TY - JOUR
T1 - Tunneled Peritoneal Catheter for Refractory Ascites in Cirrhosis
T2 - A Randomized Case-Series
AU - Kimer, Nina
AU - Riedel, Agnete Nordheim
AU - Hobolth, Lise
AU - Mortensen, Christian
AU - Madsen, Lone Galmstrup
AU - Andersen, Mette Lehmann
AU - Schiødt, Frank Vinholdt
AU - Møller, Søren
AU - Gluud, Lise Lotte
PY - 2020/10/27
Y1 - 2020/10/27
N2 - 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 One patient was withdrawn due to hyponatremia (PleurX-group). Two patients were withdrawn due to bacterial peritonitis and infection of unknown origin (control-group).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.
AB - 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.
KW - peritoneal catheter
KW - PleurX
KW - liver cirrhosis
KW - refractory ascites
KW - spontaneous bacterial peritonitis
U2 - 10.3390/medicina56110565
DO - 10.3390/medicina56110565
M3 - Journal article
C2 - 33121063
SN - 1010-660X
VL - 56
SP - 1
EP - 9
JO - Medicina (Kaunas, Lithuania)
JF - Medicina (Kaunas, Lithuania)
IS - 11
M1 - 56110565
ER -