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Endobronchial valves and spigots in a non-standard indication

Introduction: Bronchoscopy endobronchial valves (EV) and spigots implantation is an established method of endobronchial lung volume reduction (ELVR) in patients with chronic obstructive pulmonary disease (COPD). Pleurobronchial phistula, persistent cavity or massive hemoptysis management present other, so far non-standardized indication for EV or spigots use Methods: Retrospective evaluation of EV and spigots use in an unusual situation in terms of indication, efficacy and complication. Clinical analysis of cases and images are documented Results: We performed 53 implantations of EV and spigots in a period of 37 months. Usual elective ELVR in COPD was done in 41 patients. Twelve patients were presented with non-standard indication: persistent pneumothorax (PNO) in 8 patients and post-abscess cavity, advanced emphysema long-time ventilator-depended, massive hemoptysis from mycetoma, Mc Leod´s lobe occurred each in one patient. Four of the patients were on a ventilator. In 4 patients the effect was therapeutical (3x PNO, 1x ventilator depended emphysema), in 5 partial (4x PNO, 1x hemoptysis from mycetoma), in 1 there was no benefit (post-abscess cavity). In 2 patients (1x McLeod´s lobe, 1x PNO) we couldn´t evaluate the efficacy, because of a transport to another institution and a loss of contact. Among the 4 patients on a ventilator, there was 1 complete effect, while 3 partial. There were no complication associated with the procedure Conclusions: EV and spigots in a non-standard indication is an effective and substantially safe method, which can improve and shorten a treatment of the patients, including in those who are ventilator-depended. Next trials should be focused on a standardization and cost-efficacy of the application