Innovative approaches to the management of ascites in cirrhosis

Wong, Florence

doi:10.1016/j.jhepr.2023.100749

Cited by 5 publications

(4 citation statements)

References 67 publications

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“…The alfapump allows for unidirectional fluid flow with adjustable drainage rates based on dietary sodium intake. 6 Intravenous albumin is given on an ad hoc basis if there has been excess fluid removed with evidence of dehydration biochemically or clinically or the development of AKI. It is entirely internally placed and, therefore, eliminates risks such as leakage from insertion site as in IPC.…”

Section: Discussionmentioning

confidence: 99%

“…Therefore, an automatic low-flow ascites pump (alfapump) (Sequana Medical NV, Ghent, Belgium), designed for refractory ascites management, was offered to treat her refractory HH (Figure 1). 6 Under general anesthesia, the alfapump was inserted into a subcutaneous pocket in the abdomen, and the catheter designed for the peritoneal cavity was placed into the pleural cavity. Access to the left pleural cavity was achieved through a 1.5-cm transverse incision below the left breast.…”

Section: Case Reportmentioning

confidence: 99%

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Innovative Management of a Difficult Case of Hepatic Hydrothorax

Tiwari,

Shlomovitz,

Capel

et al. 2024

ACG Case Rep J

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Hepatic hydrothorax affects 5%–15% of decompensated cirrhosis patients, with up to 26% being refractory to standard treatments. For those ineligible for transjugular intrahepatic systemic shunts or liver transplants, alternatives to repeated thoracentesis are limited but can include the insertion of an indwelling pleural catheter. We present the first case of the use of an automatic low-flow ascites pump (alfapump) to manage nonmalignant pleural effusion in an elderly patient with cirrhosis.

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Section: Discussionmentioning

confidence: 99%

Section: Case Reportmentioning

confidence: 99%

Innovative Management of a Difficult Case of Hepatic Hydrothorax

Tiwari,

Shlomovitz,

Capel

et al. 2024

ACG Case Rep J

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“…Long‐term antibiotic therapy seems to be sufficient for the prevention of septic complications. 59 With these data in mind, it does not seem advisable to consider low‐flow ascites pump insertion in patients with preexisting renal dysfunction or in those who have just recovered from a urinary tract infection or from bacterial peritonitis. One unsettled issue is whether albumin infusions could prevent kidney injury.…”

Section: Recent Data On Low‐flow Ascites Pumps For the Treatment Of A...mentioning

confidence: 99%

Recent developments in the management of ascites in cirrhosis

Lan,

Chen,

Tang

et al. 2024

UEG Journal

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In recent years, advances have been made for treating ascites in patients with cirrhosis. Recent studies have indicated that several treatments that have been used for a long time in the management of portal hypertension may have beneficial effects that were not previously identified. Long‐term albumin infusion may improve survival in patients with cirrhosis and ascites while beta‐blockers may reduce ascites occurrence. Transjugular intrahepatic porto‐systemic shunt (TIPS) placement may also improve survival in selected patients in addition to the control with ascites. Low‐flow ascites pump insertion can be another option for some patients with intractable ascites. In this review, we summarize the latest data related to the management of ascites occurring in cirrhosis. There are still unanswered questions, such as the optimal use of albumin as a long‐term therapy, the place of beta‐blockers, and the best timing for TIPS placement to improve the natural history of ascites, as well as the optimal stent diameter to reduce the risk of shunt‐related side‐effects. These issued should be addressed in future studies.

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“…Ascites is the most common first decompensating event in cirrhosis and heralds the onset of the decompensation phase. Even the presence of only ultrasound detectable ascites is associated with a significant 1‐year mortality or need for liver transplant in 17% of patients irrespective of the Model of End‐staged Liver Disease (MELD) score 3,4 . Ascites occurs with an annual incidence rate of 5%–10% 5 and approximately 20% of patients with cirrhosis have ascites at their index presentation.…”

Section: Introductionmentioning

confidence: 99%

Review article: Recent advances in ascites and acute kidney injury management in cirrhosis

Adebayo,

Wong

2024

Aliment Pharmacol Ther

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SummaryBackgroundBetter understanding of disease pathophysiology has led to advances in managing ascites and its associated complications including hepatorenal syndrome‐acute kidney Injury (HRS‐AKI), especially medicinal and interventional advances.AimTo review the latest changes in the management of ascites and HRS‐AKI.MethodsA literature search was conducted in Pubmed, using the keywords cirrhosis, ascites, renal dysfunction, acute kidney injury, hepatorenal syndrome, beta‐blockers, albumin, TIPS and vasoconstrictors, including only publications in English.ResultsThe medicinal advances include earlier treatment of clinically significant portal hypertension to delay the onset of ascites and the use of human albumin solution to attenuate systemic inflammation thus improving the haemodynamic changes associated with cirrhosis. Furthermore, new classes of drugs such as sodium glucose co‐transporter 2 are being investigated for use in patients with cirrhosis and ascites. For HRS‐AKI management, newer pharmacological agents such as vasopressin partial agonists and relaxin are being studied. Interventional advances include the refinement of TIPS technique and patient selection to improve outcomes in patients with refractory ascites. The development of the alfa pump system and the study of outcomes associated with the use of long‐term palliative abdominal drain will also serve to improve the quality of life in patients with refractory ascites.ConclusionsNew treatment strategies emerged from better understanding of the pathophysiology of ascites and HRS‐AKI have shown improved prognosis in these patients. The future will see many of these approaches confirmed in large multi‐centre clinical trials with the aim to benefit the patients with ascites and HRS‐AKI.

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Innovative approaches to the management of ascites in cirrhosis

Cited by 5 publications

References 67 publications

Innovative Management of a Difficult Case of Hepatic Hydrothorax

Innovative Management of a Difficult Case of Hepatic Hydrothorax

Recent developments in the management of ascites in cirrhosis

Review article: Recent advances in ascites and acute kidney injury management in cirrhosis

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