The Localized Inflammatory Response to Bronchoscopic Thermal Vapor Ablation

Gompelmann, Daniela; Eberhardt, Ralf; Ernst, Armin; Hopkins, Peter; Egan, Jim; Stanzel, Franz; Valipour, Arschang; Wagner, Manfred; Witt, Christian; Baker, Kimberly M.; Gotfried, Mark H.; Kesten, Steven; Snell, Gregory I; Herth, Felix

doi:10.1159/000354175

Cited by 55 publications

(37 citation statements)

References 7 publications

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“…Following careful selection of the right patients, lung volume reduction may lead to clinically relevant improvements in lung function, quality of life, and exercise performance [7,8,9,10,11,12,13]. Of the available techniques, treatment with endobronchial valves (EBVs) in patients without interlobar collateral ventilation shows the best results [14,15,16,17,18].…”

Section: Introductionmentioning

confidence: 99%

Pleural Adhesion Assessment as a Predictor for Pneumothorax after Endobronchial Valve Treatment

et al. 2017

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Background: Pneumothorax after bronchoscopic lung volume reduction using one-way endobronchial valves (EBVs) in patients with advanced emphysema occurs in approximately 20% of patients. It is not well known which factors predict the development of pneumothorax. Objective: To assess whether pleural adhesions on pretreatment high-resolution computed tomography (HRCT) scans are associated with pneumothorax occurrence after EBV treatment. Methods: HRCT scan analyses were performed on all patients who received EBV treatment in a randomized controlled trial. Three blinded readers scored adhesions by number and by measuring the longest axis of each pleural adhesion in the treated lung. The Pleural Adhesion Score (PAS) was calculated by adding 1 point for each small pleural lesion (<1 mm), 5 points for each medium-sized lesion (1-5 mm), and 10 points for each large lesion (>5 mm). Results: The HRCT scans of 64 treated patients were assessed, of whom 14 developed pneumothorax. Patients who developed pneumothorax had a higher median number of pleural adhesions, 2.7 (IQR 1.9-4) compared to 1.7 (1-2.7) adhesions in the group without pneumothorax (p < 0.01). The PAS in the group with pneumothorax was higher compared to that in the group without: 14.3 (12.4-24.1) versus 6.7 (3.7-11.2) (p < 0.01). A threshold PAS of ≥12 was associated with a higher risk of pneumothorax (OR 13.0, 95% CI 3.1-54.9). A score <12 did not rule out the occurrence of pneumothorax. Conclusion: A higher number of pleural adhesions on HRCT with a subsequent higher PAS in the treated lung is associated with a higher occurrence of pneumothorax after EBV treatment.

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Section: Introductionmentioning

confidence: 99%

Pleural Adhesion Assessment as a Predictor for Pneumothorax after Endobronchial Valve Treatment

et al. 2017

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“…The study demonstrated a 48% target lobar volume reduction at 6 months after treatment, which was accompanied by improvements in lung function (140.8 ± 26.3 mL FEV 1 improvement, 17%), exercise tolerance (46.5 ± 15.0 m in the 6-minute walking test [6-MWT]), and quality of life (14.0 ± 2.4 point reduction in St. George’s Respiratory Questionnaire [SGRQ]) [3]. In a post hoc analysis, the occurrence and severity of serious adverse events increased with the volume of the treated lobe, with an inflection point identified at 1,700 mL target lobar volume [4]. Given the potential for improving the risk-benefit relationship on the basis of the above, an alternative approach was sought to limit the volume treated in a BTVA session, which has resulted in the design of the STEP-UP study [5].…”

Section: Clinical Evidence For Btvamentioning

confidence: 99%

Bronchoscopic Thermal Vapor Ablation: Best Practice Recommendations from an Expert Panel on Endoscopic Lung Volume Reduction

et al. 2018

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Bronchoscopic thermal vapor ablation (BTVA) represents one of the endoscopic lung volume reduction (ELVR) techniques that aims at hyperinflation reduction in patients with advanced emphysema to improve respiratory mechanics. By targeted segmental vapor ablation, an inflammatory response leads to tissue and volume reduction of the most diseased emphysematous segments. So far, BTVA has been demonstrated in several single-arm trials and 1 multinational randomized controlled trial to improve lung function, exercise capacity, and quality of life in patients with upper lobe-predominant emphysema irrespective of the collateral ventilation. In this review, we emphasize the practical aspects of this ELVR method. Patients with upper lobe-predominant emphysema, forced expiratory volume in 1 second (FEV₁) between 20 and 45% of predicted, residual volume (RV) > 175% of predicted, and carbon monoxide diffusing capacity (DLCO) ≥20% of predicted can be considered for BTVA treatment. Prior to the procedure, a special software assists in identifying the target segments with the highest emphysema index, volume and the highest heterogeneity index to the untreated ipsilateral lung lobes. The procedure may be performed under deep sedation or preferably under general anesthesia. After positioning of the BTVA catheter and occlusion of the target segment by the occlusion balloon, heated water vapor is delivered in a predetermined specified time according to the vapor dose. After the procedure, patients should be strictly monitored to proactively detect symptoms of localized inflammatory reaction that may temporarily worsen the clinical status of the patient and to detect complications. As the data are still very limited, BTVA should be performed within clinical trials or comprehensive registries where the product is commercially available.

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“…However, the local inflammatory reaction seems to be essential for the desired lobar volume reduction. Patients who developed respiratory adverse events following BTVA experienced a better clinical outcome [46]. …”

Section: The Technologiesmentioning

confidence: 99%

Endoscopic Lung Volume Reduction: An Expert Panel Recommendation

et al. 2016

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Chronic obstructive pulmonary disease (COPD) is a progressive condition comprising a constellation of disorders from chronic bronchitis, airflow obstruction through to emphysema. The global burden of COPD is estimated at more than 6% of the population. The standard of care is based on a combination of smoking cessation, immunization, pharmacological treatments and pulmonary rehabilitation. However, the more advanced stages of COPD are challenging to manage. In this situation, our current standards of care do not adequately control patient symptoms nor halt the progressive decline. For the emphysema phenotype, lung volume reduction surgery has shown a beneficial effect in selected patients but is counterbalanced by the morbidity experienced by some patients. Bronchoscopic volume reduction technologies have been developed to improve the clinical situation of emphysema patients. This expert statement provides broad guidance regarding patient selection and the current position of the available techniques for patients with advanced emphysema.

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The Localized Inflammatory Response to Bronchoscopic Thermal Vapor Ablation

Cited by 55 publications

References 7 publications

Pleural Adhesion Assessment as a Predictor for Pneumothorax after Endobronchial Valve Treatment

Pleural Adhesion Assessment as a Predictor for Pneumothorax after Endobronchial Valve Treatment

Bronchoscopic Thermal Vapor Ablation: Best Practice Recommendations from an Expert Panel on Endoscopic Lung Volume Reduction

Endoscopic Lung Volume Reduction: An Expert Panel Recommendation

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