Physicians will attend to minimize the amount of fluid within the intraperitoneal cavity without intravascular volume depletion. Treatment of ascites usually improves quality of life by decreasing abdominal discomfort or dyspnea to name a few.
As per guidelines, ascites management should include minimizing consumption of alcohol and dietary sodium. Depending on the degree of severity, ascites management includes oral diuretics, therapeutic (or large-volume) paracentesis, transjugular intrahepatic portosystemic shunt (TIPS), and liver transplantation.
Paracentesis is defined as the removal of fluid from a body cavity via a needle, a trocar, a cannula or other hollow instrument and can be used for either diagnostic or therapeutic purposes.
In the case of ascites, a large-bore needle is inserted into the abdomen and the ascites is drained from the patient’s abdomen over a number of hours. Paracentesis is the most common treatment for refractory ascites worldwide.
However, paracentesis only offers temporary relief from ascites as it needs to be repeated when the ascites re-accumulates, often on a weekly or bi-weekly basis. And in the meantime the patient is left feeling bloated and unwell as the fluid continues to collect.
A TIPS (Transjugular Intrahepatic Portosystemic Shunt) is a shunt to re-route blood flow around the damaged liver into the main blood vessels. The portion of excess blood bypassing the liver, may allow the reduction of portal hypertension and thus, potentially the accumulation of ascites.
Until now, treatment options for refractory ascites have been limited and unsatisfactory for some patients, leaving both patients and doctors in need of a better solution.