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Updated: Nov 8, 2025
Local Anesthetic Thoracoscopy for Undiagnosed Pleural Effusion
Published on: November 10, 2023
Medical thoracoscopy treatment for pleural infections: a systematic review and meta-analysis
Michele Mondoni1, Laura Saderi2, Federica Trogu2
1Respiratory Unit, ASST Santi Paolo e Carlo, Department of Health Sciences, Università Degli Studi Di Milano, Via Di Rudinì n. 8, 20142, Milan, Italy. michele.mondoni@asst-santipaolocarlo.it.
Background:
Complicated parapneumonic effusions and empyema represent advanced stages of pleural infections and are characterized by a high mortality. Medical thoracoscopy is a safe and minimally invasive endoscopic technique prescribed to treat severe pleural infections. However, only a few studies evaluated its success rate. A systematic review of observational studies was performed to assess the efficacy of medical thoracoscopy in patients with complicated parapneumonic effusions and empyema, as well as its predictive factors.
Methods:
A search of the scientific evidence was carried out using PubMed, EMBASE, and Cochrane Central Register of Controlled Trials. Articles describing observational studies on medical thoracoscopy in patients with parapneumonic effusions and empyema were selected.
Results:
Eight studies met the inclusion criteria. The pooled treatment success rate of thoracoscopy was 85% (95% CI 80.0-90.0%; I2: 61.8%) when used as first-line intervention or after failure of chest tube. The pooled complication rate was 9.0% (95% CI 6.0-14.0%; I2: 58.8%). A pooled difference of treatment success of 9.0% (95% CI 1.0-18.0%) was found when post-thoracoscopy intra-pleural fibrinolysis was prescribed. Pooled success rate was higher in cases with pleural fluid culture negativity (pooled difference: 14.0%; 95% CI 4.0-24.0%).
Conclusions:
Medical thoracoscopy is effective and safe when prescribed for complicated parapneumonic effusions and empyema. Bacteriological negativity of pleural effusion specimens and administration of adjuvant intra-pleural fibrinolysis after the procedure are associated with a higher success rate.
Insights
Medical thoracoscopy effectively treats complicated parapneumonic effusions and empyema, achieving an 85% success rate. Higher success is linked to negative pleural fluid cultures and post-procedure fibrinolysis.
Area of Science:
- Pulmonology
- Thoracic Surgery
- Infectious Diseases
Background:
- Complicated parapneumonic effusions and empyema are severe pleural infections with high mortality.
- Medical thoracoscopy offers a minimally invasive endoscopic approach for these advanced infections.
- Limited data exists on the efficacy and success rates of medical thoracoscopy.
Purpose of the Study:
- To systematically review observational studies assessing the efficacy of medical thoracoscopy.
- To evaluate the success rate of medical thoracoscopy in treating complicated parapneumonic effusions and empyema.
- To identify factors predicting treatment success.
Main Methods:
- A systematic literature search was conducted across PubMed, EMBASE, and Cochrane Central Register.
- Observational studies focusing on medical thoracoscopy for parapneumonic effusions and empyema were included.
- Pooled analysis was performed to determine success and complication rates.
Main Results:
- Eight studies met the inclusion criteria, with a pooled treatment success rate of 85% for medical thoracoscopy.
- The pooled complication rate was 9.0%.
- Treatment success was higher with negative pleural fluid cultures (14% difference) and when intra-pleural fibrinolysis was used post-procedure (9% difference).
Conclusions:
- Medical thoracoscopy is an effective and safe treatment for complicated parapneumonic effusions and empyema.
- Negative pleural fluid cultures are associated with improved outcomes.
- Adjuvant intra-pleural fibrinolysis administration post-procedure correlates with a higher success rate.
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