Presence of parietal edema increases risk of ascitic fluid leak after paracentesis in liver cirrhosis patients

· Post-paracentesis leak was seen in 4.8% of patients, while only 1.7% had persistent leaks.

· The leak management was stepwise, initially with tincture benzoine with tight dressing followed by topical cyanoacrylate adhesive and autologous blood patch in those not responding.

· Patients with persistent leaks had a higher proportion of patients with parietal edema, higher PT-INR and Child-Pugh scores and lower mid-upper arm circumference, short physical performance battery score, and hand-grip strength.

· On multivariate analysis, only the presence of parietal edema was an independent predictor of post-paracentesis persistent leak (Odds ratio 10.35).

"When available during large-volume paracentesis (LVP), ultrasound guidance should be considered for reducing the risk of adverse events," the researchers wrote in their study. "Parietal edema presence increases patient's risk for developing an ascitic fluid leak. Hence, the leak incidence can be reduced by the mobilization of the edema by manual pressure before needle insertion by Z-technique."

"A stepwise approach involving injection and topical therapy can be used for managing patients developing an ascitic fluid leak," they concluded.

Reference:

The "Post-Paracentesis Ascitic Fluid Leak in Patients with Cirrhosis of Liver and its Management: A Prospective Study" was published in the Journal of Clinical and Experimental Hepatology.

DOI: https://doi.org/10.1016/j.jceh.2022.10.007