Dietary interventions vs octreotide for post liver transplantation chylous ascites: A scoping review

Table 1 Characteristics of included studies

Ref.	Design	Age	Intervention	Population	Duration to the incidence of CA	Outcomes	LT characteristics and underlying diseases
Wang et al[40]	Retrospective	61 (31-83) years	MCT + EN + LFD	63	N/A	58 fully recovered	N/A
Pan et al[25]	Retrospective	Undisclosed	MCT + LFD (n = 8/36); octreotide (n = 36/58); TPN (n = 12/36); EN + MCT (n = 11)	58	N/A	Treatment with somatostatin showed immediate and significant CA decrease after 24 hours compared with no somatostatin treatment	N/A
Miserachs et al[41]	Retrospective	2.8 years	LFD or MCT diet in 94% and intravenous octreotide (6%)	317	10 days	Nutritional interventions used in 16 patients did not diminish peritoneal drain losses. octreotide used in one patient did not reduce chylous leakage volume	153 Living donor transplants and 164 deceased donor transplantations
Matsuura et al[8]	Retrospective	With post-LT CA = 10.7 ± 11.0 vs without post-LT CA = 8.3 ± 9.2	LFD containing MCT (n = 5); I patient TPN and octreotide induced in 4 cases	94 (6 with post-LT CA; 88 without post-LT CA)	10.8 ± 3.6 days	Total daily drainage volume was reduced in 2 cases with nutritional interventions; octreotide was associated with complete resolution of CA after 19.5 ± 7.6 days	LT for biliary atresia, congenital metabolic disease, congenital absence of portal vein and hepatoblastoma
Shapiro et al[28]	Case study	55-year-old male	Fasting, somatostatin analog (octreotide) and TPN	1	N/A	Complete CA resolution after 2 days	LT for hepatic cirrhosis
Ünlüsoy Aksu et al[10]	Case study	11-month-old female	Fasting + diuretics + somatostatin analog	1	N/A	Complete CA resolution after 21 days	N/A
Baran et al[1]	Case study	Case 1 3.5-year-old; Case 2 5-year-old	TPN + somatostatin analog	2	N/A	Complete CA resolution after 7 days	LT for biliary atresia and hepatoblastoma
Ijichi et al[42]	Case study	40-year-old	LFD + somatostatin	1	21 days	LFD + somatostatin analog failed to solve CA after 104 days. Somatostatin. TPN completely solved CA with no adverse events	Living donor LT for biliary cirrhosis
Mukerji et al[36]	Case study	62-year-old male	LFD + 12-hour parenteral nutrition and octreotide for 14 days	1	11 days	No resolution after 2 weeks following LFD and 12-hour parenteral nutrition: Prompt improvement seen after octreotide introduction	LT for cirrhosis, hepatitis C and HCC
Chen et al[29]	Case study	56-year-old male	TPN plus somatostatin + sirolimus	1	180 days	Complete CA clearance after 30 days following sirolimus discontinuation	Living donor LT for biliary cirrhosis and alcohol-related end-stage liver disease
Saab et al[43]	Case study	49-year-old- male	LFD + MCT	1	30 days	Complete CA resolution 2 months	LT for hepatitis C and alcohol abuse
Shiba et al[16]	Case study	46-year-old male	TPN + LFD	1	22 days	Complete CA resolution 2 months	LT for primary biliary cirrhosis
Saucedo-Crespo et al[44]	Case study	49-year-old male	LFD-high protein diet	1	5 years	Complete CA resolution after 4 days	LT for cryptogenic cirrhosis

TPN: Total parenteral nutrition; EN: Enteral nutrition; LFD: Low fat diet; MCT: Medium-chain triglycerides; LT: Liver transplantation; N/A: Not available or undisclosed: CA: Chylous ascites; HCC: Hepatocellular carcinoma.

Table 2 summarizes the quality of the included studies

Ref.	Study design	Sample size	Patient age range	Intervention(s)	Outcomes reported	Quality assessment (e.g., bias, limitations)
Wang et al[40]	Retrospective cohort	63	31-83 years	MCT + enteral nutrition + LFD	58 fully recovered	Retrospective design may introduce selection bias
Pan et al[25]	Retrospective cohort	58	Undisclosed	MCT + LFD (8/36); octreotide (36/58); TPN (12/36)	Immediate CA decrease with somatostatin	Retrospective; potential confounding factors not controlled
Miserachs et al[41]	Retrospective Cohort	317	2.8 years (range not specified)	LFD or MCT diet (94%); IV octreotide (6%)	Nutritional interventions did not reduce drain losses	Large sample size; retrospective design may lead to bias
Matsuura et al[8]	Retrospective cohort	94	10.8 ± 3.6 days	LFD containing MCT; TPN + Octreotide	Reduced drainage volume; resolution after 19.5 ± 7.6 days	Retrospective, but included a control group
Shapiro et al[28]	Case study	1	55 years	Fasting, Somatostatin analog, TPN	Complete resolution after 2 days	Single case; limited generalizability
Ünlüsoy Aksu et al[10]	Case study	1	11 months	Fasting + diuretics + somatostatin	Complete resolution after 21 days	Single case; limited generalizability
Baran et al[1]	Case study	2	3.5-5 years	TPN + somatostatin	Complete resolution after 7 days	Small sample size; findings may not be applicable to larger populations
Ijichi et al[42]	Case study	1	40 years	LFD + somatostatin	No resolution after 104 days, improvement with TPN	Single case; limited generalizability
Mukerji et al[36]	Case study	1	62 years	LFD + 12-hour TPN + octreotide	No resolution after 2 weeks; improvement with octreotide	Single case; limited generalizability
Chen et al[29]	Case study	1	56 years	TPN + somatostatin + sirolimus	Complete CA clearance after 30 days	Single case; limited generalizability
Saab et al[43]	Case study	1	49 years	LFD + MCT	Complete resolution after 2 months	Single case; limited generalizability
Shiba et al[16]	Case study	1	46 years	TPN + LFD	Complete resolution after 2 months	Single case; limited generalizability
Saucedo-Crespo et al[44]	Case Study	1	49 years	LFD - high protein diet	Complete CA resolution after 4 days	Single case; limited generalizability

Study design indicates whether the study is a cohort study or a case study. Sample size: The number of participants included in the study. Patient age range: Age range or specific age of patients involved in the study. Intervention(s): Treatment(s) used in the study for managing chylous ascites. Outcomes reported: Key outcomes or results reported in the study. Quality assessment: A brief overview of potential biases or limitations associated with the study design. TPN: Total parenteral nutrition; LFD: Low fat diet; MCT: Medium-chain triglycerides; CA: Chylous ascites.

Table 3 summarizing the bias assessment

Type of bias	Description	Impact on study
Selection bias	Participants may not have been randomly selected, leading to potential skewing of outcomes	May affect the generalizability of findings; results may not reflect the broader population
Reporting bias	Positive outcomes may be reported more prominently than negative or inconclusive results	Can lead to an overestimation of treatment effectiveness and misrepresentation of intervention success
Confounding factors	Lack of control for variables such as severity of chylous ascites and comorbidities	May obscure true treatment effects and complicate the interpretation of results
Publication bias	Studies with favorable results are more likely to be published than those with negative results	Can create a skewed perception of the effectiveness of treatments, leading to biased conclusions
Data quality bias	Variability in the quality of data collection across studies may introduce errors	Affects the reliability of findings and the overall conclusions drawn from the review

Type of bias: Identify the specific bias being assessed. Description: Provide a brief explanation of how each bias manifests in the context of this study. Impact on study: Details of the potential implications of each bias on the study's findings and conclusions.