Tunneled Peritoneal Catheter for Refractory Ascites in Cirrhosis: A Randomized Case-Series
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 cirrhos...
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doaj-dc430fec4fa7495ca72169d5fa599f2c2020-11-25T03:36:08ZengMDPI AGMedicina1010-660X2020-10-015656556510.3390/medicina56110565Tunneled Peritoneal Catheter for Refractory Ascites in Cirrhosis: A Randomized Case-SeriesNina Kimer0Agnete Nordheim Riedel1Lise Hobolth2Christian Mortensen3Lone Galmstrup Madsen4Mette Lehmann Andersen5Frank Vinholdt Schiødt6Søren Møller7Lise Lotte Gluud8Gastro Unit, Medical Division, Hvidovre University Hospital, 2650 Hvidovre, DenmarkGastro Unit, Medical Division, Hvidovre University Hospital, 2650 Hvidovre, DenmarkGastro Unit, Medical Division, Hvidovre University Hospital, 2650 Hvidovre, DenmarkGastro Unit, Medical Division, Hvidovre University Hospital, 2650 Hvidovre, DenmarkDepartment of Clinical Medicine, University Hospital Køge, 4600 Køge, DenmarkDepartment of Gastroenterology, University Hospital Herlev, 2630 Herlev, DenmarkAbdominal Center K, University Hospital Bispebjerg, 2400 Copenhagen NV, DenmarkCenter of Functional and Diagnostic Imaging and Research, Department of Clinical and Nuclear Medicine, Amager-Hvidovre University Hospital, 2650 Hvidovre, DenmarkGastro Unit, Medical Division, Hvidovre University Hospital, 2650 Hvidovre, DenmarkBackground 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 One patient was withdrawn due to hyponatremia (PleurX-group).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 <i>Staph. Epidermidis</i> (<i>n</i> = 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.https://www.mdpi.com/1010-660X/56/11/565peritoneal catheterPleurXliver cirrhosisrefractory ascitesspontaneous bacterial peritonitis |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Nina Kimer Agnete Nordheim Riedel Lise Hobolth Christian Mortensen Lone Galmstrup Madsen Mette Lehmann Andersen Frank Vinholdt Schiødt Søren Møller Lise Lotte Gluud |
spellingShingle |
Nina Kimer Agnete Nordheim Riedel Lise Hobolth Christian Mortensen Lone Galmstrup Madsen Mette Lehmann Andersen Frank Vinholdt Schiødt Søren Møller Lise Lotte Gluud Tunneled Peritoneal Catheter for Refractory Ascites in Cirrhosis: A Randomized Case-Series Medicina peritoneal catheter PleurX liver cirrhosis refractory ascites spontaneous bacterial peritonitis |
author_facet |
Nina Kimer Agnete Nordheim Riedel Lise Hobolth Christian Mortensen Lone Galmstrup Madsen Mette Lehmann Andersen Frank Vinholdt Schiødt Søren Møller Lise Lotte Gluud |
author_sort |
Nina Kimer |
title |
Tunneled Peritoneal Catheter for Refractory Ascites in Cirrhosis: A Randomized Case-Series |
title_short |
Tunneled Peritoneal Catheter for Refractory Ascites in Cirrhosis: A Randomized Case-Series |
title_full |
Tunneled Peritoneal Catheter for Refractory Ascites in Cirrhosis: A Randomized Case-Series |
title_fullStr |
Tunneled Peritoneal Catheter for Refractory Ascites in Cirrhosis: A Randomized Case-Series |
title_full_unstemmed |
Tunneled Peritoneal Catheter for Refractory Ascites in Cirrhosis: A Randomized Case-Series |
title_sort |
tunneled peritoneal catheter for refractory ascites in cirrhosis: a randomized case-series |
publisher |
MDPI AG |
series |
Medicina |
issn |
1010-660X |
publishDate |
2020-10-01 |
description |
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 <i>Staph. Epidermidis</i> (<i>n</i> = 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. |
topic |
peritoneal catheter PleurX liver cirrhosis refractory ascites spontaneous bacterial peritonitis |
url |
https://www.mdpi.com/1010-660X/56/11/565 |
work_keys_str_mv |
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