Recently, several techniques and devices have been suggested for achieving endobronchial
volume reduction in patients with emphysema. The proposed devices include bronchial
blockers, bronchial valves, glues, biomodulators, and stents for bronchial fenestration;
all could be positioned only with flexible bronchoscopy. The current available evidence
on safety and efficacy for these methods is based on animal studies and patient case
series at best; therefore, all the results should be seen with caution. However, the
preliminary work reviewed here suggests that most of the proposed techniques can work,
and seem to be safer than surgical volume reduction. We do not yet have a proven,
widely applicable endobronchial palliative treatment for severe emphysema, but we
have a rapidly growing area of new research in interventional pneumology with preliminary
results that challenge traditional medical thinking.
KEYWORDS
Emphysema - bronchoscopy - lung volume reduction - valve implants - blockers - biomodulators
- airway bypass
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Tudor P TomaM.D.
Department of Thoracic Medicine, National Heart & Lung Institute
Dovehouse St., London, SW3 6LY, UK
Email: t.toma@ic.ac.uk