Observational Study
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Hepatol. Mar 27, 2024; 16(3): 428-438
Published online Mar 27, 2024. doi: 10.4254/wjh.v16.i3.428
Palliative long-term abdominal drains vs large volume paracenteses for the management of refractory ascites in end-stage liver disease
Senamjit Kaur, Rodrigo V Motta, Bryony Chapman, Victoria Wharton, Jane D Collier, Francesca Saffioti
Senamjit Kaur, Bryony Chapman, Victoria Wharton, Jane D Collier, Francesca Saffioti, Oxford Liver Unit, Department of Gastroenterology and Hepatology, Oxford University Hospitals NHS Foundation Trust, Oxford OX3 9DU, United Kingdom
Rodrigo V Motta, Oxford Liver Unit and Translational Gastroenterology Unit, Nuffield Department of Medicine, University of Oxford, Oxford OX3 9DU, United Kingdom
Co-first authors: Senamjit Kaur and Rodrigo V Motta.
Author contributions: Saffioti F conceptualised, designed and supervised the study, performed statistical analysis, created the artwork and made critical revisions; Kaur S and Motta RV conducted the literature review, collected the data, did the analysis, interpreted the data and drafted the original manuscript; Chapman B and Wharton V collected the data and contributed to writing the manuscript; Collier JD contributed to the conception and design of the study and made critical revisions for important intellectual content; All authors have read and approved the final manuscript.
Institutional review board statement: According to the Integrated Research Application System (https://www.myresearchproject.org.uk), in the United Kingdom, research undertaken by staff within a care team using data previously collected in the course of care for their own patients or clients does not require Research Ethics Committee review provided that data is anonymised in conducting the research.
Informed consent statement: No informed consent was required for this study, as the information used was collected as part of the normal clinical care and data were collected retrospectively by the care team involved and were anonymised.
Conflict-of-interest statement: All authors declare no conflict of interests for this article.
Data sharing statement: Data may be shared upon request sent to the corresponding author.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Francesca Saffioti, MD, PhD, Consultant Physician-Scientist, Researcher, Oxford Liver Unit, Department of Gastroenterology and Hepatology, Oxford University Hospitals NHS Foundation Trust, Headley Way, Headington, Oxford OX3 9DU, United Kingdom. francesca.saffioti@nhs.net
Received: December 10, 2023
Peer-review started: December 10, 2023
First decision: December 28, 2023
Revised: January 25, 2024
Accepted: February 29, 2024
Article in press: February 29, 2024
Published online: March 27, 2024
Processing time: 107 Days and 18.3 Hours
ARTICLE HIGHLIGHTS
Research background

Repeat large volume paracentesis (LVP) with albumin infusion is currently the standard treatment for the management of refractory ascites (RA) in patients with end-stage liver disease who are not eligible for transjugular intrahepatic portosystemic shunt or liver transplant, including those on a palliative care pathway. This treatment requires frequent patient-hospital contact and is associated with poor quality of life. Long-term abdominal drains (LTAD) are a reliable and cost-effective strategic option in the palliative management of recurrent malignant ascites, but are currently not routine practice in patients with end-stage liver disease and RA. The safety and cost-effectiveness of LTAD are currently being studied in this setting, with preliminary encouraging results.

Research motivation

As the use of LTAD may improve the quality of life of palliated patients with end-stage liver disease and RA, it is important to assess their utility and safety in this setting. We aimed to provide real-world data from our own experience to the available scarce evidence.

Research objectives

The objective of this study was to retrospectively assess the effectiveness and safety of LTAD in comparison with recurrent LVP for the management of ascites in palliated patients with end-stage liver disease and RA.

Research methods

This observational study included 49 consecutive patients with end-stage liver disease and RA requiring palliative drainage of ascites. Overall survival, the incidence of drain-related complications and endpoint-free survival for first ascites/drain-related hospitalisation, time to acute kidney injury and time to drain-related complications were compared between 30 patients who were managed with LTAD and 19 patients who underwent LVP.

Research results

The study found similar incidence of peritonitis between the two groups, although prophylactic antibiotics were more frequently prescribed in patients with LTAD. However, the incidence of acute kidney injury, ascites- and drain-related hospital admissions was lower in the LTAD group. There was no difference in the overall survival between the two groups, but time to acute kidney injury, first ascites/drain-related hospital admission and drain-related complications were shorter in the LTAD group.

Research conclusions

The use of palliative LTAD for the management of RA in patients with end-stage liver disease appears to be effective and overall safe. Compared to LVP, the use of LTAD in this setting may reduce the incidence of renal dysfunction, hospital admissions and healthcare resource utilisation.

Research perspectives

Larger, more heterogeneous cohorts and randomised controlled trials are needed to validate the findings of this study.