Alfapump^®implantable device in management of refractory ascites: An update

Abstract

Refractory ascites (RA) is a frequent and life-threatening complication of cirrhosis. In selected patients with RA, transjugular intrahepatic portosystemic shunt (TIPS) placement and liver transplantation (LT) are currently considered the best therapeutic alternatives to repeated large volume paracentesis. In patients with a contraindication to TIPS or LT, the alfapump ® system (Sequana Medical, Ghent, Belgium) has been developed to reduce the need for iterative paracentesis, and consequently to improve the quality of life and nutritional status. We report here recent data on technical progress made since the first implantation, the efficacy and tolerance of the device, the position of the pump in the therapeutic arsenal for refractory ascites, and the grey areas that remain to be clarified regarding the optimal selection of patients who are potential candidates for this treatment.

Innovative approaches to the management of ascites in cirrhosis

“…Currently, there are several ongoing trials that will address the cost effectiveness of the alfapump system and the optimal candidates for this device. 62 …”

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

“…However, TIPS is contraindicated in patients with marked pulmonary arterial hypertension, heart failure, hepatic encephalopathy, coagulopathy, and elevated right or left heart pressures[ 12 ], whereas the alfapump ® system is contraindicated in patients with obstructive uropathy, advanced sarcopenia, bed confinement and abdominal skin infections[ 13 ]. Clinical trials are still being conducted to determine the best candidates for the alfapump ® device and its cost effectiveness[ 14 ].…”