External Abdominal Compression for Refractory Ascites: A Pilot Study

Abstract

Introduction: Cirrhotic ascites may persist despite a daily 2 g dietary salt restriction and diuretics. Large volume paracentesis (LVP) is the mainstay of treatment for patients with refractory ascites. Limited data exists on typical intra-abdominal pressures (IAP) in patients with refractory ascites. We investigated IAP in such patients before and following LVP as well as immediately after placement of an elastic, external abdominal binder. The study was a feasibility and proof of concept trial in anticipation of a future studies which aim to assess if wearing a quantified compressive binder for a period of days will slow the rate of ascites accumulation and reduce the frequency that LVP is required for treatment of refractory ascites.Figure 1Figure 2Figure 3Methods: We consented and prospectively studied cirrhotic patients who regularly require LVP for refractory ascites. Investigators assisted the primary operator in attaching a standard disposable lumbar puncture manometer to the paracentesis catheter, in order to measure IAP. IAP was obtained upon placement of the paracentesis catheter (opening pressure) and again upon completion of LVP (closing pressure). A final pressure measurement was obtained after placement of an elastic abdominal binder, adjusted for a target IAP of 16 cm H20. The abdominal binder remained in place for several minutes to allow for appropriately zeroed pressure readings and was then removed. Results: Analysis was performed on 8 patients (5 males and 3 females) with refractory ascites. The mean frequency of scheduled LVP for patients was every 2.6 weeks. The mean volume of ascites removed was 9.4 L. The mean opening IAP was 13.2 cm H2O and mean closing pressure was 3.8 cm H2O, resulting in a mean reduction of IAP 9.4 cm H2O (p=0.012). Applying the binder increased mean pressure to 9.1 cm H20 (p=0.011). Conclusion: This is the first study to report post-paracentesis IAP after application of an external elastic abdominal binder. Our results show that IAP is higher in patients with tense ascites preceding paracentesis and decreases after LVP. We also demonstrated that application of an external elastic binder would significantly elevate the IAP. The application of the binder worn without complications. We anticipate obtaining further qualitative data, designing a binder with a quantifiable external compressive force, as well as methods to non-invasively estimate IAP all of which will allow us to study the efficacy of long term use of external abdominal compression in refractory ascites.