A Novel Percutaneous Volume Reduction Technique for Giant Emphysematous Bullae: Combined Percutaneous Erythromycin Sclerotherapy With Bronchoscopic Occlusion

Zeqiang Wang, Zhiguang Liu, Weidong Zhang, Wei Liu, Jianlong Tan, Xiuying Li, Huaiqiu Wu, Yun Li, Hongying Deng, Jiangchuan Chen, Lingjia Chen Department of Respiratory and Critical Care Medicine, Hunan Provincial People’s Hospital/The First Affiliated Hospital of Hunan Normal University, Changsha, Hunan, People’s Republic of ChinaCorrespondence: Zhiguang Liu, Department of Respiratory and Critical Care Medicine, Hunan Provincial People’s Hospital/The First Affiliated Hospital of Hunan Normal University, Changsha, Hunan, People’s Republic of China, Tel +86 13808476705, Email [email protected]: To evaluate the efficacy and safety of a novel percutaneous volume reduction technique combining erythromycin sclerotherapy with bronchoscopic occlusion for giant emphysematous bulla (GEB) patients unsuitable for surgery.Methods: This retrospective study analyzed 70 patients with GEB who underwent a novel percutaneous volume reduction technique. Outcomes including St. George’s Respiratory Questionnaire (SGRQ), 6-minute walk test (6MWT), modified Medical Research Council (mMRC) score, pulmonary function, and blood gas analysis were assessed before the procedure, at discharge, and 6 months post-procedure. The primary endpoint was improvement in mMRC grade. Related complications were also recorded.Results: The average GEB size of 70 patients was 14.91± 2.68cm (10– 21cm). The mMRC grade improved in 43 patients, and the efficacy of volume reduction was 61.4%. The forced expiratory volume in 1 s (FEV1), forced vital capacity (FVC), residual volume (RV), total lung capacity (TLC), PaO2/FIO2, PaCO2, 6MWT, total SGRQ, mMRC grades before discharge showed significant improvement compared to those before the procedure. FEV1, FVC, 6MWT, total SGRQ score, and PaO2/FIO2 continued to improve at 6 months after the procedure compared to those before discharge. There was significant correlation between mediastinal displacement and postoperative efficacy of GEB volume reduction (OR=3.609, 95% CI: 1.263– 10.316, p=0.017). In addition, the major postoperative complications included pneumothorax (36 cases, 51%) and pleural effusion (44 cases, 63%). Most of the symptoms were mild and improved after symptomatic treatment for the involved patients. There were no deaths during the perioperative period.Conclusion: The novel percutaneous bulla volume reduction technique represents a safe and effective non-surgical alternative for patients with inoperable GEB, demonstrating sustained therapeutic benefits lasting at least six months. The procedure appears particularly beneficial for patients with mediastinal displacement. However, the study has limitations, including its retrospective design and lack of long-term efficacy data, which may affect the generalizability of the findings.Keywords: giant emphysematous bulla, percutaneous puncture, bulla volume reduction, non-surgical strategy