blood (PaCO2) of hypercapnic patients (from 51.60±4.1 to 46.55±6.6 mm Hg; P=0.001). BLVR coil treatment is reliable and effective in emphysema patients who have hypoxic or mild hypercapnic respiratory failure. Besides improving lung function, BLVR coil treatment can significantly increase PaO2 and decrease PaCO2 in the medium term.

Importance of bronchoscopic lung volume reduction coil therapy in potential candidates for lung transplantation.

Bronchoscopic lung volume reduction (BLVR) coil treatment is a alternative and promising treatment modality for selected severe emphysema patients. The main indication of this treatment modality is a forced expiration volume in one second (FEV1) of 15-45% and a residual volume (RV) > 175%. The aim of this study was to investigate the efficacy of BLVR coil therapy in patients with end-stage emphysema who were potential candidates for lung transplantation and had FEV1 values less than 25%. Twenty-one patients who underwent bilateral BLVR coil therapy between September 2013 and May 2015 were retrospectively reviewed. We compared the changes in clinical and laboratory parameters at the baseline and 12 months after the treatment. Twelve months after the bilateral BLVR coil treatment, we observed an average increase in FEV1 (110 mL and 4.6%), a decrease in residual volume (660 mL and 33%), and an increase in 6-minute walk tests (67 m). The most common complications were chronic obstructive pulmonary disease exacerbation (47.6%) and pneumonia (23.8%). All patients tolerated the general anesthesia and procedure very well. BLVR coil therapy is safe and effective in patients with end-stage emphysema, who are potential candidates for lung transplantation within a short to medium period. The complication rates of this treatment were not different from those of the other coil treatments, and the improvements in the clinical parameters after the treatment resulted in gaining time for lung transplantation. Future research for evaluating the long-term efficacy of BLVR coil therapy in these patients is essential.

A comparison of the I-Gel supraglottic device with endotracheal intubation for bronchoscopic lung volume reduction coil treatment

Study objectiveTo compare the use of the I-gel airway with orotracheal intubation (OTI) for bronchoscopic lung volume reduction (BLVR) coil treatment in patients with severe chronic obstructive pulmonary disease (COPD) with heterogeneous emphysema, since it has been proved that supraglottic airways have lower incidence of postoperative respiratory complaints compared to OTI. DesignA comparative, prospective observational study was designed to assess the use of the I-gel airway compared with the OTI. SettingBronchoscopy room at the University Hospital Fundación Jimenez Diaz, Madrid. Tertiary care center. PatientsThirty-three procedures were carried out in 22 patients diagnosed with COPD with severe heterogeneous emphysema undergoing BLVR coil treatment under general anaesthesia. InterventionSeventeen procedures were carried out with I-gel and 16 with endotracheal tube. Airway device choice was left to the attendant anesthesiologist. MeasurementsTidal volume, peak pressure, and the presence of gas leaks were compared. Adverse events during the procedure and within the first 3 hours later were also recorded. Main resultsVentilation parameters obtained showed no significant differences. Mean tidal volume was 466.6 ± 28.2 mL and 478.7 ± 34.0 mL (P > .05), mean peak pressure was 17.9 ± 2.5 cmH2O and 19.4 ± 2.4 cmH2O (P > .05) and mean gas leaks was 71 ± 17.6 mL and 79 ± 15.5 mL (P > .05) for I-gel group (IgelG) and endotracheal tube group respectively. No serious complications were reported. One case of pneumothorax was reported in the endotracheal tube group, which was resolved with a chest drainage tube without further complications. ConclusionThe I-gel airway ensures appropriate ventilation and makes the use of the flexible fiberoptic bronchoscope quite easy. Therefore, we consider that the I-gel device is an effective and safe alternative to classical OTI for airway management in COPD patients with severe heterogeneous emphysema undergoing BLVR coil treatment.

Treatment of emphysema using bronchoscopic lung volume reduction coil technology: an update on efficacy and safety.

In the last decade several promising bronchoscopic lung volume reduction (BLVR) treatments were developed and investigated. One of these treatments is BLVR treatment with coils. The advantage of this specific treatment is that it works independently of collateral flow, and also shows promise for patients with a more homogeneous emphysema disease distribution. Seven years ago, the very first patients were treated with BLVR coil treatment and currently large randomized, controlled trials are underway. The aim of this article is to review the available literature and provide an update on the current knowledge on the efficacy and safety of BLVR treatment with coils.

Bronchoscopic Lung Volume Reduction Coil Treatment of Patients With Severe Heterogeneous Emphysema

The lung volume reduction coil (LVR-coil), a new experimental device to achieve lung volume reduction by bronchoscopy in patients with severe emphysema, works in a manner unaffected by collateral airflow. We investigated the safety and efficacy of LVR-coil treatment in patients with heterogeneous emphysema. In this prospective cohort pilot study, patients were treated bronchoscopically with Nitinol LVR-coils under fluoroscopic guidance in either one procedure or two sequential procedures. Follow-up tests included the St. George Respiratory Questionnaire (SGRQ), pulmonary function testing, and the 6-min walk test (6MWT). Twenty-eight LVR-coil procedures were performed in 16 patients (baseline FEV₁, 28% [± 7.6%] predicted). Four patients were treated in one lung, and 12 patients were treated in both lungs. A median of 10 (5-12) coils was placed per lung in 36.5 (20-60) min. Adverse events (AEs) rated as possibly related to either the device or the procedure < 30 days after treatment were pneumothorax (n ± 1), pneumonia (n ± 2), COPD exacerbation (n ± 6), chest pain (n ± 4), and mild (< 5 mL) hemoptysis (n ± 21). From 30 days to 6 months, the AEs that occurred were pneumonia (n ± 3) and COPD exacerbation (n ± 14). All events resolved with standard care. Six months after LVR-coil treatment, there were significant improvements in SGRQ (-14.9 points [± 12.1 points, with 11 patients improving by > 4 points]), FEV₁ (+14.9% ± 17.0%), FVC (+13.4% ± 12.9%), residual volume (-11.4% ± 9.0%), and 6MWT (+84.4 ± 73.4 m), all P < .005. LVR-coil treatment is a promising technique for the treatment of patients with severe heterogeneous emphysema. The treatment is technically feasible and results in significant improvements in pulmonary function, exercise capacity, and quality of life, with an acceptable safety profile. ClinicalTrials.gov; No.:NCT01220908; URL: www.clinicaltrials.gov

Bronchoscopic Lung Volume Reduction Coil Treatment of Severe Heterogeneous Emphysema

Bronchoscopic Lung Volume Reduction Coil Treatment of Severe Heterogeneous Emphysema