Endoscopic lung volume reduction coils for patients with severe emphysema – a single-center retrospective analysis

Abstract

BackgroundPatients with chronic obstructive pulmonary disease (COPD) and lung emphysema may benefit from surgical or endoscopic lung volume reduction (ELVR). Previously reported outcomes of nitinol-coil-based endoscopic lung volume reduction techniques have been ambiguous.Objectives The analysis was done to analyze outcomes of ELVR with nitinol-coils in patients with severe pulmonary emphysema.MethodsFrom September 2013 to November 2014, our center performed a total of 41 coil implantations on 29 patients with severe emphysema. Coils were bronchoscopically placed during general anesthesia. 12 out of 29 patients received contralateral treatments 4-6 weeks later to avoid bilateral pneumothorax. Lung function and 6-minute walking distance were assessed one week prior, one week after as well as 6 to 12 months after the procedure. Patients were followed up to 48 months after ELVR and overall mortality was compared to a historic cohort.ResultsWhile coil-based ELVR led to significant short-term improvement of vital capacity (VC, + 0.14 l ± 0.39 l, p = 0.032) and hyperinflation (ΔRV / TLC -2.32% ± 6.24%, p = 0.022), no significant changes were observed in 6-minute walking distance (6-MWD) or forced expiratory volume in one second (FEV1). Benefits were short-lived, with only 15.4% and 14.3% of patients showing sustained improvements in FEV1 or residual volume (RV) after 6 months. Adverse events included hemoptysis (40 %) and pneumothorax (3.4 %), major complications occurred in 6.9% of cases. Overall survival without lung transplant was 63.8% after 48 months following ELVR, differing insignificantly from what BODE indices of patients would have predicted as median 4-year survival (57%) at the time of ELVR treatment.ConclusionEndoscopic lung volume reduction coils can achieve small and short-lived benefits in lung function at the cost of major complications in a highly morbid cohort. Treatment failed to improve 4-year overall survival. ELVR coils are not worthwhile the risk for most patients with severe emphysema.