Follow-up outcomes of chronic obstructive pulmonary disease patients who underwent dilatation and curettage with the Karakoca resector balloon

Abstract

We previously reported satisfactory results with the Karakoca resector balloon in 10 patients with stage IV chronic obstructive pulmonary disease (COPD) who did not respond to medical treatment. In this article, we present the outcomes of the Karakoca resector balloon dilatation and curettage technique in a larger case series (n = 188).A total of 188 COPD patients [mean age (SD): 69.2 (8.0) years; 46 females] classified as stage III to IV by the Global Initiative for Obstructive Lung Disease criteria underwent balloon desobstruction for segmental and subsegmental bronchi by therapeutic bronchoscopy. None of the patients could have achieved symptom relief even under high-dose inhaled bronchodilators and corticosteroids, oral corticosteroids, or oxygen and noninvasive mechanical ventilation therapy before the intervention. Forced expiratory volume in 1 s (FEV1) and oxygen saturation (SpO2) were measured, and modified Borg dyspnea scale (MBS) scores were determined before and 1 week and 1 month after the intervention.All patients were active smokers and 80% had concomitant chronic diseases. After the intervention, there was a notable reduction in the oxygen need of the patients. Comparison of lung function tests 1 week after the procedure with results before the procedure showed significant improvements in FEV1, MBS, and SpO2 levels (P < 0.001 for each), and the improvements were maintained for the entire postprocedural month (P < 0.001 for each). Except for 4 males, all patients were free of symptoms.These results confirmed our early observations that balloon dilatation and curettage is a safe and successful technique for medical treatment-resistant COPD.

Developing Interventions for Chronic Obstructive Pulmonary Disease

“…No significant intra-or postoperative complications were reported with the use of balloon deobstruction for chronic bronchitis. 89,90 These results were confirmed in a second, larger study that included 188 patients, 89 but additional evaluation is necessary to determine overall safety and durability of response given these have thus far not been well studied.…”

New bronchoscopic treatment modalities for patients with chronic bronchitis

“…Biopsies after intervention showed decreases in the number of goblet cells and mucus-containing goblet cells (no actual numbers or statistical tests were reported). Later, the same authors published a larger single-centre case series investigating the technique including 188 COPD patients [32]. According to the authors, none of the 188 patients developed intraoperative, perioperative or post-operative complications.…”

“…The balloon is inserted into the narrowed bronchial lumen and repeatedly inflated and deflated, resulting in a force applied to the bronchial mucosa of ∼2.0-2.5 bar [31], mechanically disrupting the hyperplasic goblet cells. The treatment is performed in a single session, and in total 100-300 segmental bronchi could be treated during a 60-min bronchoscopy [32].…”

Epithelial Resurfacing: The Bronchial Skin Peel

“…In this small early study, there were some improvements in oxygenation and spirometric values and a relative decrease in goblet cells after the procedure. A further cohort of 188 patients with COPD who were treated and followed up for 1 month demonstrated similar improvements ( 12 ). However, this approach has only been evaluated in uncontrolled studies at a single center.…”