Treatment of refractory ascites with an automated low-flow ascites pump in patients with cirrhosis.

Stirnimann, Guido; Berg, T; Spahr, L; Zeuzem, S; McPherson, S; Lammert, F; Storni, Federico Lorenzo; Banz Wüthrich, Vanessa; Babatz, J; Vargas, V; Geier, A; Stallmach, A; Engelmann, C; Trepte, C; Capel, J; De Gottardi, Andrea (2017). Treatment of refractory ascites with an automated low-flow ascites pump in patients with cirrhosis. Alimentary pharmacology & therapeutics, 46(10), pp. 981-991. Wiley-Blackwell 10.1111/apt.14331

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BACKGROUND Refractory ascites (RA) is a frequent complication of cirrhosis, requiring large volume paracentesis or placement of a transjugular intrahepatic portosystemic shunt (TIPSS). The automated low-flow ascites pump (alfapump, Sequana Medical AG, Zurich, Switzerland) is an innovative treatment option for patients with RA. AIM To assess safety and efficacy of this treatment in patients with a contraindication to TIPSS. METHODS Fifty-six patients (43 males; mean age 62 years) from centres in Germany, Switzerland, UK and Spain were included and followed for up to 24 months. Complications, device deficiencies, paracentesis frequency and patient survival were recorded. RESULTS At the time of this analysis, 3 patients completed the 24-month observation period, monitoring of 3 was ongoing, 9 underwent liver transplantation, 17 patients were withdrawn due to serious adverse events and 23 patients died. Most frequently observed technical complication was blocking of the peritoneal catheter. Twenty-three pump-related reinterventions (17 patients) and 12 pump exchanges (11 patients) were required during follow-up. The pump system was explanted in 48% of patients (in 17 patients due to serious adverse events, in 9 at the time of liver transplantation and in 1 due to recovery from RA). Median frequency of paracentesis dropped from 2.17 to 0.17 per month. CONCLUSIONS The alfapump can expand therapeutic options for cirrhotic patients with RA. Continuous drainage of ascites in a closed loop automated system led to significant reduction in paracentesis frequency. Technical and procedural improvements are required to reduce the rate of adverse events and reinterventions. https://clinicaltrials.gov/ct2/show/NCT01532427.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Gastro-intestinal, Liver and Lung Disorders (DMLL) > Clinic of Visceral Surgery and Medicine > Hepatology
04 Faculty of Medicine > Pre-clinic Human Medicine > BioMedical Research (DBMR) > DBMR Forschung Mu35 > Forschungsgruppe Viszeralchirurgie
04 Faculty of Medicine > Pre-clinic Human Medicine > BioMedical Research (DBMR) > DBMR Forschung Mu35 > Forschungsgruppe Viszeralchirurgie

04 Faculty of Medicine > Department of Gastro-intestinal, Liver and Lung Disorders (DMLL) > Clinic of Visceral Surgery and Medicine > Visceral Surgery
04 Faculty of Medicine > Pre-clinic Human Medicine > BioMedical Research (DBMR) > DBMR Forschung Mu35 > Forschungsgruppe Hepatologie
04 Faculty of Medicine > Pre-clinic Human Medicine > BioMedical Research (DBMR) > DBMR Forschung Mu35 > Forschungsgruppe Hepatologie

UniBE Contributor:

Stirnimann, Guido; Storni, Federico Lorenzo; Banz Wüthrich, Vanessa and De Gottardi, Andrea

Subjects:

600 Technology > 610 Medicine & health

ISSN:

0269-2813

Publisher:

Wiley-Blackwell

Language:

English

Submitter:

Lilian Karin Smith-Wirth

Date Deposited:

13 Feb 2018 14:36

Last Modified:

13 Feb 2018 14:36

Publisher DOI:

10.1111/apt.14331

PubMed ID:

28940225

BORIS DOI:

10.7892/boris.109041

URI:

https://boris.unibe.ch/id/eprint/109041

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