Drainage of ascites in cirrhosis

Abstract

For cirrhotic refractory ascites, diuretics combined with albumin and vasoactive drugs are the first-line choice for ascites management. However, their therapeutic effects are limited, and most refractory ascites do not respond to medication treatment, necessitating consideration of drainage or surgical interventions. Consequently, numerous drainage methods for cirrhotic ascites have emerged, including large-volume paracentesis, transjugular intrahepatic portosystemic shunt, peritoneovenous shunt, automated low-flow ascites pump, cell-free and concentrated ascites reinfusion therapy, and peritoneal catheter drainage. This review introduces the advantages and disadvantages of these methods in different aspects, as well as indications and contraindications for this disease.

Keywords: Liver cirrhosis ascites; Large-volume paracentesis; Transjugular intrahepatic portosystemic shunt; Peritoneovenous shunt; Automated low-flow ascites pump; Cell-free and concentrated ascites reinfusion therapy; Peritoneal catheter drainage

Core Tip: For cirrhotic refractory ascites, peritoneovenous shunt is rarely used due to its high complication rate. Initial treatment for most refractory ascites prioritizes large-volume paracentesis combined with albumin infusion and peritoneal catheter drainage. If these treatments are ineffective or result in severe complications, transjugular intrahepatic portosystemic shunt or automated low-flow ascites pump may be considered. Cell-free and concentrated ascites reinfusion therapy requires further validation for suitability.