Palliative long-term abdominal drains for the management of refractory ascites due to cirrhosis: A consensus document

TY - JOUR

T1 - Palliative long-term abdominal drains for the management of refractory ascites due to cirrhosis

T2 - A consensus document

AU - Macken, Lucia

AU - Corrigan, Margaret

AU - Prentice, Wendy

AU - Finlay, Fiona

AU - McDonagh, Joanne

AU - Rajoriya, Neil

AU - Salmon, Claire

AU - Donnelly, Mhairi

AU - Evans, Catherine

AU - Ganai, Bhaskar

AU - Bedlington, Joan

AU - Steer, Shani

AU - Wright, Mark

AU - Hudson, Ben

AU - Verma, Sumita

N1 - Publisher Copyright: © 2022 BMJ Publishing Group. All rights reserved.

PY - 2022/8/1

Y1 - 2022/8/1

N2 - Palliative care remains suboptimal in advanced cirrhosis, in part relating to a lack of evidence-based interventions. Ascites remains the most common cirrhosis complication resulting in hospitalisation. Many patients with refractory ascites are not candidates for liver transplantation or transjugular intrahepatic portosystemic shunt, and therefore, require recurrent palliative large volume paracentesis in hospital. We review the available evidence on use of palliative long-term abdominal drains in cirrhosis. Pending results of a national trial (REDUCe 2) and consistent with recently published national and American guidance, long-term abdominal drains cannot be regarded as standard of care in advanced cirrhosis. They should instead be considered only on a case-by-case basis, pending definitive evidence. This manuscript provides consensus to help standardise use of long-term abdominal drains in cirrhosis including patient selection and community management. Our ultimate aim remains to improve palliative care for this under researched and vulnerable cohort.

AB - Palliative care remains suboptimal in advanced cirrhosis, in part relating to a lack of evidence-based interventions. Ascites remains the most common cirrhosis complication resulting in hospitalisation. Many patients with refractory ascites are not candidates for liver transplantation or transjugular intrahepatic portosystemic shunt, and therefore, require recurrent palliative large volume paracentesis in hospital. We review the available evidence on use of palliative long-term abdominal drains in cirrhosis. Pending results of a national trial (REDUCe 2) and consistent with recently published national and American guidance, long-term abdominal drains cannot be regarded as standard of care in advanced cirrhosis. They should instead be considered only on a case-by-case basis, pending definitive evidence. This manuscript provides consensus to help standardise use of long-term abdominal drains in cirrhosis including patient selection and community management. Our ultimate aim remains to improve palliative care for this under researched and vulnerable cohort.

KW - ASCITES

KW - CLINICAL TRIALS

KW - LIVER CIRRHOSIS

KW - PERITONITIS

UR - http://www.scopus.com/inward/record.url?scp=85133030263&partnerID=8YFLogxK

U2 - doi: 10.1136/flgastro-2022-102244

DO - doi: 10.1136/flgastro-2022-102244

M3 - Review article

AN - SCOPUS:85133030263

SN - 2041-4137

VL - 13

SP - E116-E125

JO - Frontline Gastroenterology

JF - Frontline Gastroenterology

IS - e1

M1 - 102128

ER -