Vapor for lung volume reduction; pros and cons

ABSTRACT

Introduction

Bronchoscopic lung volume reduction (BLVR) is a novel approach for treatment of emphysema. Several techniques are available to accomplish BLVR including Bronchoscopic Vapor Thermal Ablation (BVTA). This technique is easy to perform and considered safe due to its gradual effect. We discuss BTVA in detail in this editorial.

Areas covered

We discuss our experience with BTVA in detail including patient selection, equipment, procedure, post-procedural care and complications. We also review the literature to determine the pros and cons for its use. Other modalities such as endobronchial valves, coils and lung sealants are also briefly discussed.

Expert opinion

Vapor ablation is a novel and safe approach in inducing lung volume reduction in emphysema patients. The effects are gradual, and therefore potentially making it safer than other minimally invasive modalities. Pneumonitis and infection are common side effects. Just as in other BLVR techniques, a case by case evaluation is needed to determine the right candidate for BTVA. Further larger studies are needed before BTVA becomes standard of care in treatment of patients with emphysema.

KEYWORDS:

• Lung volume reduction
• bronchoscopy
• fluoroscopy
• COPD
• jet-ventilation

Article highlights

• BLVR is an efficient alternative treatment method for emphysema.

• Custom made valves could be an option in the future.

• Novel sealants that induce fibrosis could be also available in the future.

• Novel programs could help us asses in a more efficient way the CT of the thorax.

• Vapour has the advantage that has a slow effect in comparison to valves and therefore lower pneumothorax incidence.

• By the time remodeling occurs until a second vapour ablation (>30 days), the patient has the advantage of starting his/her rehabilitation and increase thoracic muscle and stamina

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.