Drainage of ascites in cirrhosis

Table 1 Methods and characteristics of ascites drainage in cirrhosis

Ascites drainage methods	Characteristics
LVP	In the majority of patients suffering from refractory ascites, the preferred treatment approach involves the prioritization of LVP in conjunction with HSA administration. An advisable frequency for this therapeutic regimen is approximately once every two weeks, ensuring that the maximum volume of fluid removed during a single paracentesis does not surpass 5 L. It is imperative to note that repetitive LVP procedures heighten the potential for the development of complications.
TIPS	For patients who require frequent paracentesis procedures, frequent hospitalizations, or are awaiting liver transplantation, TIPS can act as a vital bridge therapy, facilitating the transition to definitive liver transplantation. However, due to its associated complications and contraindications, TIPS is typically reserved as a second-line therapeutic option, employed subsequent to the failure of LVP treatment. This approach ensures that the most appropriate and safe treatment pathway is pursued for each individual patient’s unique circumstances.
PVS	When addressing refractory ascites, PVS has not demonstrated superiority over repeated LVP in terms of treatment outcomes. Furthermore, the risk of severe complications associated with PVS has rendered this approach virtually obsolete, as it has led to its near-complete abandonment in clinical practice.
Alfapump	The alfapump system holds significant potential in drastically reducing the reliance on LVP for patients. Nonetheless, it is important to acknowledge that the complication rate associated with this treatment modality remains relatively high. For those individuals diagnosed with non-malignant refractory ascites who are deemed ineligible for alternative therapies, such as TIPS or liver transplantation, the implantation of an alfapump represents an efficacious and viable treatment option.
CART	CART exhibits remarkable efficacy in swiftly alleviating abdominal distension, mitigating the burden of ascites, and enhancing nutritional intake for patients. Nevertheless, this innovative therapy is not without its challenges, including substantial equipment costs, intricate procedural requirements, and potential allergic reactions. Presently, CART is predominantly utilized in Japan, and its universal applicability across global healthcare settings remains an area of ongoing investigation and verification.
Peritoneal catheter drainage	The adoption of peritoneal catheter drainage as a management strategy for cirrhotic ascites boasts a high rate of symptom alleviation, coupled with low financial costs and a minimal incidence of associated complications. This approach significantly diminishes the necessity for repeated LVP procedures, positioning it as a potential cornerstone in the evolving landscape of cirrhotic ascites management. Nevertheless, meticulous attention must be paid to minimizing the duration of catheter retention, as this is paramount in preventing the emergence of complications.

LVP: Large-volume paracentesis; HAS: Human serum albumin; TIPS: Transjugular intrahepatic portosystemic shunt; PVS: Peritoneovenous shunt; Alfapump: Automated low-flow ascites pump; CART: Cell-free and concentrated ascites reinfusion therapy.