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    Interventional procedure overview of tunnelled peritoneal drainage catheter insertion of refractory ascites in cirrhosis

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    Appendix

    The following table outlines the studies that are considered potentially relevant to the IP overview but were not included in the summary of the key evidence. It is by no means an exhaustive list of potentially relevant studies.

    Additional papers identified

    Article

    Number of patients/follow up

    Direction of conclusions

    Reasons for non-inclusion in summary of key evidence section

    Corrigan M, Thomas R, McDonagh J et al. (2021) Tunnelled peritoneal drainage catheter placement for the palliative management of refractory ascites in patients with liver cirrhosis. Frontline Gastroenterology;12:108–112.

    Retrospective cohort study

    N=25

    Cirrhosis, peritoneal, pleural

    Unspecified indwelling peritoneal catheter.

    All procedures were technically successful. 6 patients were readmitted for abdominal pain and suspected infected ascites. There were 3 cases of abdominal wall cellulitis and 3 of leakage around the tunnel site; all managed conservatively.

    Included in systematic review added to summary of evidence.

    Fukui H, Kawaratani H, Kaji K et al. (2018) Management of refractory cirrhotic ascites: challenges and solutions. Hepatic Medicine: Evidence and Research. 10 55–71

    Review

    This review briefly summarizes the changing landscape of variable treatment modalities for cirrhotic patients with refractory ascites, aiming at clarifying their possibilities and limitations.

    Review

    Lungren MP, Kim CY, Stewart JK et al. (2013) Tunneled peritoneal drainage catheter placement for refractory ascites: Single‐center experience in 188 patients. J Vasc Interv Radiol; 24:1303‐1308

    Retrospective cohort study

    N=7 ESLD

    Mixed peritoneal

    pleurX inserted under ultrasound guidance.

    Ascites managed at home.

    Mean catheter survival 60 days. Patient survival not reported. Cellulitis reported in 3 with mixed aetiology. "catheter malfunction" in 5, 4 ascites leakage at incisional site (requiring suture placement).

    Included in systematic review added to summary of evidence.

    Macken L, Mason L, Evans C et al. (2018) Palliative long-term abdominal drains versus repeated drainage in individuals with untreatable ascites due to advanced cirrhosis: study protocol for a feasibility randomised controlled trial. Trials 19:401

    Study protocol for a feasibility RCT.

    plan to recruit 48 patients with refractory ascites and randomise them (1:1) to either (1) LTAD or (2) current standard of care (LVP) for 12 weeks. Outcomes of interest include acceptability of the LTAD to patients, carers and healthcare professionals as well as recruitment and retention rates.

    Study protocol.

    Macken L, Joshi D, Messenger J, et al. Palliative long‐term abdominal drains in refractory ascites due to end‐stage liver disease: a case series. Palliat Med. 2017;31(7):671‐675.

    Retrospective case series

    N=7

    Cirrhosis, peritoneal

    Rocket IPC inserted managed at home.

    Following LTAD, mean hospital attendances reduced to 1 (0-4) from 9 (4-21); with none for ascites management. Median survival after LTAD insertion was 29 days (8- 219). The complication rate was low and non-life-threatening.

    Included in systematic review added to summary of evidence.

    Ngu NL, Anderson P, Hunter J et al (2021) Short-term intraperitoneal catheters: An ambulatory care intervention for refractory ascites secondary to cirrhosis during COVID-19. JGH Open. 2021 Sep 1;5(10):1154-1159. doi: 10.1002/jgh3.12641. PMID: 34622001; PMCID: PMC8485402.

    Case series

    N=12 patients with cirrhosis and refractory ascites had frequent low‐volume ascitic drainage through a tunneled, Rocket IPC.

    with 1–2 litre of ascitic fluid drained over 1–3 sessions per week either at the patients' homes or at the hospital day ward over 12‐week multidisciplinary ambulatory care program.

    Median IPC duration was 65‐days (IQR: 16.5–93). There were no IPC‐related deaths. Early removal was necessitated in 3 patients because of leakage, non-adherence, and bacteraemia. On day 30, the median self‐reported health score increased from 50 (IQR: 50–70) to 78 (IQR: 50–85), attributable to a reduction in symptom burden.

    Larger studies included.

    Olson JC (2020). Palliative interventions in patients with cirrhosis with refractory ascites and hepatic hydrothorax: who, what, and when? Clinical Liver Disease, 16 (2), 63-65.

    Review

    This review analyses more recent publications that evaluate the safety and feasibility of certain palliative procedures for management of refractory ascites and HH in selected patients with cirrhosis.

    Review

    Po C, Bloom E, Mischler L, Raja R. Home ascites drainage using a permanent Tenckhoff catheter. Adv Perit Dial. 1996;12:235‐236.

    Prospective case series

    N=1 mixed peritoneal. Peritoneal dialysis catheter inserted surgically. Managed at home by patient.

    Median duration of survival 6 months.

    Included in systematic review added to summary of evidence.

    Reinglas J, Amjadi K, Petrcich B, Momoli F, Shaw‐Stiffel T. The palliative management of refractory cirrhotic ascites using the PleurX catheter. Can J Gastroenterol Hepatol. 2016;2016:4680543.

    Retrospective cohort study

    N=33 patients with refractory ascites (cirrhosis, peritoneal)

    pleurX inserted under ultrasound guidance.

    Home care by nurses.

    Technical success 100%. The median duration catheter in situ was 117.5 days. Drain patency was maintained in 90% of patients. s SBP in 38% of patients. The median time to infection was 105 days. All patients had antibiotics.

    Included in systematic review added to summary of evidence.

    Reisfield G, Wilson G. Management of intractable, cirrhotic ascites with an indwelling drainage catheter. J Palliat Med. 2003;6:787‐791.

    Case report

    N=5 patients with refractory ascites as a result of liver disease

    Cirrhosis, peritoneal

    pleurX tunnelled indwelling peritoneal catheter.

    Mean duration of catheter in situ 6 weeks. no evidence of bleeding or peritonitis

    Included in systematic review added to summary of evidence.

    Riedel AN, Kimer N, Hobolth L, Gluud LL. Prognosis of patients with ascites after PleurX insertion: an observational study. Scand J Gastroenterol. 2018;53(3):340‐344

    Retrospective cohort study

    N=7 cirrhotic patients with refractory ascites

    Mixed peritoneal

    pleurX tunnelled indwelling peritoneal catheter

    follow-up 480 days.

    Mean survival 200 days.

    Included in systematic review added to summary of evidence.

    Solbach P, Höner zu Siederdissen C, Taubert R, et al. Home‐based drainage of refractory ascites by a permanent‐tunneled peritoneal catheter can safely replace large‐volume paracentesis. Eur J Gastroenterol Hepatol. 2017;29(5):539‐546.

    Prospective cohort study

    N=24 patients with refractory ascites in end-stage liver disease

    Placement was successful in all. The number of paracentesis decreased from 2.2 to 0/week, the volume of daily ascites removal remained stable. kidney function, serum sodium, and serum albumin remained stable. Seven adverse events occurred in six (25%) patients.

    Included in systematic review added to summary of evidence.