This protocol addresses liver cirrhosis complicated by refractory ascites — defined as ascites that is either diuretic-resistant (fails to respond to maximum tolerated diuretic therapy and sodium restriction) or diuretic-intractable (diuretics cannot be used at effective doses due to adverse effects). The diagnosis relies on the formal assessment of response to diuretic therapy and salt restriction.
When standard diuretic-based strategies are no longer viable in patients with cirrhosis and refractory ascites, a specialised device-based intervention becomes relevant. This intervention is performed at experienced centres and targets the management of recurrent fluid accumulation. The full algorithm — including patient selection criteria, procedural considerations, and follow-up — is detailed in the protocol.
The diagnosis of refractory ascites relies on the assessment of the response of ascites to diuretic therapy and salt restriction.
Repeated LVP plus albumin (8 g/L of ascites removed) are recommended as first line treatment for refractory ascites (I;1).
AlfapumpÒ implantation in patients with refractory ascites not amenable to TIPS insertion is suggested in experienced centres.
DOI: 10.1016/j.jhep.2018.03.024
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