Paracentesis with Intravenous Infusion of Albumin as Compared with Peritoneovenous Shunting in Cirrhosis with Refractory Ascites

Ginès, Pere; Arroyo, Vicente; Vargas, Vı́ctor; Planas, Ramón; Casafont, F.; Panés, J; M, Hoyos; Viladomiu, L; Rimola, Antoni; Morillas, Rosa; Salmerón, Joan Manuel; Ginés, Àngels; Esteban, Rafael; Rodés, Joan

doi:10.1056/nejm199109193251201

Cited by 279 publications

(101 citation statements)

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“…56 Peritoneovenous shunt, e.g., LeVeen or Denver, was popularized in the 1970s as a physiologic treatment of ascites. Shunt placement has been shown in controlled trials to decrease the duration of hospitalization, to decrease the number of hospitalizations, and to decrease the dose of diuretics 36,57 ; however, poor long-term patency, excessive complications, and no survival advantage compared with medical therapy in controlled trials have led to near abandonment of this procedure. 36,57 Shunt-related fibrous adhesions, and even ''cocoon'' formation, can make subsequent liver transplantation difficult.…”

Section: Introductionmentioning

confidence: 99%

“…Shunt placement has been shown in controlled trials to decrease the duration of hospitalization, to decrease the number of hospitalizations, and to decrease the dose of diuretics 36,57 ; however, poor long-term patency, excessive complications, and no survival advantage compared with medical therapy in controlled trials have led to near abandonment of this procedure. 36,57 Shunt-related fibrous adhesions, and even ''cocoon'' formation, can make subsequent liver transplantation difficult. 58 Peritoneovenous shunting should probably now be reserved for diuretic-resistant patients who are not transplant candidates and who are not candidates for serial therapeutic paracenteses because of multiple abdominal surgical scars or distance from a physician who is willing and capable of performing paracenteses.…”

Section: Introductionmentioning

confidence: 99%

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Management of adult patients with ascites caused by cirrhosis

Runyon¹

1998

Hepatology

302

131

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Ascites is the most common of the major complications of cirrhosis. The development of ascites is an important landmark in the natural history of cirrhosis and has been proposed as an indication for liver transplantation. The initial evaluation of a patient with ascites should include a history, physical evaluation, and abdominal paracentesis with ascitic fluid analysis. Treatment should consist of abstinence from alcohol, sodium restricted diet, and diuretics. This regimen is effective in Ϸ90% of patients. The treatment options for the diuretic-resistant patients include serial therapeutic paracenteses, liver transplantation, and peritoneovenous shunting. (HEPATOLOGY 1998;27;264-272.) PREAMBLE These guidelines provide a data-supported approach to the care of patients with ascites. They are based on the following: 1) a formal review and analysis of the published world literature (1,045 papers) on ascites (Medline Search from 1966-1996, search terms included ascites, diet therapy, drug therapy, radiotherapy, surgery, and therapy); 2) the American College of Physician' s Manual for Assessing Health Practices and Designing Practice Guidelines 1 ; and 3) several published and draft guidelines, including the American Association for the Study of Liver Diseases' Policy Statement on Development and Use of Practice Guidelines and American Gastroenterological Association' s Policy Statement on Guidelines 2 ; and 4) 15 years of experience on the part of the author in the clinical and laboratory investigations of and care for patients with this problem.These guidelines, intended for use by physicians, suggest preferable approaches to the diagnostic, therapeutic, and preventative aspects of care. These guidelines are intended to be flexible, in contrast with ''standards of care,'' which are inflexible policies to be followed in almost every case. 1 Furthermore, these guidelines were developed for the care of adult patients with clinically detectable ascites. Although the general approach may be applicable to children, the pediatric data base is much smaller and there may be unanticipated differences between adults and children. Patients with ascites that is detected by imaging modalities alone, but not yet clinically evident, are not included because of the lack of published information regarding the natural history of this entity.Specific recommendations are based on relevant published information. In an attempt to standardize recommendations, the Practice Guidelines Committee of the American Association for the Study of Liver Diseases modified the categories of the Infectious Diseases Society of America' s Quality Standards. 3 These categories are reported with each recommendation, using the letters A through E to determine the strength of recommendation and roman numerals I through III to determine quality of evidence upon which recommendations are based, as follows: A, survival benefit; B, improved diagnosis; C, improvement in quality of life; D, relevant pathophysiologic parameters improved; E, impacts cost of heal...

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Management of adult patients with ascites caused by cirrhosis

Runyon¹

1998

Hepatology

302

131

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“…8,9 Attempts to control an intractable lymphocele using multiple surgical procedures was eventually achieved with use of a Denver shunt (Care Fusion, Waukegan, IL) . 10 However, peritoneovenous shunts are prone to blockage and disseminated intravascular coagulation and may pose an infectious risk in the immunocompromised patient.…”

Section: Discussionmentioning

confidence: 99%

Surgical Correction of Nephrogenic Ascites in a Renal Transplant Recipient

Jaffers¹,

Narayanan²,

Fasola³

2012

Exp Clin Transplant

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“…Os "shunts" peritoneo-venosos (LeVeen or Denver) ou os "shunts" portosistêmicos cirúrgicos têm indicações muito limitadas, até mesmo para os pacientes com ascite refratária. Vários problemas, como a manutenção da permeabilidade do cateter, o número excessivo de complicações, sem vantagens na sobrevida em comparação com a terapêutica clínica, têm levado ao progressivo abandono do uso deste tipo de shunt 68 . O uso do TIPS tem ganhado espaço no tratamento das ascites refratárias (Evidência grau A).…”

Section: Opções Cirúrgicasunclassified

Ascite: estado da arte baseado em evidências

Júnior

Galvão

Santos

et al. 2009

Rev. Assoc. Med. Bras.

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Definição:Denomina-se ascite ao acúmulo de líquido livre de origem patológica na cavidade peritoneal. O termo ascite tem origem na palavra grega "askos" que significa saco ou conteúdo de um saco. Deste radical derivou "askites" e depois "ascite". Embora a origem do líquido que se acumula na cavidade peritoneal possa variar (plasma, bile, sangue, suco pancreático, líquido intestinal, linfa, urina, etc.), a grande maioria das ascites tem como causa a cirrose hepática. Fisiopatologia: Teorias da formação de ascite no cirrótico:O desenvolvimento da ascite é a consequência final de uma série de anormalidades anatômicas, fisiopatológicas e bioquímicas que ocorrem em pacientes com cirrose hepática. Três teorias foram elaboradas ao longo do tempo para explicar o surgimento da ascite no cirrótico: o "underfill" (baixoenchimento), o "overflow" (super-fluxo) e a vasodilatação. A visão moderna preconiza que as três teorias estão presentes no mesmo paciente com cirrose, em maior ou menor grau dependendo da fase e do tempo de doença. A teoria da vasodilatação estaria presente na fase pré-ascítica e seria importante em toda a evolução posterior 1 . A teoria do "overflow" 2 seria a mais importante nos primeiros meses do desenvolvimento da ResumoA ascite é o acúmulo de líquido livre de origem patológica na cavidade abdominal, fenômeno presente em várias doenças da prática clínica. A doença mais associada com ascite é a cirrose hepática. Na sua fisiopatologia destacam-se três teorias que ocorrem sempre em determinado paciente, porém em momentos diferentes de sua doença: vasodilatação, "overflow" e "underfill". O conceito mais moderno sugere que as três teorias estão presentes no mesmo paciente com cirrose, dependendo do tempo de evolução de sua doença. A teoria da vasodilatação estaria presente desde a fase pré-ascítica até a ascite de longa data. A teoria do overflow seria predominante nos primeiros meses de ascite e a teoria underfill explicaria a maioria dos achados em pacientes com ascite por longo tempo. Neste artigo são comentadas em detalhes as várias doenças que produzem ascite, os métodos diagnósticos empregados na pesquisa clínica da ascite, as complicações da ascite e as opções terapêuticas disponíveis. Em cada item é mostrado o grau de evidência (A até C) presente na literatura médica. ascite no cirrótico, e a teoria do "underfill" 3 explicaria a maior parte dos achados em pacientes com vários meses de ascite.A teoria da vasodilatação veio harmonizar as ideias sobre a formação de ascite no cirrótico, englobando as teorias do "overflow" e do "underfill". Nas fases iniciais da cirrose hepática haveria vasodilatação periférica e retenção renal de água e sódio. A seguir haveria "overflow" e escape de fluido para a cavidade peritoneal (vindo principalmente da superfície hepática). Provavelmente depois que a ascite começa a se formar e piora a vasodilatação periférica, o "underfill" passa a assumir papel relevante, com queda do volume efetivo circulante e estimulação permanente dos sistemas vasopressores, levando à retenç...

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Paracentesis with Intravenous Infusion of Albumin as Compared with Peritoneovenous Shunting in Cirrhosis with Refractory Ascites

Abstract: The LeVeen shunt and paracentesis are equally effective in relieving refractory ascites. The former may provide better long-term control of ascites, but shunt occlusion is common and survival is not improved.

Cited by 279 publications

References 20 publications

Management of adult patients with ascites caused by cirrhosis

Management of adult patients with ascites caused by cirrhosis

Surgical Correction of Nephrogenic Ascites in a Renal Transplant Recipient

Ascite: estado da arte baseado em evidências

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