Thermic and chemical procedures for bronchoscopic lung volume reduction

Challenges in clinical practice, biological mechanism and prospects of physical ablation therapy for COPD

Chronic obstructive pulmonary disease (COPD) is projected to become the third leading cause of death globally by 2030. Despite the limited treatment options available for advanced COPD, which are mostly restricted to costly lung transplants, physical ablation therapy offers promising alternatives. This technique focuses on ablating lesioned airway epithelium, reducing secretions and obstructions, and promoting normal epithelial regeneration, demonstrating significant therapeutic potential. Physical ablation therapy primarily involves thermal steam ablation, cryoablation, targeted lung denervation, and high-voltage pulsed electric field ablation. These methods help transform the hypersecretory phenotype, alleviate airway inflammation, and decrease the volume of emphysematous lung segments by targeting goblet cells and damaged lung areas. Compared to traditional treatments, endoscopic physical ablation offers fewer injuries, quicker recovery, and enhanced safety. However, its application in COPD remains limited due to inconsistent clinical outcomes, a lack of well-understood mechanisms, and the absence of standardized guidelines. This review begins by exploring the development of these ablation techniques and their current clinical uses in COPD treatment. It then delves into the therapeutic effects reported in recent clinical studies and discusses the underlying mechanisms. Finally, the review assesses the future prospects and challenges of employing ablation technology in COPD clinical practice, aiming to provide a practical reference and a theoretical basis for its use and inspire further research.

Hydrothermal ablation in recurrent or chronic olecranon bursitis: a prospective study

BACKGROUND

Olecranon bursitis can be difficult to treat, resulting in persistent or recurrent symptoms. Bursectomy is a frequently applied treatment option for refractory cases but has high complication rates. This is the first in vivo study to investigate the safety and efficacy of hydrothermal ablation, a new treatment modality for recurrent or chronic olecranon bursitis that aims to cause thermal obliteration of the bursal lining by irrigation with heated saline.

METHODS

First, a pilot animal trial was set up to determine a safe irrigation temperature window. Second, in a human trial the bursae of patients with chronic, recurrent, or refractory olecranon bursitis were irrigated with a 3-mL/s flow of physiological saline for a duration of 180 seconds at temperatures between 50°C and 52°C. Patients were followed up for 6 months, allowing for assessment of the surgical site to screen for adverse events, volumetric ultrasonographic assessment of the bursae, and collection of the Quick Disabilities of the Arm, Shoulder, and Hand questionnaire (QuickDASH), Patient Global Impression Score, and Clinical Global Impression Score, as well as data on return to activities or work.

RESULTS

Twenty-four elbows were prospectively included and underwent a full cycle of hydrothermal ablation. The mean age was 58.4 years (range 40.5-81.5), including 20 male and 4 female patients. None had clinical signs of septic bursitis. Bursal fluid cultures were positive in only 1 case. The average preoperative bursal volume was 11.18 mL (range 4.13-30.75). Eighteen of 24 elbows (75%) were successfully treated, showing a complete remission of symptoms or decided improvement within 6 weeks and without any signs of recurrence during the entire follow-up period of 6 months. The average reduction of ultrasonography-measured bursal volume was 91.9% in the group of patients who responded to treatment. In patients without recurrence, the mean QuickDASH scores before and after treatment were 13.6 (range 0-50) and 3.1 (range 0-27.5), respectively, showing a statistically significant improvement. All patients were able to fully return to work within 6 weeks after the index procedure. No serious adverse events were encountered. Moderate local adverse events were found in 2 patients. Increasing temperatures of irrigation did not result in a higher treatment efficacy.

CONCLUSION

Hydrothermal ablation at temperatures between 50°C and 52°C is a safe treatment option for recurrent or chronic olecranon bursitis with fewer complications than open bursectomy and a comparable efficacy.

[Imaging before and after endoscopic lung volume reduction]

The treatment of symptomatic lung emphysema by lung volume reduction has become established over the last 15 years. While surgical partial lung resection has profited from improved and less invasive surgical techniques, various endoscopic interventional procedures have been developed and are now available for use. All treatment approaches are dependent on individual anatomical variants and a regional distribution of the lung emphysema, which is why no procedure can be designated as the gold standard for all patients. High-resolution computed tomography can be qualitatively evaluated and provides decisive information for treatment, which is why radiologists play a particularly important role in treatment planning and aftercare of an intervention for reduction of the lung volume. This article presents the various endoscopic techniques, names the demands of the treating physician on the advising radiologist and finally describes how a treatment decision is derived from the results obtained.