Improvement in the management of nontuberculous mycobacteria after lobar collapse therapy with Endobronchial valves (EBV)

Background: The incidence of Non Tuberculous Mycobacteria (NTM) has been increasing worldwide. Treatment success rate is unsatisfactory with a successfully eradicate in 60-80% of patients with a significant proportion of successfully treated patients experience disease recurrence. In a study of Corbetta et al., the Zephyr® EBV have been using in the successful management of inoperable cases of MDR and XDR-TB with cavities. Aim: We describe our first case series of NTM with cavities not responder to therapy or/and relapsed treated with EBV as treatment adjunct to pharmacotherapy in order to accelerate the healing of the patients and increase our experience whilst awaiting the start of a randomized protocol. Methods: We recruited patients in Florence and EBV were implanted using a rigid bronchoscopy in general anesthesia. The number of implanted valves depended on the endobronchial anatomy of each patients. Results: We treated 3 patients (2F/1M) with M. Xenopi (2/3) and M. Avium complex (1/3). Sputum were positive at the time of the procedure. Target of EBV placement were the cavities that were located Right upper lobe (2/3) and right lower lobe (1/3). A median of 3 valves were inserted. Loss of volume of the treated lobe and cavities were seen in all patients. No complications were observed after procedure. Sputum at 3 months were negative. Conclusions: Our early experience showed benefit in terms of conversion of sputum smear and culture to negative and radiological closure or reduction in size of the cavities with no complications. After these further demonstration of efficacy, our group is working on developing a prospective and randomized study.