E-ISSN 2149-2530
Review
Efficacy and safety of Stent, vapour ablation, coil and sealant therapies in advanced emphysema: A meta-analysis
1 All India Institute of Medical Sciences, Jodhpur, Rajasthan, 342005, India - Department of Community & Family Medicine, Jodhpur, India  
2 All India Institute of Medical Sciences Jodphur Ringgold Standard Institution, Jodhpur, Rajasthan, India  
3 All India Institute of Medical Sciences, Jodhpur, Rajasthan, 342005, India - Pulmonary Medicine, AIIMS residential complex, Basni-II, Jodhpur, Jodhpur 342005, India  
4 Pacific Institute of Medical Sciences, Udaipur - Pulmonary Medicine, 1007, Gyan nagar, near gyan mandir school, sector-4, Hiran Magri, Udaipur, Rajasthan 313002, India  
5 All India Institute of Medical Sciences, Jodhpur, Rajasthan, 342005, India – Dentistry, Jodhpur, India  
6 All India Institute of Medical Sciences, Jodhpur, Rajasthan, 342005, India - Department of Obstetrics & Gynaecology, Jodhpur, India  
7 Christian Medical College, Vellore, Tamil Nadu, 632004, IN - Department of Biostatistics, Vellore, India  
Turk Thorac J ; 5: -
DOI: 10.5152/TurkThoracJ.2018.18062
Key Words: Bronchoscopic lung volume reduction (BLVR); emphysema; COPD; collateral ventilation
Abstract

 

Background: Bronchoscopic lung volume reduction (BLVR) methods are emerging as a new treatment option for patients with severe emphysema. Endobronchial valves have been studied extensively but their broader use is limited by ineffectiveness in presence of collateral ventilation. This review assesses efficacy, safety and cost effectiveness of BLVR procedures which works independent of collateral ventilation in patients of severe emphysema.

 

Methods: Databases were searched till October 2016 and randomized controlled trials (RCTs) comparing available BLVR procedures to standard medical care or sham bronchoscopy were included. Random effect model and Generic Inverse Variance approach were used for meta-analysis.

 

Results: Out of 381 records identified, fifteen RCTs were included. BLVR procedures are effective in improving quality of life [SGRQ score (WMD= -6.70, -9.37 to -4.02)] and 6MWT (WMD = 28.67; 12.31 to 45.02) as compared to recommended medical care or sham bronchoscopy. Increased risk of serious adverse events (RR= 2.18; 1.63 to 2.93), specifically for COPD exacerbations and LRTI combined (RR = 1.37; 1.07, 1.75) are observed with bronchoscopic interventions while there was no difference in number of deaths (RR= 1.25; 0.79 to 1.99) and respiratory failure (RR= 1.13; 0.57 to 2.21).

 

Conclusions: BLVR procedures, especially endobronchial coils are found to be effective in the management of patients of severe emphysema irrespective of collateral ventilation. However, characterization of patients who would be most benefitted from these procedures is required and effectiveness of these procedures in long run is also to be established. 

 

Cite this article as: Dutt N, Rustagi N, Singh S, et al. Efficacy and safety of Stent, vapour ablation, coil and sealant therapies in advanced emphysema: A meta-analysis. Turk Thorac J 2018; DOI: 10.5152/TurkThoracJ.2018.18062

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