Tunneled Peritoneal Catheter for Refractory Ascites in Cirrhosis: A Randomized Case-Series.

Nina Kimer,Christian Mortensen,Mette Lehmann Andersen,Lone Galmstrup Madsen,Søren Møller,Lise Lotte Gluud,Lise Hobolth,Agnete Nordheim Riedel,Frank Vinholt Schiødt

doi:10.3390/medicina56110565

Abstract

Background and objectives: Refractory ascites markedly worsens prognosis in cirrhosis. Large volume paracentesis (LVP) is standard treatment, but complications are common. In a randomized controlled case-series, we assessed a permanent tunneled peritoneal catheter versus LVP in patients with cirrhosis and ascites. Materials and Methods: Random allocation was computer-generated, and concealment used opaque envelopes. Patients were included from January 2017 to December 2018. Inclusion criteria were cirrhosis and recurrent ascites and expected survival of more than 3 months. Results: Thirteen patients were enrolled (PleurX =6 versus LVP = 7). Seven were female, ranging in age from 51 to 80 years. No procedure-related complications occurred. Two patients died due to variceal bleeding (PleurX-group) and sepsis (LVP-group). One patient was withdrawn due to hyponatremia (PleurX-group). Two patients were withdrawn due to bacterial peritonitis and infection of unknown origin (control-group). In the PleurX-group, all patients colonized the catheter, two developed bacterial peritonitis. The most common bacterial colonization was Staph. Epidermidis (n = 4). Conclusions: In selected patients, the PleurX catheter mobilizes ascites and may be an alternative to LVP. The risk of infection should be considered in each case. The impact of colonization and risk of infections needs further investigation. The present trial does not allow for statistical conclusions.

Highlights

Ascites is one of the most common complications to cirrhosis and a frequent cause for hospitalization [1]
In a randomized controlled study, we aimed to evaluate the beneficial and harmful effects of the PleurX catheter versus Large volume paracentesis (LVP) and albumin in patients with non-malignant ascites due to cirrhosis
Included patients were allocated to PleurX (n = 6) versus LVP (n = 7)

Summary

Introduction

Ascites is one of the most common complications to cirrhosis and a frequent cause for hospitalization [1]. About 5–10% of patients with cirrhosis and ascites develop refractory ascites, which is associated with a median survival of about six months [3]. Large volume paracentesis (LVP) is standard treatment, but complications are common. LVP in patients with cirrhosis and ascites. Inclusion criteria were cirrhosis and recurrent ascites and expected survival of more than 3 months. Results: Thirteen patients were enrolled (PleurX =6 versus LVP = 7). One patient was withdrawn due to hyponatremia (PleurX-group). Two patients were withdrawn due to bacterial peritonitis and infection of unknown origin (control-group). In the PleurX-group, all patients colonized the catheter, two developed bacterial peritonitis.

Objectives

Methods

Results