Endoskopische Interventionen beim Lungenemphysem

Zusammenfassung

Die endoskopische Lungenvolumenreduktion (ELVR) ist bei ausgewählten Patienten mit einem schwergradigen Lungenemphysem, die trotz Ausschöpfen der leitliniengerechten konservativen Behandlung Symptome sowie eine erhebliche lungenfunktionelle Einschränkung aufweisen, eine additive Therapieoption. Die Ventiltherapie, als einzige vollständig reversible Methode, führt bei Patienten mit fehlender interlobärer Kollateralventilation durch eine Atelektasenbildung des emphysematös destruierten Lungenlappens zur Volumenreduktion. Bei den alternativen, nicht-blockierenden Techniken (Coil-Therapie, bronchoskopische Thermoablation, polymerische Lungenvolumenreduktion), die hingegen unabhängig von der Kollateralventilation sind, wird eine Volumenreduktion durch Kompression des Lungenparenchyms bzw. durch einen inflammatorischen Reiz induziert. Die derzeit verfügbare Datenlage ist für die endoskopische Ventiltherapie bereits umfassend, während hingegen für die nicht-blockierenden Techniken weitere randomisierte Studien notwendig sind, um diese Verfahren mit hinreichender Evidenz zu etablieren.

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