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Bronchoscopic Lung Volume Reduction with Nitinol Coils for the Treatment of Emphysema: Systematic Review and Meta-Analysis
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A5016 - Bronchoscopic Lung Volume Reduction with Nitinol Coils for the Treatment of Emphysema: Systematic Review and Meta-Analysis
Author Block: T. Vandemoortele, D. St-Pierre, G. Courteau-Godmaire; Pulmonology, Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada.
Introduction
Lung volume reduction with coils (LVRC) consists of the deployment of nitinol coils in small airways that then resume a folded shape, literally folding the diseased portion of emphysematous lung, thereby collapsing it. This results in improved elastic recoil of the affected parenchyma and decreased air trapping.We performed a systematic review of the literature and meta-analysis to evaluate the longterm clinical effectiveness and safety profile of LVRC in severe emphysema.
Methods
A literature search using Pubmed, Web of Science and the Cochrane library was performed in August 2016. A handsearch was performed of selected articles and of relevant meta-analyses. The corresponding authors and the company manufacturing the coils for LVRC were contacted by email for additional data. Only articles in English were selected. Randomized controlled trials (RCT) and observational before/after studies that measured shortness of breath indicators and physiological measures at baseline and at the end of a follow-up period were included. Conference abstracts and case reports were excluded.
The authors assessed the selected studies for risk of bias, allocation, blinding, incomplete outcome data, selective reporting and other potential source of bias, effect of intervention and heterogeneity. Meta-analyses were conducted for the following outcomes: Saint-George Respiratory Questionnaire (SGRQ), 6-minute walk distance (6MWD), Forced Expiratory Volume in 1 second (FEV1) and Residual Volume (RV), and for response rates for SGRQ and 6MWD.
Results
There were 4,758 unique citations from the literature search, of which 15 articles were eligible for inclusion. There were three RCTs and 5 observational studies that met the inclusion criteria, with 7 additional papers reporting on duplicate populations for a different follow-up period. LVRC improved the SGRQ by -9.14 units (95%CI: -10.85, -7.44), 6MWD by +31.61m (95%CI: -0.85, 64.08), FEV1 by +10.2% (95%CI: 8.2, 12.1), and RV by -555.7mL (95%CI: -573.0, -538.5) compared to controls. Treated patient had an Odds Ratio (OR) of 4.46 (95%CI: 2.85, 6.96) to have a ≥4-unit decrease in SGRQ, and an OR of 2.13 (95%CI: 1.42, 3.18) to have an increase of at least 25m in 6MWD, compared to controls.
Conclusions
LVRC improves the quality of life and exercise capacity of patients with severe COPD. Future studies should focus on identifying candidates that are more likely to respond to the procedure.
Author Block: T. Vandemoortele, D. St-Pierre, G. Courteau-Godmaire; Pulmonology, Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada.
Introduction
Lung volume reduction with coils (LVRC) consists of the deployment of nitinol coils in small airways that then resume a folded shape, literally folding the diseased portion of emphysematous lung, thereby collapsing it. This results in improved elastic recoil of the affected parenchyma and decreased air trapping.We performed a systematic review of the literature and meta-analysis to evaluate the longterm clinical effectiveness and safety profile of LVRC in severe emphysema.
Methods
A literature search using Pubmed, Web of Science and the Cochrane library was performed in August 2016. A handsearch was performed of selected articles and of relevant meta-analyses. The corresponding authors and the company manufacturing the coils for LVRC were contacted by email for additional data. Only articles in English were selected. Randomized controlled trials (RCT) and observational before/after studies that measured shortness of breath indicators and physiological measures at baseline and at the end of a follow-up period were included. Conference abstracts and case reports were excluded.
The authors assessed the selected studies for risk of bias, allocation, blinding, incomplete outcome data, selective reporting and other potential source of bias, effect of intervention and heterogeneity. Meta-analyses were conducted for the following outcomes: Saint-George Respiratory Questionnaire (SGRQ), 6-minute walk distance (6MWD), Forced Expiratory Volume in 1 second (FEV1) and Residual Volume (RV), and for response rates for SGRQ and 6MWD.
Results
There were 4,758 unique citations from the literature search, of which 15 articles were eligible for inclusion. There were three RCTs and 5 observational studies that met the inclusion criteria, with 7 additional papers reporting on duplicate populations for a different follow-up period. LVRC improved the SGRQ by -9.14 units (95%CI: -10.85, -7.44), 6MWD by +31.61m (95%CI: -0.85, 64.08), FEV1 by +10.2% (95%CI: 8.2, 12.1), and RV by -555.7mL (95%CI: -573.0, -538.5) compared to controls. Treated patient had an Odds Ratio (OR) of 4.46 (95%CI: 2.85, 6.96) to have a ≥4-unit decrease in SGRQ, and an OR of 2.13 (95%CI: 1.42, 3.18) to have an increase of at least 25m in 6MWD, compared to controls.
Conclusions
LVRC improves the quality of life and exercise capacity of patients with severe COPD. Future studies should focus on identifying candidates that are more likely to respond to the procedure.
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