Large-Volume Paracentesis in the Treatment of Cirrhotic Patients with Refractory Ascites

Abstract

Ascites is a common complication of cirrhosis and has a major clinical impact on the patient's general well-being. Approximately 10% of patients with cirrhosis can develop diuretic-resistant, tense ascites that requires other therapeutic interventions. In recent years, there has been a renewed interest in large-volume paracentesis (LVP) as a safe, simple, and inexpensive method to substitute for other more complicated and costly therapeutic interventions for refractory ascites. In this article, we review the latest literature supporting the use of LVP for the treatment of refractory, tense ascites. We also address the role of intravascular volume expansion after LVP, note that usually no postparacentesis volume expansion is necessary, and compare, when used, the different plasma volume expanders in terms of efficacy, safety, and cost.

Patients with severe ovarian hyperstimulation syndrome can be managed safely with aggressive outpatient transvaginal paracentesis

“…Paracentesis as part of the management of OHSS is not a new concept and was first suggested by Rabau et al in 1967 (10). The physiologic basis behind the technique has its foundation in the gastrointestinal literature with the use of large-volume paracentesis in the management of patients with cirrhosis who were refractory to diuretics (24). Immediately after paracentesis, characteristic hemodynamic changes occur including decreased intraabdominal pressure, improved venous return, and improved renal perfusion.…”

Review article: management of ascites and associated complications in patients with cirrhosis

“…9 Although many studies have shown that when plasma expansion is applied during LVP subsequent complications are significantly less severe, the use of plasma expanders in this case is, for some doctors, still controversial. 16,17 The current gold standard is intravenous albumin, 8 g ⁄ L ascitic fluid removed. With this substitution the lowest incidence of PICD is seen.…”

Prospective study comparing human albumin vs. reinfusion of ultrafiltrate-ascitic fluid after total paracentesis in cirrhotic patients with tense ascites

“…10 So far previous investigations have demonstrated that these patients benefit from repeated large-volume [4±6 l/d) or total paracentesis associated with the substitution of albumin (5±10 g/l ascites) [3±5]. Although, albumin substitution has shown to be a rapid, effective and safe therapy for diuretic refractory ascites, it implies high costs and has a limited availability [6]. Therefore an alternative procedure, the reinfusion of concentrated ascites, has gained popularity in recent years [7±10].…”