Pros and Cons of Endoscopic Treatment of Emphysema

For a long time now, pulmonologists have been searching for a minimally-invasive alternative to lung volume reduction surgery, especially since the NETT study demonstrated that the surgical technique improves the functional capacity and quality of life of some patients with severe enfisema. 1 What is most striking of the NETT study is that a subgroup of patients with emphysema, predominantly in the upper lobes and with poor tolerance to effort, reached an unprecedented increase in survival. As strange as it may seem, it was that same assay that led to the demise of lung volume reduction surgery in the United States when evidence was given of the high price that some patients had to pay for improvement (5.5% mortality and morbidity higher than 50%), including a notable increase in mortality of some high-risk subgroups. 2 Currently, and despite the positive results of NETT, less than 200 surgical interventions are performed annually in the US. 3 The paradoxical