Efficacy and Safety of Large Volume Paracentesis in Cirrhotic Patients with Spontaneous Bacterial Peritonitis: A Randomized Prospective Study.
- Author:
Chang Hwan CHOI
1
;
Kwang Hyub HAN
;
Do Young KIM
;
Jae Hee CHO
;
Jae Youn CHEONG
;
Kun Hoon SONG
;
Chae Yoon CHON
;
Young Myoung MOON
Author Information
1. Department of Internal Medicine, Gastroenterology division, Yonsei University College of Medicine, Seoul, Korea.
- Publication Type:Original Article ; Clinical Trial ; English Abstract ; Randomized Controlled Trial
- Keywords:
Spontaneous bacterial peritonitis;
Large volume paracentesis;
Liver cirrhosis
- MeSH:
Adult;
Aged;
Ascites/etiology/*therapy;
Bacterial Infections/*complications;
English Abstract;
Female;
Human;
Liver Cirrhosis/complications/*therapy;
Male;
Middle Aged;
*Paracentesis/methods;
Peritonitis/complications/microbiology/*therapy;
Plasma Substitutes/administration & dosage;
Prospective Studies
- From:The Korean Journal of Hepatology
2002;8(1):52-60
- CountryRepublic of Korea
- Language:Korean
-
Abstract:
BACKGROUND/AIMS: Large volume paracentesis (LVP) associated with plasma volume expansion is known to be an effective and safe therapy for tense or refractory ascites in cirrhosis. Spontaneous bacterial peritonitis (SBP) is one of the frequent infections in patients with cirrhosis. We conducted a study to assess the efficacy and safety of large volume paracentesis in cirrhotic patients with SBP. METHODS: We randomly assigned 40 patients with cirrhosis and SBP to either treatment with LVP (21 patients) or general management (19 patients). LVP was defined as drainage of ascitic fluid of more than 4 liters in a single tap or loss of shifting dullness after paracentesis. LVP was performed within 48 hours after the diagnosis of SBP in the LVP group. Cefotaxime was given daily in doses that varied according to the serum creatinine level in both groups. Albumin was given at a dose of 6-8 g per 1 liter of removed ascites in the LVP group. RESULTS: After seven days of treatments, the blood chemistry test, and WBC (PMN) counts and protein concentration in the ascitic fluid were not different between the two groups. Among them, the WBC (PMN) counts were decreased significantly in both groups and protein concentrations tended to increase. Durations of abdominal tenderness and pain were shorter in the LVP group but the differences were statistically not significant. Admission periods, resolution rates of SBP after seven days of treatment, complication rates and in-hospital mortality rates were not different between the two groups. CONCLUSIONS:: The two treatment methods demonstrated almost the same effectiveness and safety. The symptoms were improved slightly faster in the LVP group. We concluded that large volume paracentesis is not an absolute contraindication and can be a tolerable and safe therapy in some selected cirrhotic patients with tense ascites and SBP.
