Abstract
Context Chemical pleurodesis is an effective treatment for malignant effusion. Although this therapy is less accepted in the treatment of patients with hepatic hydrothorax, the need for treatment in such patients encouraged us to analyze the outcome of chemical pleurodesis using tigecycline and bleomycin in the treatment of hepatic hydrothorax. Aims We aimed to analyze the outcome of chemical pleurodesis using tigecycline and bleomycin in the treatment of hepatic hydrothorax. Settings and design A randomized controlled clinical study was conducted. Patients and methods A prospective study including 40 patients with right-side hepatic hydrothorax, who did not respond to medical treatment and repeated thoracentesis and admitted to the Chest Department, Zagazig University Hospitals, was carried out from January 2017 till August 2017. The patients were divided into two groups: Group A: pleurodesis with tigecycline (n=20). Group B: pleurodesis with bleomycin (n=20). Statistical analysis SPSS, version 20.0, for Windows and MedCalc 13 for Windows were used for statistical analysis. Results After 3 months, complete success was seen in 10 (50%) cases in group A, whereas partial response was found in 10 (50%) cases in the form of two cases of obliteration costophrenic angle (CPA), four cases of mild effusion, and four cases of moderate effusion, whereas failure was found in zero cases. In group B, complete response was seen in five (25%) cases, whereas partial response was found in 13 (65%) cases in the form of one case of obliteration of CPA, four cases of mild effusion, four cases moderate effusion, and two (10%) cases of failure, which was statistically different. Adverse effects of bleomycin were higher than tigecycline. There was pain at the time of pleurodesis in three (15%) patients of tigecycline group and in 12 (60%) patients of bleomycin group; delayed pain occurred in 10 (50%) patients of bleomycin group and in only 5% in the tigecycline group. Fever was seen in approximately 80% of bleomycin group and 20% of tigecycline group. There was a significant statistical difference between both groups regarding complications. Conclusion Pleurodesis with tigecycline is an effective and safe procedure in patients with hepatic hydrothorax. Long-term studies are necessary to define the optimal therapeutic guidelines, effectiveness, and adverse effects.
Published Version
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