Ethanolamine oleate as a sclerosant in bronchoscopic treatment of pulmonary emphysema: effectiveness and safety

Abstract

Introduction Loss of elastic recoil in pulmonary emphysema can be corrected by lung volume reduction through decreasing the volume of the most destroyed lung segments (dead space), which allow the remaining (less destroyed lung tissues) to regain its size. This article was planned to study the effectiveness and safety of ethanolamine oleate as a sclerosant in bronchoscopic lung volume reduction in patients with pulmonary emphysema. Patients and methods A total of 19 patients with pulmonary emphysema (age >40 years old) were included. Clinical evaluation, routine laboratory investigations, and bronchoscopic ethanolamine oleate instillation using fiberoptic video bronchoscopy were done. Outcome assessment measures were reviewed before bronchoscopic instillation of ethanolamine oleate and 4 weeks later using Modified Medical Research Council, 6-min walk distance, and pulmonary function tests such as a high-resolution computed tomography. Results Although there was a statistically significant improvement of Modified Medical Research Council scale after 1 month of bronchoscopic ethanolamine instillation, this value failed to meet the minimal clinically important difference (MCID) criteria. Moreover, forced expiratory volume in the 1 s improvement failed to meet the MCID criteria. Regarding 6-min walk distance, there was a statistically significant improvement that met the MCID criteria. There was a statistically significant and clinical improvement of high-resolution computed tomography volumetric quantification of emphysema. Approximately 31.5% of patients had no complications. Conclusion This study showed statistical improvement in exercise tolerance and pulmonary function tests in patients with pulmonary emphysema after bronchoscopic instillation of ethanolamine oleate. However, clinical improvement was detected only in exercise tolerance.

Keywords

• bronchoscopic lung volume reduction
• emphysema
• ethanolamine oleate