Palliative long-term abdominal drains in refractory ascites due to end-stage liver disease: A case series. (July 2017)

• Record Type: Journal Article
• Authors: Macken, Lucia; Joshi, Deepak; Messenger, Jenny; Austin, Mark; Tibble, Jeremy; Mason, Louise; Verma, Sumita
• Is Part Of: Palliative medicine. Volume 31:Number 7(2017)
• Page Start: 671
• Page End: 675
• Publication Date: 2017-07
• Subjects: End-stage liver disease -- cirrhosis -- ascites -- paracentesis -- palliative care -- end-of-life care; Pain -- Treatment -- Periodicals; Cancer -- Palliative treatment -- Periodicals; Palliative Care -- Periodicals; Palliatieve behandeling; 616.029
• DOI: 10.1177/0269216316671281
• Languages: English
• ISSNs: 0269-2163

Abstract

Background: Ascites, the commonest complication of cirrhosis, leads to frequent hospitalisations. Refractory ascites confers a median survival of 6 months without liver transplantation. In many, the management remains palliative (large-volume paracentesis). Despite calls for improvement, palliative and end-of-life care is not yet integrated into end-stage liver disease. Long-term abdominal drains are a palliative strategy in malignant ascites, but not end-stage liver disease. Case presentation: A retrospective, single centre, case series review was performed of patients undergoing long-term abdominal drain placement for refractory ascites secondary to end-stage liver disease at a large teaching hospital between August 2011 and March 2013. Case management: Patients with end-stage liver disease and refractory ascites, where liver transplantation was not an option, were considered for long-term abdominal drains. Seven patients underwent successful long-term abdominal drain insertion after multi-professional assessment. Case outcome: Following long-term abdominal drain insertion, mean hospital attendances reduced to 1 (0–4) from 9 (4–21), with none for ascites management. Median survival after long-term abdominal drain insertion was 29 days (8–219). The complication rate was low and none life threatening. Conclusion: Palliative and end-of-life care needs in end-stage liver disease remain under-addressed. Our data suggest that long-term abdominal drains may be a safe and effective palliative intervention in end-stage liver disease. Prospective randomised controlled trials comparing large-volume paracentesis versus long-term abdominal drains in refractory ascites secondary to end-stage liver disease are warranted.