Effectiveness and Safety of Pleurodesis for Hepatic Hydrothorax: A Systematic Review and Meta-Analysis

Hou, Feifei; Qi, Xingshun; Guo, Xiaozhong

doi:10.1007/s10620-016-4260-9

Cited by 50 publications

(40 citation statements)

References 49 publications

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“…However, the pooled rate of complications related to this procedure was as high as 82%. 139 Finally, thoracoscopic repair with mersilene mesh appears to be effective in patients with well-defined diaphragmatic defects. 140 Advanced liver disease, as assessed by MELD score, and preoperative renal dysfunction appear to adversely affect three-month survival.…”

Section: Hepatic Hydrotoraxmentioning

confidence: 99%

EASL Clinical Practice Guidelines for the management of patients with decompensated cirrhosis

Angeli¹,

Bernardi

Villanueva³

et al. 2018

Journal of Hepatology

1,953

1,750

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The natural history of cirrhosis is characterised by an asymptomatic compensated phase followed by a decompensated phase, marked by the development of overt clinical signs, the most frequent of which are ascites, bleeding, encephalopathy, and jaundice. The following Clinical Practice Guidelines (CPGs) represent the first CPGs on the management of decompensated cirrhosis. In this context, the panel of experts, having emphasised the importance of initiating aetiologic treatment for any degree of hepatic disease at the earliest possible stage, extended its work to all the complications of cirrhosis, which had not been covered by the European Association for the Study of the Liver guidelines, namely: ascites, refractory ascites, hyponatremia, gastrointestinal bleeding, bacterial infections, acute kidney injury, hepatorenal syndrome, acute-on-chronic liver failure, relative adrenal failure, cirrhotic cardiomyopathy, hepatopulmonary syndrome, and porto-pulmonary hypertension. The panel of experts, produced these GPGs using evidence from PubMed and Cochrane database searches providing up to date guidance on the management of decompensated cirrhosis with the only purpose of improving clinical practice.

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Section: Hepatic Hydrotoraxmentioning

confidence: 99%

EASL Clinical Practice Guidelines for the management of patients with decompensated cirrhosis

Angeli¹,

Bernardi

Villanueva³

et al. 2018

Journal of Hepatology

1,953

1,750

View full text Add to dashboard Cite

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“…The recurrence rate was as high as 50%. [82][83][84] Chen and colleagues showed a 16.7% risk of pleural space infection that was confirmed in subsequent studies. [85][86][87] VATS to repair the diaphragmatic defects is another potential solution, but again studies are small, although results were impressive with 70 to 100% success rates.…”

Section: Pleurodesis For Nonmalignant Effusionmentioning

confidence: 77%

Pleurodesis

Lamb

Thakkar

et al. 2019

Semin Respir Crit Care Med

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Symptomatic pleural disease, specifically malignant pleural effusion, refractory benign pleural effusion, and pneumothoraces are common diseases that often require therapeutic interventions. The spectrum of management strategies often includes selection of a chemical pleurodesis agent administered in combination with an indwelling pleural catheter or chest tube.Additionally, there is a role for minimally invasive techniques which include medical thoracoscopy or more advanced video-assisted thoracoscopic approaches. Ongoing clinical trials continue to evolve best practices regarding the optimal sclerosant agents and procedural approaches in the management of these diseases.

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“…Pleurodesis has been attempted for the treatment of HH, but it is relatively ineffective. In a pooled analysis of chemical pleurodesis in 189 patients in refractory HH, the overall success rate was 50% and complications were high . Certainly, better alternatives would be desirable.…”

Section: Discussionmentioning

confidence: 99%

“…In a pooled analysis of chemical pleurodesis in 189 patients in refractory HH, the overall success rate was 50% and complications were high. 19 Certainly, better alternatives would be desirable. Indwelling tunnelled pleural catheter drainage is another potential treatment option but lacks clear evidence.…”

Section: Discussionmentioning

confidence: 99%

Efficacy and safety of transjugular intrahepatic portosystemic shunt in difficult‐to‐manage hydrothorax in cirrhosis

Jindal

Mukund

Kumar

et al. 2019

Liver International

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Background Pleural effusions (PE) complicate cirrhosis in ~5% of patients. Identification of cause and related complications is imperative. Unlike refractory ascites, large‐scale studies on interventions for refractory PE are limited. Methods Consecutive hospitalized cirrhotics having PE were retrospectively analysed. None had liver transplantation (LT) within 6‐month follow‐up. We determined safety, efficacy and mortality predictors for PE managed with standard medical treatment (SMT), thoracentesis, catheter drainage and TIPS. Results Of 1149 cirrhotics with PE (mean Child‐Pugh 10.6 ± 1.8 and MELD 21.2 ± 7.4), 82.6% had hepatic hydrothorax (HH) and 12.3% were suspected tubercular PE (TBPE). Despite comparable HVPG and MELD scores, patients with HH developed more AKI, encephalopathy and septic shock (all P < .01) on follow‐up. Among HH, 73.5% were symptomatic, 53.2% isolated right‐sided PE and 21.3% had SBE. Presence of SBP [Odd's ratio, OR: 4.5] and catheter drainage [OR: 2.1] were independent predictors for SBE. In 70.3% of admissions, HH responded to SMT alone, 12.9% required thoracentesis and 11.5% underwent catheter drainage. Fifty‐one patients were selected for TIPS [lower mean CTP 9.9 ± 1.6 and MELD score 18.7 ± 5.4]. Despite reduction in pressure gradient from 23.1 ± 3.8 mm Hg to 7.2 ± 2.5 mm Hg, 25 patients had partial response, 10 had complete HH resolution. Major post‐TIPS complications were portosystemic encephalopathy (eight patients, six resolved) and ischaemic hepatitis (four patients, two resolved). Overall, 35.9% patients with HH had 6‐month mortality and independent predictors were MELD > 25, SBP and septic shock. Conclusion Refractory PE in cirrhosis requiring interventions including TIPS has poor outcome. The role of haemodynamics in predicting post‐TIPS response and complications is limited. Early referral for LT is imperative.

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Effectiveness and Safety of Pleurodesis for Hepatic Hydrothorax: A Systematic Review and Meta-Analysis

Abstract: Pleurodesis may be a promising treatment for HH, but carries a high rate of complications.

Cited by 50 publications

References 49 publications

EASL Clinical Practice Guidelines for the management of patients with decompensated cirrhosis

EASL Clinical Practice Guidelines for the management of patients with decompensated cirrhosis

Pleurodesis

Efficacy and safety of transjugular intrahepatic portosystemic shunt in difficult‐to‐manage hydrothorax in cirrhosis

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