Palliative long-term abdominal drains in refractory ascites due to end-stage liver disease: A case series

Abstract

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Permanent indwelling peritoneal catheters for palliation of refractory ascites in end‐stage liver disease: A systematic review

“…Overall patient survival was limited, as expected in all aetiologies of RA. Where reported, median survival in ESLD varied between 29 days to 6 months, consistent with known median survival in this group . Median PIPC survival in ESLD ranged between 6 weeks to 5 months, in‐keeping with mean PleurX™ catheter survival in the malignant ascites NICE technology appraisal …”

“…In six studies there were no episodes of BP in patients with ESLD . In our case series we reported organisms ( Pseudomonas aeruginosa and Corynebacterium striatum ) cultured from the PIPC in one case, however the clinical significance was uncertain.…”

“…The AKI case followed leakage of ascites at an access port site . The HE case had no clear precipitating cause, the authors felt likely representing ESLD progression . This was the same case of Pseudomonas aeruginosa and Corynebacterium striatum grown from the PIPC with uncertain clinical significance, without other features of infection or empirical antibiotics leading to improvement …”

“…Catheters were inserted by interventional nephrologists in two studies, one stating under ultrasound and fluoroscopic guidance . In a further two, catheters were inserted by consultant physicians/gastroenterologists under ultrasound guidance . Two studies did not report on insertion methods; one study reported catheters were inserted by trained physicians using X‐ray guidance, and one drainage catheter was inserted surgically (Tenckhoff catheter) (Table ).…”

“…Two studies with a mixed cohort of malignant and non‐malignant ascites reported 11 cases of BP but without differentiating between aetiology . Cellulitis at catheter insertion site was reported in nine of 147 (6%) patients with ESLD . Four mixed cohort studies reported 11 patients with either cellulitis or “local infection”; without stating underlying aetiology, therefore not included in analysis …”