Skip to main content
SpringerLink
Log in

Permanent catheters for recurrent ascites—a critical and systematic review of study methodology

  • Review Article
  • Published:
Supportive Care in Cancer Aims and scope Submit manuscript

Abstract

Purpose

Management of refractory ascites traditionally includes medical treatment with diuretics or intermittent paracentesis. Patients with recurrent ascites may benefit from the use of permanent intra-abdominal catheters with more frequent drainage without hospitalization. The objective was to systematically asses the methodology of factors and endpoints reported in studies investigating permanent catheters for recurrent ascites treatment.

Methods

Using a systematic search strategy, we critically assessed the methodology when treating refractory ascites using a permanent catheter. Studies critically assessed included both retro- and prospective studies.

Results

A total of 715 unique articles were found via PubMed, The Cochrane Library and Embase. Twenty-nine studies (tunnelled catheter = 12, peritoneal ports = 6 and peritoneovenous shunts = 11) with three distinct types of permanent catheters fulfilled the inclusion criteria. Only three studies reported technical success less than 100 %. Data on complications and treatment were not available in all papers; peritonitis (48 %), cellulitis (41 %), prophylactic antibiotics (48 %) and complications to catheter insertion were difficult to distinguish from advanced co-morbidity of patients. Thirteen studies (45 %) reported some type of evaluating patient experience or functional outcome, but only three studies used validated reproducible scales when assessing outcomes. Fifteen of the 29 studies included 30 patients or less.

Conclusion

Knowledge is limited because complications and outcomes are poorly defined. The expected increase in catheter treatment of refractory ascites necessitates comparative studies, using validated patient-related outcomes, and the reporting of unambiguous complications. A proposal of variables to include in future studies is presented.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Coupe NA, Cox K, Clark K, Boyer M, Stockler M (2013) Outcomes of permanent peritoneal ports for the management of recurrent malignant ascites. J Palliat Med 2013(16):938–940

    Article  Google Scholar 

  2. Lungren MP, Kim CY, Stewart JK, Smith TP, Miller MJ (2013) Tunneled peritoneal drainage catheter placement for refractory ascites: single-center experience in 188 patients. J Vasc Interv Radiol 2013(24):1303–1308

    Article  Google Scholar 

  3. Ginès A, Planas R, Angeli P, et al. (1995) Treatment of patients with cirrhosis and refractory ascites using LeVeen shunt with titanium tip: comparison with therapeutic paracentesis. Hepatology 1995(22):124–131

    Google Scholar 

  4. Ginès P, Arroyo V, Vargas V, et al. (1991) Paracentesis with intravenous infusion of albumin as compared with peritoneovenous shunting in cirrhosis with refractory ascites. N Engl J Med 1991(325):829–835

    Article  Google Scholar 

  5. Rosenberg S, Courtney A, Nemcek AA Jr, Omary RA (2004) Comparison of percutaneous management techniques for recurrent malignant ascites. J Vasc Interv Radiol 2004(15):1129–1131

    Article  Google Scholar 

  6. Seike M, Maetani I, Sakai Y (2007) Treatment of malignant ascites in patients with advanced cancer: peritoneovenous shunt versus paracentesis. J Gastroenterol Hepatol 2007(22):2161–2166

    Article  Google Scholar 

  7. Courtney A, Nemcek AA Jr, Rosenberg S, Tutton S, Darcy M, Gordon G (2008) Prospective evaluation of the PleurX catheter when used to treat recurrent ascites associated with malignancy. J Vasc Interv Radiol 2008(19):1723–1731

    Article  Google Scholar 

  8. Liberati A, Altman DG, Tetzlaff J, et al. (2009) The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. PLoS Med 6:e1000100

    Article  PubMed  PubMed Central  Google Scholar 

  9. National Center for Biotechnology Information. PubMed Help. http://www.ncbi.nlm.nih.gov/books/NBK3827/. Accessed on 1–4-2015

  10. Savin MA, Kirsch MJ, Romano WJ, Wang SK, Arpasi PJ, Mazon CD (2005) Peritoneal ports for treatment of intractable ascites. J Vasc Interv Radiol 2005(16):363–368

    Article  Google Scholar 

  11. Tapping CR, Ling L, Razack A (2012) PleurX drain use in the management of malignant ascites: safety, complications, long-term patency and factors predictive of success. Br J Radiol 2012(85):623–628

    Article  Google Scholar 

  12. Barnett TD, Rubins J (2002) Placement of a permanent tunneled peritoneal drainage catheter for palliation of malignant ascites: a simplified percutaneous approach. J Vasc Interv Radiol 2002(13):379–383

    Article  Google Scholar 

  13. Akinci D, Erol B, Ciftci TT, Akhan O (2011) Radiologically placed tunneled peritoneal catheter in palliation of malignant ascites. Eur J Radiol 2011(80):265–268

    Article  Google Scholar 

  14. Narayanan G, Pezeshkmehr A, Venkat S, Guerrero G, Barbery K (2014) Safety and efficacy of the Pleurx catheter for the treatment of malignant ascites. Journal of Palliative Medicine 2014(17):906–912

    Article  Google Scholar 

  15. Abdel Ghaffar MK, Hassan MS, Mostafa MY (2014) Value of implantable peritoneal ports in managing recurrent malignant ascites. Egyptian Journal of Radiology and Nuclear Medicine 2014(45):417–422

    Article  Google Scholar 

  16. Lee A, Lau TN, Yeong KY (2000) Indwelling catheters for the management of malignant ascites. Support Care Cancer 2000(8):493–499

    Google Scholar 

  17. Mercadante S, Intravaia G, Ferrera P, Villari P, David F (2008) Peritoneal catheter for continuous drainage of ascites in advanced cancer patients. Support Care Cancer 2008(16):975–978

    Article  Google Scholar 

  18. O’Neill MJ, Weissleder R, Gervais DA, Hahn PF, Mueller PR (2001) Tunneled peritoneal catheter placement under sonographic and fluoroscopic guidance in the palliative treatment of malignant ascites. AJR Am J Roentgenol 2001(177):615–618

    Article  Google Scholar 

  19. Ozkan O, Akinci D, Gocmen R, Cil B, Ozmen M, Akhan O (2007) Percutaneous placement of peritoneal port-catheter in patients with malignant ascites. Cardiovasc Intervent Radiol 2007(30):232–236

    Article  Google Scholar 

  20. Park JS, Won JY, Park SI, Park SJ, Lee DY (2001) Percutaneous peritoneovenous shunt creation for the treatment of benign and malignant refractory ascites. J Vasc Interv Radiol 2001(12):1445–1448

    Article  Google Scholar 

  21. Richard HM III, Coldwell DM, Boyd-Kranis RL, Murthy R, Van Echo DA (2001) Pleurx tunneled catheter in the management of malignant ascites. J Vasc Interv Radiol 2001(12):373–375

    Article  Google Scholar 

  22. Rosenblum DI, Geisinger MA, Newman JS, et al. (2001) Use of subcutaneous venous access ports to treat refractory ascites. J Vasc Interv Radiol 2001(12):1343–1346

    Article  Google Scholar 

  23. Zanon C, Grosso M, Apra F, et al. (2002) Palliative treatment of malignant refractory ascites by positioning of Denver peritoneovenous shunt. Tumori 2002(88):123–127

    Google Scholar 

  24. Millard FC, Powis SJA (1988) Management of intractable malignant ascites using the Denver peritoneovenous shunt. J R Coll Surg Edinb 1988(33):138–139

    Google Scholar 

  25. Monsky WL, Yoneda KY, MacMillan J, et al. (2009) Peritoneal and pleural ports for management of refractory ascites and pleural effusions: assessment of impact on patient quality of life and hospice/home nursing care. J Palliat Med 2009(12):811–817

    Article  Google Scholar 

  26. Bratby MJ, Hussain FF, Lopez AJ (2007) Radiological insertion and management of peritoneovenous shunt. Cardiovasc Intervent Radiol 2007(30):415–418

    Article  Google Scholar 

  27. Shepherd KE, Miller BJ (1988) Peritoneovenous shunts—devices of last resort. Can J Surg 1988(31):444–447

    Google Scholar 

  28. Sugawara S, Sone M, Arai Y, et al. (2011) Radiological insertion of Denver peritoneovenous shunts for malignant refractory ascites: a retrospective multicenter study (JIVROSG-0809). Cardiovasc Intervent Radiol 2011(34):980–988

    Article  Google Scholar 

  29. Tomiyama K, Takahashi M, Fujii T, et al. (2006) Improved quality of life for malignant ascites patients by Denver peritoneovenous shunts. Anticancer Res 2006(26):2393–2395

    Google Scholar 

  30. Guzman E, Wigness BD, Dorman FD, Rohde TD, Buchwald H (1988) Advances and new concepts in the designing of peritoneovenous shunts for the treatment of refractory ascites. ASAIO Trans 1988(34):805–807

    Google Scholar 

  31. Po CL, Bloom E, Mischler L, Raja RM (1996) Home ascites drainage using a permanent Tenckhoff catheter. Adv Perit Dial 1996(12):235–236

    Google Scholar 

  32. Easson AM, Bezjak A, Ross S, Wright JG (2007) The ability of existing questionnaires to measure symptom change after paracentesis for symptomatic ascites. Ann Surg Oncol 2007(14):2348–2357

    Article  Google Scholar 

  33. Abdel-Aal AK, Dybbro P, Hathaway P, Guest S, Neuwirth M, Krishnamurthy V (2014) Best practices consensus protocol for peritoneal dialysis catheter placement by interventional radiologists. Perit Dial Int 2014(34):481–493

    Article  Google Scholar 

  34. Hagen SM, Lafranca JA, IJzermans JN, Dor FJ (2014) A systematic review and meta-analysis of the influence of peritoneal dialysis catheter type on complication rate and catheter survival. Kidney Int 2014(85):920–932

    Article  Google Scholar 

  35. Barretti P, Doles JV, Pinotti DG, El Dib RP (2015) Evidence-based medicine: an update on treatments for peritoneal dialysis-related peritonitis. World J Nephrol 2015(4):287–294

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Anaesthesiology, Slagelse Hospital, Fælledvej 1, 4200, Slagelse, Denmark

    Lars Christensen & Kim Wildgaard

  2. Royal School of Library and Information Science, Faculty of the Humanities, Copenhagen University, Birketinget 6, 2300, Copenhagen S, Denmark

    Lorna Wildgaard

  3. Department of Anaesthesiology, Næstved Hospital, Ringstedgade 40, 4700, Næstved, Denmark

    Kim Wildgaard

Authors
  1. Lars Christensen
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Lorna Wildgaard
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Kim Wildgaard
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Kim Wildgaard.

Ethics declarations

Conflicts of interest

All authors declare no conflicts of interest. Data analysed is controlled by the authors of the papers included in this review. Our data is available for review by Supportive Care in Cancer upon request.

Funding

The funding was purely departmental/institutional.

Electronic Supplementary Materials

ESM 1

(DOCX 16 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Christensen, L., Wildgaard, L. & Wildgaard, K. Permanent catheters for recurrent ascites—a critical and systematic review of study methodology. Support Care Cancer 24, 2767–2779 (2016). https://doi.org/10.1007/s00520-016-3145-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00520-016-3145-y

Keywords

Search

Navigation