12
views
0
recommends
+1 Recommend
0 collections
    0
    shares
      • Record: found
      • Abstract: found
      • Article: not found

      The Palliative Management of Refractory Cirrhotic Ascites Using the PleurX © Catheter

      research-article

      Read this article at

      ScienceOpenPublisherPMC
      Bookmark
          There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

          Abstract

          Background. Treatment options are limited for patients with refractory cirrhotic ascites (RCA). As such, we assessed the safety and effectiveness of the PleurX catheter for RCA. Methods. A retrospective analysis was performed on all patients with RCA who have undergone insertion of the PleurX catheter between 2007 and 2014 at our clinic. Results. Thirty-three patients with RCA were included in the study; 4 patients were lost to follow-up. All patients were still symptomatic despite bimonthly large volume paracentesis and were not candidates for TIPS or PV shunt. Technical success was achieved in 100% of patients. The median duration the catheter remained in situ was 117.5 days, with 95% CI of 48–182 days. Drain patency was maintained in 90% of patients. Microorganisms consistent with spontaneous bacterial peritonitis (SBP) from a catheter source were isolated in 38% of patients. The median time to infection was 105 days, with 95% CI of 34–233 days. All patients were treated for SBP successfully with antibiotics. Conclusion. Use of the PleurX catheter for the management of RCA carries a high risk for infection when the catheter remains in situ for more than 3 months but has an excellent patency rate and did not result in significant renal injury.

          Related collections

          Most cited references24

          • Record: found
          • Abstract: not found
          • Article: not found

          Management of adult patients with ascites due to cirrhosis: an update.

            Bookmark
            • Record: found
            • Abstract: not found
            • Article: not found

            Guidelines on the management of ascites in cirrhosis.

            K P Moore (2006)
              Bookmark
              • Record: found
              • Abstract: found
              • Article: not found

              Automated low flow pump system for the treatment of refractory ascites: a multi-center safety and efficacy study.

              Refractory ascites (RA) affects 10% of patients with advanced cirrhosis and ascites. Usual therapy includes large volume paracentesis, and in selected patients, a transjugular portosystemic shunt (TIPS). These therapies may be associated with increased morbidity: paracentesis may induce circulatory dysfunction and impair quality of life and TIPS may induce encephalopathy and is associated with increased mortality in patients with severe liver dysfunction. We present the results of a multicenter, non-randomized trial to assess the safety and efficacy of a new automated pump system for treatment of RA. Forty patients at 9 centers (February 2010-June 2011) received an implanted pump for the automated removal of ascites from the peritoneal cavity into the bladder, from where it was eliminated through normal urination. Patients were followed-up for 6months. The primary study outcome was safety. Secondary outcomes included recurrence of tense ascites and pump performance. Surgical complications occurred early in the study and became less frequent. The pump system removed 90% of the ascites and significantly reduced the median number of large volume paracentesis per month [3.4 (range 1-6) vs. 0.2 (range 0-4); p <0.01]. Cirrhosis-related adverse events decreased along follow-up. The automated pump seems an efficacious tool to move out ascites from the peritoneal cavity to the bladder. Its safety is still moderate, but a broad use in different countries will improve the surgical technique as well as the medical surveillance. A prospective randomized clinical trial vs. large volume paracentesis is underway to confirm these preliminary results. Copyright © 2013 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved.
                Bookmark

                Author and article information

                Journal
                Can J Gastroenterol Hepatol
                Can J Gastroenterol Hepatol
                CJGH
                Canadian Journal of Gastroenterology & Hepatology
                Hindawi Publishing Corporation
                2291-2789
                2291-2797
                2016
                5 June 2016
                : 2016
                : 4680543
                Affiliations
                1Department of Medicine, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada K1Y 4E9
                2Department of Epidemiology and Community Medicine, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada K1Y 4E9
                Author notes
                *Jason Reinglas: jreing@ 123456gmail.com

                Academic Editor: Eric M. Yoshida

                Article
                10.1155/2016/4680543
                4912988
                27446840
                53295ce8-9c29-410f-a1c6-8b8a112934b9
                Copyright © 2016 Jason Reinglas et al.

                This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 3 November 2015
                : 17 May 2016
                Categories
                Research Article

                Comments

                Comment on this article