Effect of endoscopic lung volume reductions in patients with emphysema – a single center experience

Introduction: Endoscopic lung volume reduction (ELVR) has become standard for patients with emphysema-associated hyperinflation. It is unclear how published evidence from high-volume specialized centers can be reproduced in a real world situation. Aim: Perform a retrospective chart review in order to assess safety and efficacy of ELVR in a single center real world situation. Methods: All consecutive 61 patients referred from 2010 to 2017 to the Department of Pulmonary Medicine of the Cantonal Hospital St. Gallen for an ELVR were included. Lung function data (FEV1, VC, FVC, RV, TLC, DLCO) as well as 6-min walking distance were collected and analyzed using linear mixed models. Results: Patients had a median age of 67 (IQR: 61.5 - 72) years and a pre-operative FEV1 of 29% (range: 15-62) and residual volume of 214% (range: 106-321). Intrabronchial valves were used in 43 patients, whereas coil implantation was used in 17 patients. One patient received consecutively valves and coils. Complications included pneumothorax (13%) and minor bleeding (8%). One patient died 4 days after intervention. The effect of ELVR 3 months within intervention included a significant decrease of 0.40 L of TLC (p < 0.001) and 0.45 L of RV (p < 0.001), as well as a significant increase of 5.3% of VCmax (p = 0.025) and an improved exercise capacity (59 m increase of the 6-min walking distance, p = 0.043). FEV1 remained unchanged with a non-significant increase of 2.4% (p = 0.070). A significant improvement of 350 mL of FVC was observed 6 months after intervention. Conclusion: In this real world, single center experience it was possible to reproduce effects of ELVR comparable to published evidence.