Abstract
Introduction: Hepatic hydrothorax (HH) is an infrequent but debilitating and therapeutically challenging complication of advanced liver cirrhosis. As evidence suggests against chest tube placement in HH many clinicians are reluctant to place indwelling pleural catheters (IPCs) for non-malignant effusions like HH as well. We aim to study the efficacy and safety of IPCs as an alternative treatment option in our systematic review. Methods: A literature search was conducted using the electronic database engines MEDLINE through PubMed, EMBASE, Ovid, Scopus and Cochrane Library (Cochrane Central Register of Controlled trialsand Cochrane Database of Systematic Reviews)from inception to April, 2018 to identify published articles and reports addressing outcomes in patients treated with an IPC for the treatment of HH [figure 1]. Risk of bias was rated for each study by using the Cochrane criteria. Results: The search strategy retrieved 370 papers out of which 4 observational studies were selected with a total of 111 patients.After insertion of IPCs for HH spontaneous pleurodesis was achieved in 16 (31.4%) out of 51 patients and mean duration to achieve spontaneous pleurodesis was 73-222 days. As far as secondary outcomes are concerned, frequency of pneumothorax during or after the procedure was 0 (0%) out of 92 patients, pain at insertion site 12 (20%) out of 60 patients, catheter blockage 2 (2.9%) out of 68 patients, pleural fluid infection 5 (4.5%) out of 111 patients and catheter site cellulitis 1 (3.1%) out of 32 patients. Re-accumulation of pleural fluid after catheter removal was mentioned in one study in which 12 (20%) out of 60 patients developed recurrence of pleural effusion. Primary and secondary end points are summarized in figure 2. Conclusion: We conclude that IPC is an acceptable therapeutic option for the management of refractory pleural effusion in patients with hepatic hydrothorax. Although TIPS and liver transplantation are gold standards for management of pleural effusion in these patients, cost and availability are major concerns with these treatment modalities. Tunneled pleural catheter is safe and efficacious alternative with a reasonable rate of spontaneous pleurodesis.969_A Figure 1. Prisma diagram showing method of study selection969_B Figure 2. showing primary and secondary end points
Highlights
BackgroundHepatic hydrothorax (HH) is defined as a transudative pleural effusion >500 mL in patients with cirrhosis in the absence of cardiac and pulmonary diseases [1]
A literature search was conducted using the electronic database engines MEDLINE, PubMed, EMBASE, Ovid, Scopus and Cochrane Library (Cochrane Central Register of Controlled trials and Cochrane Database of Systematic Reviews) from inception to April 2018 to identify published articles and reports addressing outcomes in patients treated for HH with indwelling pleural catheters (IPCs)
Articles were excluded if (1) they were not written in English, (2) no outcomes were reported, or (3) they represented single case reports, review articles or studies published as abstracts only
Summary
BackgroundHepatic hydrothorax (HH) is defined as a transudative pleural effusion >500 mL in patients with cirrhosis in the absence of cardiac and pulmonary diseases [1]. The incidence of HH is 5% to 10%, and HH occurs typically as an isolated right-sided pleural effusion in 70% to 80% of cases. As the majority of these patients have concomitant ascites, the therapeutic aim is typically to treat the ascites with salt restriction and diuretics and provide thoracentesis as needed [3]. It can become increasingly challenging when patients develop diuretic-resistant HH, as the only options available are liver transplantation, trans-jugular intrahepatic portosystemic shunt (TIPS) and indwelling pleural catheter (IPC). Limited objective data are available on the efficacy of IPCs in this patient population
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
