Transforming pulmonary care with applications of endobronchial valves beyond emphysema: a narrative review

Endobronchial one‑way valves (EBVs) were originally developed for lung volume reduction in severe emphysema. Because EBVs allow unidirectional airflow, they have been used off‑label to manage persistent air leaks (PALs)/bronchopleural fistulas (BPFs), haemoptysis, cavitary tuberculosis (TB), and other complex pulmonary conditions. This review summarises the evidence of endobronchial valve applications beyond emphysema.

We conducted a narrative review of English‑language literature from January 1, 2000 to August 1, 2025, searching PubMed, Embase, Scopus, and Google Scholar for clinical trials, observational studies, case series, and case reports describing EBV use beyond emphysema. The selection of articles was based on relevance to the topic, with emphasis on clinical outcomes. No formal quantitative synthesis was performed given the narrative scope.

Across case series, EBV placement achieves cessation or substantial reduction of air leaks in roughly half to 80% of patients with postoperative or spontaneous BPFs, often allowing chest tube removal within days and avoiding reoperation. Reported complications are uncommon and include valve migration, expectoration, transient hypoxaemia, and localized infection. Case reports indicate EBVs can serve as emergency bronchoscopic plugs to control massive haemoptysis when conventional therapy fails. Emerging evidence in multidrug‑resistant TB shows that collapse therapy using EBVs alongside appropriate chemotherapy accelerates sputum culture conversion and cavity closure; in a randomized trial, EBV treatment markedly improved culture conversion and long‑term cure rates compared with chemotherapy alone. EBVs have also been used in critical care settings to isolate injured lungs and facilitate weaning from mechanical ventilation or extracorporeal membrane oxygenation (ECMO).

EBVs have evolved into a versatile tool in pulmonary medicine, extending well beyond emphysema treatment. The literature to date indicates that EBVs can effectively seal PALs, control focal pulmonary haemorrhage, and induce therapeutic lung collapse in cavitary disease-all with a minimally invasive approach. EBVs hold significant promise for improving patient care in challenging scenarios, and further research is warranted.