Pigtail Catheter: a Less Invasive Option for Pleural Drainage of Recurrent Hepatic Hydrothorax

Last updated: December 22, 2017
Sponsor: Sherief Abd-Elsalam
Overall Status: Active - Recruiting

Phase

N/A

Condition

Lung Disease

Pleural Effusion

Treatment

N/A

Clinical Study ID

NCT02119169
Mohamed Sharaf-Eldin
Tanta university hospital
  • Ages 18-70
  • All Genders

Study Summary

The effectiveness of pigtail catheter as a less invasive option for pleural drainage in patients with resistant hepatic hydrothorax.

Eligibility Criteria

Inclusion

Inclusion Criteria:

  • Patients with cirrhotic liver and recurrent pleural effusion.

  • Pleural fluid should be transudate according to Light's criteria:

  • Pleural fluid-to-serum protein ratio less than 0.5

  • Pleural fluid lactic dehydrogenase (LDH) less than 200 IU

  • Pleural fluid-to-serum LDH ratio and pleural fluid-to-high normal serum LDH ratioless than 0.6

Exclusion

Exclusion Criteria:

  • Diagnosis of hepatocellular carcinoma or other neoplasm able to shorten lifeexpectancy.

  • Congestive heart failure.

  • Recent (i.e. within the previous 2 weeks) episode of digestive hemorrhage.

  • Exudative pleural effusion.

  • Ascitic fluid or pleural fluid infection

  • Platelet count below 50,000

  • Prothrombin activity below 50%

Study Design

Total Participants: 30
Study Start date:
March 01, 2014
Estimated Completion Date:
December 31, 2022

Study Description

Hepatic hydrothorax (HH) is defined as a transudative pleural effusion in patients with liver cirrhosis in the absence of cardiopulmonary disease. The estimated prevalence among patients with liver cirrhosis is approximately 5-6% (Baikati et al., 2014).

HH is an infrequent but a well-known complication of portal hypertension. Trans-diaphragmatic passage of ascitic fluid from peritoneal to the pleural cavity through numerous diaphragmatic defects has been shown to be the predominant mechanism in the formation of HH (Kumar&Kumar, 2014).

Patients with hepatic hydrothoraces often have few options (Goto et al., 2011). Diuretic-resistant HH could be managed with liver transplantation, transjugular intrahepatic portosystemic shunt (TIPS) or indwelling pleural catheters. However, tube thoracotomy and pleurodesis failed in most patients (Singh et al., 2013).

Case reports and small case series have reported a high rate of complications associated with chest tube placement for hepatic hydrothorax. The most common reported complications were acute kidney injury, pneumothorax, and empyema. Death has been recorded in some cases. Chest tube insertion for hepatic hydrothorax carries significant morbidity and mortality, with questionable benefit (Orman&Lok, 2009).

Pigtail catheter insertion is an effective and safe method of draining pleural fluid. Its use is safe and recommended for all cases of pleural effusion requiring chest drain except for empyema and other loculated effusions that yielded low success rate (Bediwy and Amer, 2012).

Connect with a study center

  • Tanta university hospital

    Tanta,
    Egypt

    Active - Recruiting

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