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Liver
Review
Palliative long-term abdominal drains for the management of refractory ascites due to cirrhosis: a consensus document
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  1. Lucia Macken1,
  2. Margaret Corrigan2,
  3. Wendy Prentice3,
  4. Fiona Finlay4,
  5. Joanne McDonagh5,
  6. Neil Rajoriya5,
  7. Claire Salmon6,
  8. Mhairi Donnelly7,
  9. Catherine Evans8,
  10. Bhaskar Ganai1,
  11. Joan Bedlington9,
  12. Shani Steer10,
  13. Mark Wright11,
  14. Ben Hudson12,
  15. Sumita Verma1,13
  16. on behalf of the British Association for the Study of the Liver/British Society of Gastroenterology (BASL/BSG) End of Life Special Interest Group
  1. 1 Gastroenterology and Hepatology, University Hospitals Sussex NHS Foundation Trust, Brighton, UK
  2. 2 Hepatology, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
  3. 3 Department of Palliative Care Medicine, King's College Hospital NHS Foundation Trust, London, UK
  4. 4 Palliative Medicine, Queen Elizabeth University Hospital Campus, Glasgow, UK
  5. 5 Liver Unit, Queen Elizabeth Hospital, Birmingham, UK
  6. 6 Hepatology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
  7. 7 Liver Unit, Freeman Hospital, Newcastle upon Tyne, UK
  8. 8 King's College London, London, UK
  9. 9 LIVErNORTH, Newcastle, UK
  10. 10 Patient and Public involvement, Brighton, UK
  11. 11 Hepatology, University Hospital Southampton, Southampton, UK
  12. 12 Hepatology, Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
  13. 13 Clinical and Experimental Medicine, Brighton and Sussex Medical School, Brighton, UK
  1. Correspondence to Professor Sumita Verma, Clinical and Experimental Medicine, Brighton and Sussex Medical School, Brighton, East Sussex, UK; s.verma{at}bsms.ac.uk

Abstract

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.

  • LIVER CIRRHOSIS
  • PERITONITIS
  • CLINICAL TRIALS
  • ASCITES

https://doi.org/10.1136/flgastro-2022-102128

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    Footnotes

    • Twitter @jomcDonagh2, @NeilRaj1, @MhairiDonnelly, @marktheliverdoc

    • Contributors SV and LM wrote the first draft with input from BH. MC, WP, FF, JM, NR, CS, MD, CE, BG, MW provided critical revisions. JB and SS provided service user perspective. All coauthors reviewed and approved the final draft of the manuscript.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests SV: Rocket Medical plc provided the LTAD free of cost for the REDUCe trial. They were not involved in data collection or preparation of manuscript and nor will they be claiming any intellectual property based on the trial.

    • Provenance and peer review Commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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      Frontline Gastroenterology 2022; 13 e1-e2 Published Online First: 20 Jun 2022. doi: 10.1136/flgastro-2022-102244