Alfapump® System versus Large Volume Paracentesis in the Treatment of Refractory Ascites; Results from a Multicenter Randomised Controlled Study (Rct)

Adebayo, Danielle; Bureau, Christophe; Rieu, Martine; Valla, Dominique; Elkrief, Laure; Peck‐Radosavljevic, Markus; Bota, Simona; McCune, Anne; Abbadi, Reyad; Vargas, Vı́ctor; Simón-Talero, Macarena; Córdoba, Joan; Angeli, P.; Rosi, S.; Macdonald, Stewart; Whittaker, Scott; Trepte, C. T.; Jalan, Rajiv

doi:10.1016/s0168-8278(16)01698-6

Cited by 6 publications

(2 citation statements)

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“…Finally, the preliminary results of a multicenter randomized controlled study that compared the Alfapump with LVP showed that the number of paracentesis per month were lower (0.2) for the alfapump compared to LVP (1.4) ( p < 0.0001). There were no differences in survival between groups, and side effects were slightly more common in the Alfapump group [40] .…”

Section: Diuretic-intractable Ascitesmentioning

confidence: 76%

Translating Our Current Understanding of Ascites Management into New Therapies for Patients with Cirrhosis and Fluid Retention

Pose

Cárdenas²

2017

Dig Dis

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Ascites is the most common complication associated with cirrhosis resulting in poor quality of life, high risk of development of other complications of cirrhosis, increased morbidity and mortality associated with surgical interventions, and poor long-term outcome. Patients with cirrhosis and a first onset of ascites, have a probability of survival of 85% during the first year and 56% at 5 years without liver transplantation. Ascites is caused due to increased renal sodium retention as a result of increased activity of the renin-angiotensin-aldosterone system in response to marked vasodilation of the splanchnic circulation. The practical management of ascites involves the proper evaluation of a patient with a thorough history and physical exam. In addition, complete laboratory, ascitic fluid, and radiological tests should be performed. One of the most important steps in the initial assessment of patients with ascites is to refer the appropriate candidates for liver transplantation, as it offers a definitive cure for cirrhosis and its complications. While the initial management of uncomplicated ascites with low sodium diet and diuretic treatment is straightforward in a majority of patients, approximately 10% of patients fail to respond to diuretics and become a real therapeutic challenge. The initial treatment of choice in patients with refractory ascites is large-volume paracentesis (LVP) associated with intravenous albumin; some patients also benefit from transjugular intrahepatic portosystemic shunts (TIPS). When repeated LVP or TIPS cannot be performed, other approaches using vasoconstrictors such as midodrine can be considered although data are scarce. A newly designed automated low flow pump system (Alfapump), which is designed to move ascites from the peritoneal cavity to the urinary bladder where it is eliminated spontaneously through diuresis is promising, but the data are also limited and safety is still a matter of concern. This article focuses on the practical aspects of the evaluation and treatment of patients with ascites and cirrhosis and also discusses how to translate our current understanding of ascites pathophysiology into new treatment methods for patients with fluid retention.

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Section: Diuretic-intractable Ascitesmentioning

confidence: 76%

Translating Our Current Understanding of Ascites Management into New Therapies for Patients with Cirrhosis and Fluid Retention

Pose

Cárdenas²

2017

Dig Dis

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“…Pilot series [9][10][11] and a randomized controlled trial [12] have shown a significant reduction in the need for paracentesis in patients with refractory ascites who underwent implantation of the alfapump system compared with the patients who were treated with conventional paracentesis [12]. The combination treatment strategy for refractory cirrhotic ascites by the alfapump system and surgical hernia repair has the theoretical advantages of reducing the hospitalization time, performing scheduled surgery with a lower theoretical mortality rate [6], avoiding placement of a peritoneal drain, and having only one anesthesia.…”

Section: Discussionmentioning

confidence: 99%

Combined treatment of refractory ascites by alfapumpTM and surgical umbilical hernia repair in cirrhotic patients: Is this the right paradigm?

Nk¹,

D²,

Abir³

et al. 2017

J Hepatol Gastroenterol

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Treatment for ascites in adults with decompensated liver cirrhosis: a network meta-analysis

Benmassaoud

Freeman

Roccarina

et al. 2020

Cochrane Database of Systematic Reviews

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BackgroundApproximately 20% of people with cirrhosis develop ascites. Several di erent treatments are available; including, among others, paracentesis plus fluid replacement, transjugular intrahepatic portosystemic shunts, aldosterone antagonists, and loop diuretics. However, there is uncertainty surrounding their relative e icacy. ObjectivesTo compare the benefits and harms of di erent treatments for ascites in people with decompensated liver cirrhosis through a network meta-analysis and to generate rankings of the di erent treatments for ascites according to their safety and e icacy. Search methodsWe searched CENTRAL, MEDLINE, Embase, Science Citation Index Expanded, World Health Organization International Clinical Trials Registry Platform, and trials registers until May 2019 to identify randomised clinical trials in people with cirrhosis and ascites. Selection criteriaWe included only randomised clinical trials (irrespective of language, blinding, or status) in adults with cirrhosis and ascites. We excluded randomised clinical trials in which participants had previously undergone liver transplantation. Data collection and analysisWe performed a network meta-analysis with OpenBUGS using Bayesian methods and calculated the odds ratio, rate ratio, and hazard ratio (HR) with 95% credible intervals (CrI) based on an available-case analysis, according to National Institute of Health and Care Excellence Decision Support Unit guidance.Treatment for ascites in adults with decompensated liver cirrhosis: a network meta-analysis (Review)

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Alfapump® System versus Large Volume Paracentesis in the Treatment of Refractory Ascites; Results from a Multicenter Randomised Controlled Study (Rct)

Cited by 6 publications

References 0 publications

Translating Our Current Understanding of Ascites Management into New Therapies for Patients with Cirrhosis and Fluid Retention

Translating Our Current Understanding of Ascites Management into New Therapies for Patients with Cirrhosis and Fluid Retention

Combined treatment of refractory ascites by alfapumpTM and surgical umbilical hernia repair in cirrhotic patients: Is this the right paradigm?

Treatment for ascites in adults with decompensated liver cirrhosis: a network meta-analysis

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