Observational Study
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Hepatol. Mar 27, 2024; 16(3): 428-438
Published online Mar 27, 2024. doi: 10.4254/wjh.v16.i3.428
Palliative long-term abdominal drains vs large volume paracenteses for the management of refractory ascites in end-stage liver disease
Senamjit Kaur, Rodrigo V Motta, Bryony Chapman, Victoria Wharton, Jane D Collier, Francesca Saffioti
Senamjit Kaur, Bryony Chapman, Victoria Wharton, Jane D Collier, Francesca Saffioti, Oxford Liver Unit, Department of Gastroenterology and Hepatology, Oxford University Hospitals NHS Foundation Trust, Oxford OX3 9DU, United Kingdom
Rodrigo V Motta, Oxford Liver Unit and Translational Gastroenterology Unit, Nuffield Department of Medicine, University of Oxford, Oxford OX3 9DU, United Kingdom
Co-first authors: Senamjit Kaur and Rodrigo V Motta.
Author contributions: Saffioti F conceptualised, designed and supervised the study, performed statistical analysis, created the artwork and made critical revisions; Kaur S and Motta RV conducted the literature review, collected the data, did the analysis, interpreted the data and drafted the original manuscript; Chapman B and Wharton V collected the data and contributed to writing the manuscript; Collier JD contributed to the conception and design of the study and made critical revisions for important intellectual content; All authors have read and approved the final manuscript.
Institutional review board statement: According to the Integrated Research Application System (https://www.myresearchproject.org.uk), in the United Kingdom, research undertaken by staff within a care team using data previously collected in the course of care for their own patients or clients does not require Research Ethics Committee review provided that data is anonymised in conducting the research.
Informed consent statement: No informed consent was required for this study, as the information used was collected as part of the normal clinical care and data were collected retrospectively by the care team involved and were anonymised.
Conflict-of-interest statement: All authors declare no conflict of interests for this article.
Data sharing statement: Data may be shared upon request sent to the corresponding author.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Francesca Saffioti, MD, PhD, Consultant Physician-Scientist, Researcher, Oxford Liver Unit, Department of Gastroenterology and Hepatology, Oxford University Hospitals NHS Foundation Trust, Headley Way, Headington, Oxford OX3 9DU, United Kingdom. francesca.saffioti@nhs.net
Received: December 10, 2023
Peer-review started: December 10, 2023
First decision: December 28, 2023
Revised: January 25, 2024
Accepted: February 29, 2024
Article in press: February 29, 2024
Published online: March 27, 2024
Abstract
BACKGROUND

Long-term abdominal drains (LTAD) are a cost-effective palliative measure to manage malignant ascites in the community, but their use in patients with end-stage chronic liver disease and refractory ascites is not routine practice. The safety and cost-effectiveness of LTAD are currently being studied in this setting, with preliminary positive results. We hypothesised that palliative LTAD are as effective and safe as repeat palliative large volume paracentesis (LVP) in patients with cirrhosis and refractory ascites and may offer advantages in patients’ quality of life.

AIM

To compare the effectiveness and safety of palliative LTAD and LVP in refractory ascites secondary to end-stage chronic liver disease.

METHODS

A retrospective, observational cohort study comparing the effectiveness and safety outcomes of palliative LTAD and regular palliative LVP as a treatment for refractory ascites in consecutive patients with end-stage chronic liver disease followed-up at our United Kingdom tertiary centre between 2018 and 2022 was conducted. Fisher’s exact tests and the Mann-Whitney U test were used to compare qualitative and quantitative variables, respectively. Kaplan-Meier survival estimates were generated to stratify time-related outcomes according to the type of drain.

RESULTS

Thirty patients had a total of 35 indwelling abdominal drains and nineteen patients underwent regular LVP. The baseline characteristics were similar between the groups. Prophylactic antibiotics were more frequently prescribed in patients with LTAD (P = 0.012), while the incidence of peritonitis did not differ between the two groups (P = 0.46). The incidence of acute kidney injury (P = 0.014) and ascites/drain-related hospital admissions (P = 0.004) were significantly higher in the LVP group. The overall survival was similar in the two groups (log-rank P = 0.26), but the endpoint-free survival was significantly shorter in the LVP group (P = 0.003, P < 0.001, P = 0.018 for first ascites/drain-related admission, acute kidney injury and drain-related complications, respectively).

CONCLUSION

The use of LTAD in the management of refractory ascites in palliated end-stage liver disease is effective, safe, and may reduce hospital admissions and utilisation of healthcare resources compared to LVP.

Keywords: Decompensated liver cirrhosis, Indwelling abdominal catheter, Rocket drain, Palliative care, Safety, Quality of life

Core Tip: The standard treatment of refractory ascites in palliated patients with end-stage liver disease is repeated large volume paracentesis (LVP) with albumin infusion. This study focuses on real-world data comparing the effectiveness and safety of long-term abdominal drains (LTAD) in comparison with LVP. The incidence of acute kidney injury, ascites and drain-related hospital admissions was lower in the LTAD group. There was no difference in the overall survival between the two groups, but time to acute kidney injury, first ascites/drain-related hospital admission and drain-related complications were shorter in the LTAD group.