Abstract
Chronic obstructive pulmonary disease (COPD) is a widespread disease associated with
high morbidity and mortality. The principal aim of therapy is preventing disease progression.
Besides rehabilitation and pharmacological treatment, different endoscopic approaches
were developed in the past decade extending the therapeutic spectrum. Various endoscopic
lung volume reduction (ELVR) techniques are available that differ in the implementation,
mechanism of action, complication spectrum, and reversibility. So far, the data on
efficacy and safety are variable and still very limited. The most comprehensive data
are available for endoscopic valve therapy. This reversible technique leads to lobar
atelectasis and thus significant lobar volume reduction in patients with severe emphysema
and low collateral ventilation. Implantation of coils leading to parenchymal compression
and bronchoscopic thermal vapor ablation inducing an inflammatory reaction are nonblocking
ELVR techniques and thus independent of collateral ventilation. Besides ELVR techniques,
targeted lung denervation has evolved as the latest development in the field of endoscopic
therapy in COPD. The aim of this endoscopic method is sustainable bronchodilation
by minimizing the influence of parasympathetic pulmonary nerves on smooth muscles
of the airways. This review summarizes the different endoscopic procedures, their
mechanism of action, and the results of the clinical trials including efficacy and
safety.
Keywords
endoscopic lung volume reduction - endoscopic valve therapy - thermal vapor ablation
- collateral ventilation - emphysema - targeted lung denervation
