The National Institute for Health and Care Excellence (NICE) issued full guidance to the NHS in England, Wales, Scotland and Northern Ireland on Insertion of endobronchial valves for lung volume reduction in emphysema in September 2013. NICE is currently updating this guidance. The new guidance will be published shortly. Until then the NHS should continue to follow the recommendations outlined in the current version of the guidance. The Interventional Procedures Advisory Committee (IPAC) will consider this procedure review and NICE will issue an interventional procedures consultation document about its safety and efficacy for 4 weeks’ public consultation. IPAC will then review the consultation document in the light of comments received and produce a final interventional procedures document, which will be considered by NICE before guidance is issued to the NHS in England, Wales, Scotland and Northern Ireland.
 
Status In progress
Process IP
Description The aim of insertion of endobronchial valves (also known as intrabronchial valves) to reduce lung volume in emphysema is to achieve atelectasis of selected lung segments. It uses an endoscopic approach, which is less invasive than open or thoracoscopic lung volume reduction surgery. Before the procedure, it is usual practice to assess the presence of collateral ventilation (when air enters a lobe of the lung through a passage that bypasses the normal airway). A surrogate for this is CT scanning to assess the completeness of fissures. A functional approach, specially developed for use before airway valve insertion, involves a specially designed balloon catheter with a flow sensor. Endobronchial valve insertion is done with the patient under sedation or general anaesthesia. Using a delivery catheter passed through a bronchoscope, a synthetic valve is placed in the target location and fixed to the bronchial wall. The valve is designed to prevent air inflow during inspiration but to allow air and mucus to exit during expiration. Several valves may be needed (1 or more for each segment of the lung to be treated). Patients may sometimes be given antibiotics or corticosteroids. Different devices of slightly varying designs are available for this procedure, – 1 is duckbill shaped and the other umbrella shaped.

Timeline

Key events during the development of the guidance:

Date Update
25 August 2017 - 25 September 2017 Interventional procedure consultation

For further information on how we develop guidance, please see our page about NICE interventional procedures guidance