Targeting the leak: endobronchial valves for treatment of pneumothorax

The global health burden of pneumothorax is rising. Persistent air leak (PAL) from pneumothorax is a major driver of morbidity, prolonged hospitalization, and healthcare cost. Endobronchial valves (EBVs) are increasingly used as a minimally invasive treatment option for PAL based on limited evidence.

This review examines published evidence on clinical effectiveness in reducing/stopping air leak, and the risks and limitations on EBV use in management of PAL. A targeted search of PubMed from database inception to December 2025 was performed, and reference lists of key publications were screened. Relevant recommendations from current clinical guidelines are summarized.

Evidence supporting the use of EBV in PAL is limited to case series/reports in which EBV appears effective in selected patients, often as a 'last resort.' Successful use of EBV requires expertise in patient selection, valve placement and their aftercare. EBV is expensive and has recognized risks. Its efficacy, safety and generalizability to unselected PAL patients are yet to be determined. Early phase clinical trials are underway to gather data to inform future definitive studies. As it stands, EBV remains an available option with limited evidence base, alongside autologous blood patch and chemical pleurodesis, for patients with PAL unsuitable for surgery.