Silver nitrate versus histoacryl in bronchoscopic lung volume reduction

Abstract

Context It is reported that chronic obstructive pulmonary disease (COPD) has a prevalence of 251 million cases worldwide in 2016. Where medical treatment failed to control or insufficiently control symptoms, and when surgical treatments are contraindicated, bronchoscopic lung volume reduction (BLVR) is considered the last option for patients with different types of severe emphysema. Sclerosing agents, such as vapor ablation or sealants, can be used. Aim To compare between silver nitrate and N-butyl cyanoacrylate (histoacryl) in BLVR. Settings and design In this randomized prospective interventional study, we recruited 24 patients with COPD from the Chest Department, Alexandria Main University Hospital, having homogenous or heterogonous emphysema and complaining of severe symptoms despite optimized medical treatment, and they were divided into group I, including 12 patients subjected to BLVRS using silver nitrate, and group II, including 12 patients subjected to BLVRS using histoacryl. Patients and methods Five parameters, namely, forced expiratory volume in 1\u2009s, 5-min walk test, modified Medical Research Council, COPD assessment test score, and Saint George’s respiratory questionnaire were collected, compared, and statistically analyzed for both groups preoperatively and 12 weeks postoperatively. Results There were statistically significant improvements in all studied outcomes on postoperative follow-up of both groups. The only statistically significant difference between both groups was in the postoperative Saint George’s respiratory questionnaire, which was slightly better in the silver nitrate arm. None of the major complications occurred in any of the patients. Conclusion Both silver nitrate and histoacryl show promising results in improving patients with refractory COPD. Although both agents have nearly similar results, silver nitrate is much affordable and easier to use.