What are the primary conditions bronchoscopic treatments aim to address?

Bronchoscopic treatments primarily target persistent air leaks and emphysema. These conditions often arise from issues like spontaneous pneumothorax, lung resection surgery, or lung volume reduction surgeries. These treatments offer an alternative to traditional surgical interventions, particularly for those with chronic obstructive pulmonary disease (COPD), a major global health concern.

How do endobronchial valves work, and what are their applications?

Endobronchial valves, such as Zephyr valves and IBV valves, are one-way valves placed into the affected airway segments. They are designed to prevent air from entering the target area while still allowing air to exit, thus reducing lung volume. Initially developed for COPD, these valves are now also employed to manage persistent air leaks and bronchopleural fistulas. The IBV valve use on a compassionate basis has been recognized by the FDA for persistent air leaks.

What are the different types of bronchoscopic lung volume reduction techniques described, and what are their outcomes?

Several bronchoscopic techniques are discussed, each with its own approach and outcomes. Watanabe Spigots, designed for bronchopleural fistulas, face limitations due to potential pneumonia. Silicone Balloons show questionable efficacy with complications such as pneumonia and desaturation. Endobronchial Coils aim to reduce lung volume, showing promising improvements in lung function. Artificial Accessory Airway, a technique suggested in 1978, showed no significant difference compared to sham arms. Biologic Agents show initial improvement but face issues of irreversibility. Thermal Vapor Ablation shows promising results with complications like COPD exacerbations. The outcomes vary; some are promising while others are limited by complications or lack of definitive evidence.

What is the role of endobronchial coils in treating emphysema and persistent air leaks?

Endobronchial Coils are nitinol self-actuating devices used in the treatment of emphysema and persistent air leaks. They work by retracting the pulmonary parenchyma, which reduces lung volume and restores tissue tension. Preliminary studies suggest that these coils can lead to significant improvements in lung function and exercise capacity for patients. Further research is being carried out to evaluate their long-term efficacy and safety.

Why is the 'jury still out' on the long-term efficacy of bronchoscopic treatments, and what is the future outlook?

The author states that the 'jury is not out' on the long-term efficacy of bronchoscopic treatments due to ongoing trials. While significant advances have been made, particularly in the past decade, most evidence is based on small patient studies, except for the VENT trial. The author suggests that the use of these devices should be based on an individual case basis. The cost of these devices remains a concern. The future outlook depends on the results of these ongoing studies, which should provide more conclusive answers regarding the efficacy and safety of these treatments.

Illustration of bronchoscopic treatment inside a lung.

Persistent Air Leak? How Bronchoscopic Treatments Can Help

Theo Raines in Health & Wellness December 2025 • 5 min read.

"Explore the latest minimally invasive techniques and devices that are revolutionizing the treatment of persistent air leaks and emphysema."

For decades, thoracic surgeons have been at the forefront of addressing air leaks resulting from various conditions, including spontaneous pneumothorax, lung resection surgery, and lung volume reduction surgeries. While surgical interventions have been the standard approach, the landscape has begun to shift in the last decade.

Bronchoscopic techniques have emerged as promising alternatives, offering less invasive solutions to these challenging conditions. Among these innovative approaches, lung volume reduction surgeries have gained traction in treating chronic obstructive pulmonary disease (COPD), a debilitating and progressive disease affecting millions worldwide.

COPD, characterized by persistent airflow limitations and an enhanced inflammatory response in the airways, is now the fourth leading cause of death globally. Bronchoscopic techniques, including endobronchial valves, silicone balloons, and Watanabe spigots, offer a range of options for patients seeking improved respiratory function and quality of life.

Breaking Down Bronchoscopic Lung Volume Reduction Techniques

Illustration of bronchoscopic treatment inside a lung.

In recent years, several bronchoscopic techniques have been proposed for lung volume reduction surgery besides medical and surgical options. The main focus is on endobronchial valves, mainly Zephyr valves and IBV valves, and the data pertaining to them in regards to bronchoscopic lung volume reduction surgeries and its use in patients with persistent air leaks.

Several innovative devices and techniques are making a difference in treating emphysema and persistent air leaks. Here's a breakdown of some key methods:

Watanabe Spigots: These silicone bronchial blocking devices, named after their inventor, were initially designed for broncho-pleural fistulas and persistent pneumothorax. However, their use has been limited due to concerns about pneumonia caused by secretion drainage issues.
Silicone Balloons: A small study showed questionable efficacy, with pneumonia and desaturation during the procedure being common complications.
Endobronchial Coils: These nitinol self-actuating devices work by retracting the pulmonary parenchyma, reducing lung volume, and restoring tissue tension. Preliminary results have been promising, with some studies showing significant improvements in lung function and exercise capacity.
Artificial Accessory Airway: First suggested in 1978, this involves creating an extra anatomic passage between the emphysematous lung parenchyma and the larger airway. While initial studies showed some promise, a randomized, double-blind study found no significant difference between treatment and sham arms after six months.
Biologic Agents: This approach uses biologic agents as sealants to block off airways, causing atelectasis and reducing lung volume. While initial studies showed improvement, the challenge lies in the irreversibility and inevitable scar formation.
Thermal Vapor Ablation: This technique uses a vapor generator to deliver heated water vapor into the bronchial tree, leading to permanent fibrosis. Studies have shown promising results, especially with higher doses, but complications like COPD exacerbations and pneumonia remain a concern.

Among these different devices, the endobronchial valve has been extensively studied. The basic principles involve deploying a one-way valve into the affected segment. The one way valve prevents the entry of the air into the airway, while allowing the exit of the air. These valves were initially designed for the COPD, but now are also utilized for persistent air leak and bronchopleural fistula.

The Future of Bronchoscopic Interventions

In the past ten to fifteen years, significant advances and attempts have been made to come up with the bronchoscopic solution for the treatment of severe emphysema and replacing the lung volume reduction surgery with non-surgical treatment of the condition with one way valve, coil, or other devices as discussed. At this point, the author feels that the jury is not out and some major trial are on-going. In the mean time the use of these devices should be based on an individual case basis. The high cost of these devices still remains a concern. Research has shown that the IBV valve use on a compassionate base by FDA for persistent air leaks may be of good use in a patient with persistent air leaks. In summary, the efficacy and safety of emphysema by bronchoscopy is mainly based on small patient studies except for the VENT trial. Hopefully in the near future the ongoing studies may provide some conclusive answers.