Effectiveness of bronchoscopic lung volume reduction using unilateral endobronchial valve: a systematic review and meta-analysis

Figures & data

Table 1 Characteristics of selected studies

No	Study type	Author (year)	Location	Population (N)	Intervention group (N)/valve	Comparison (N)	Quality*
1	RCT	Herth et al (2012)^Citation7	Europe	Emphysema (171) VENT	EBV for BLVR (111)/Zephyr^® valve	Medical treatment (60)	1+
2	RCT	Sciurba et al (2010)^Citation8	USA	Heterogeneous emphysema (321) VENT	EBV for BLVR (220)/Zephyr^® valve	Medical treatment (101)	1+
3	RCT	Ninane et al (2012)^Citation12	Europe	Emphysema (73)	EBV for BLVR (37)/IBV valve	Sham bronchoscopy (36)	1+
4	Retrospective cohort	Brown et al (2012)^Citation13	USA	Emphysema (421) VENT	EBV for BLVR (289)/Zephyr^® valve	Medical treatment (132)	2+
5	Case series	Venuta et al (2012)^Citation21	Italy	Emphysema (40)	EBV for BLVR (40)/Zephyr^® valve		3
6	Case series	Santini et al (2011)^Citation20	Italy	Emphysema (9)	EBV for BLVR (9)/Zephyr^® valve		3
7	Case series	D’Andrilli et al (2009)^Citation15	Italy	Emphysema (7)	EBV for BLVR (7)/Zephyr^® valve		3
8	Case series	Hopkinson et al (2011)^Citation17	UK	COPD patients underwent BLVR (19)	EBV for BLVR (19)/Emphasys^® valve		3
9	Case series	Kotecha et al (2011)^Citation19	Australia	Emphysema (23)	EBV for BLVR (23)/Emphasys^® valve		3
10	Case series	Chung et al (2010)^Citation14	Australia	COPD with emphysema (8)	EBV for BLVR (8)/Emphasys^® valve		3
11	Case series	de Oliveira et al (2006)^Citation16	Brazil	Emphysema (19)	EBV for BLVR (19)/Emphasys^® valve		3
12	Case series	Wan et al (2006)^Citation23	People’s Republic of China	Emphysema (98)	EBV for BLVR (98)/Emphasys^® valve		3
13	Case series	Hopkinson et al (2005)^Citation18	UK	COPD with emphysema (19)	EBV for BLVR (19)/Emphasys^® valve		3
14	Case series	Venuta et al (2005)^Citation22	Italy	Emphysema (13)	EBV for BLVR (13)/Emphasys^® valve		3
15	Case series	Yim et al (2004)^Citation24	People’s Republic of China	Emphysema underwent BLVR (20)	EBV for BLVR (20)/Emphasys^® valve		3

Note:

* Scottish Intercollegiate Guidelines Network criteria were used for quality assessment of literature.⁹

Abbreviations: RCT, randomized controlled trial; VENT, Endobronchial Valve for Emphysema Palliation Trial; EBV, endobronchial valve; BLVR, bronchoscopic lung volume reduction; COPD, chronic obstructive pulmonary disease.

Figure 1 Flow diagram for identification of selected articles.

Abbreviation: BLVR, bronchoscopic lung volume reduction.

Figure 2 Forest plots of effectiveness outcomes – mean change differences from baseline between BLVR group and control group.

Abbreviations: BLVR, bronchoscopic lung volume reduction; ΔFEV₁, change in forced expiratory volume in 1 second; SE, standard error; IV, independent variable; CI, confidence interval; Δ6MWD, change in 6-minute walking distance; ΔCycle workload, change in cycle workload; ΔSGRQ, change in St George’s Respiratory Questionnaire.

Table 2 Clinical outcomes in change from baseline according to fissure

Outcome	Author (year)	Quality	N		Percent change difference between BLVR vs control
					6 months			12 months
			BLVR	Control	MD (95% CI)	SE	Difference (P)	MD (95% CI)	SE	Overall mean (P)
Complete fissure
ΔFEV1 (%)	Herth et al (2012)^Citation7	1+	44	19	14 (5.16 to 22.84)	4.51	15.29 (P<0.001)	17 (3.91 to 30.09)	6.68	17.65 (P<0.001)
	Sciurba et al (2010)^Citation8	1+	68	33	16.2 (8.80 to 23.50)	3.75		17.9 (9.8 to 25.9)	4.11
Δ6MWD (%)	Herth et al (2012)^Citation7	1+	44	19	−8 (−34.3 to 18.28)	13.41	5.86 (P=0.193)	3 (−19.32 to 25.32)	11.39	3.80 (P=0.311)
	Sciurba et al (2010)^Citation8	1+	68	32	7.7 (−1.80 to 17.20)	4.85		3.9 (−4 to 11.8)	4.03
ΔCycle workload	Herth et al (2012)^Citation7	1+	44	19	7.0 (1.80 to 12.20)	2.65		6 (0.21 to 11.79)	2.95
ΔSGRQ	Herth et al (2012)^Citation7	1+	44	19	−9 (−17.07 to −0.93)	4.12		−4 (−10.64 to −2.65)	3.39
Incomplete fissure
ΔFEV1 (%)	Herth et al (2012)^Citation7	1+	67	40	2 (−5.81 to 9.81)	3.98	2.0 (P=0.399)	2 (−6.06 to 10.06)	7.69	2.48 (P=0.335)
	Sciurba et al (2010)	1+	29	56	2 (−3.9 to 7.9)	3.01		2.8 (−3.8 to 9.4)	3.37
Δ6MWD (%)	Herth et al (2012)^Citation7	1+	67	40	5 (−5.44 to 15.44)	5.33	5.21 (P=0.071)	5 (−2.73 to 12.73)	3.94	4.62 (P=0.145)
	Sciurba et al (2010)^Citation8	1+	29	56	5.3 (−1.5 to 12.2)	3.49		4.5 (−2.7 to 11.8)	3.70
ΔCycle workload	Herth et al (2012)^Citation7	1+	67	40	3 (−1.78 to 7.78)	2.44		4 (−1.09 to 9.09)	2.60
ΔSGRQ	Herth et al (2012)^Citation7	1+	67	40	−3 (−8.48 to 2.80)	2.80		0 (−5.48 to 5.48)	2.80

Abbreviations: BLVR, bronchoscopic lung volume reduction; MD, mean difference; CI, confidence interval; SE, standard error; ΔFEV₁, change in forced expiratory volume in 1 second; Δ6MWD, change in 6-minute walking distance; ΔCycle workload, change in cycle workload; ΔSGRQ, change in St George’s Respiratory Questionnaire.

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Scottish Intercollegiate Guidelines NetworkCritical appraisal: notes and checklists [web page on the Internet] Available from: http://www.sign.ac.uk/methodology/checklists.htmlAccessed January 29, 2015

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