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. 2024 Mar 27;16(3):428-438.
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  1 , Rodrigo V Motta  2 , Bryony Chapman  1 , Victoria Wharton  1 , Jane D Collier  1 , Francesca Saffioti  3
Affiliations

Palliative long-term abdominal drains vs large volume paracenteses for the management of refractory ascites in end-stage liver disease

Senamjit Kaur et al. World J Hepatol. .

Abstract

Background: Long-term abdominal drains (LTAD) are a cost-effective palliative measure to manage malignant ascites in the community, but their use in patients with end-stage chronic liver disease and refractory ascites is not routine practice. The safety and cost-effectiveness of LTAD are currently being studied in this setting, with preliminary positive results. We hypothesised that palliative LTAD are as effective and safe as repeat palliative large volume paracentesis (LVP) in patients with cirrhosis and refractory ascites and may offer advantages in patients' quality of life.

Aim: To compare the effectiveness and safety of palliative LTAD and LVP in refractory ascites secondary to end-stage chronic liver disease.

Methods: A retrospective, observational cohort study comparing the effectiveness and safety outcomes of palliative LTAD and regular palliative LVP as a treatment for refractory ascites in consecutive patients with end-stage chronic liver disease followed-up at our United Kingdom tertiary centre between 2018 and 2022 was conducted. Fisher's exact tests and the Mann-Whitney U test were used to compare qualitative and quantitative variables, respectively. Kaplan-Meier survival estimates were generated to stratify time-related outcomes according to the type of drain.

Results: Thirty patients had a total of 35 indwelling abdominal drains and nineteen patients underwent regular LVP. The baseline characteristics were similar between the groups. Prophylactic antibiotics were more frequently prescribed in patients with LTAD (P = 0.012), while the incidence of peritonitis did not differ between the two groups (P = 0.46). The incidence of acute kidney injury (P = 0.014) and ascites/drain-related hospital admissions (P = 0.004) were significantly higher in the LVP group. The overall survival was similar in the two groups (log-rank P = 0.26), but the endpoint-free survival was significantly shorter in the LVP group (P = 0.003, P < 0.001, P = 0.018 for first ascites/drain-related admission, acute kidney injury and drain-related complications, respectively).

Conclusion: The use of LTAD in the management of refractory ascites in palliated end-stage liver disease is effective, safe, and may reduce hospital admissions and utilisation of healthcare resources compared to LVP.

Keywords: Decompensated liver cirrhosis; Indwelling abdominal catheter; Palliative care; Quality of life; Rocket drain; Safety.

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Conflict of interest statement

Conflict-of-interest statement: All authors declare no conflict of interests for this article.

Figures

Figure 1
Figure 1
Comparison of overall survival between cirrhotic patients with refractory ascites palliated with long-term abdominal drain or repeat large volume paracentesis. LTAD: Long-term abdominal drain; LVP: Large volume paracentesis.
Figure 2
Figure 2
Kaplan-Meier curves illustrating prediction of endpoints according to drain type. A: Comparison of time to first ascites/drain-related hospitalisation between patients with long-term abdominal drains (LTAD) and patients undergoing large volume paracentesis (LVP); B: Comparison of time to acute kidney injury between patients with LTAD and patients undergoing LVP; C: Comparison of time to drain-related complications between patients with LTAD and patients undergoing LVP. LTAD: Long-term abdominal drain; LVP: Large volume paracentesis; AKI: Acute kidney injury.
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