TREATMENT OF ASCITES .2. LARGE-VOLUME PARACENTESIS

The role of paracentesis in the management of ascites has been revived after it was temporarily abandoned. The reasons for this were several : a) safety: complications such as hypotension, abdominal leaks, infec tions and renal dysfunction are very rare if appropriate techniques an d plasma expanders (i.e., intravenous albumin) are used; b) efficacy: compared with diuretics and dietary restrictions, which remain the sta ndard treatment, paracentesis is quicker; and c) cost: paracentesis ca n be performed in the outpatient setting, thus reducing the length of hospitalization. Intravenous albumin is the recommended plasma expande r after paracentesis to avoid circulatory or renal dysfunction as pote ntial complications. New techniques, such as transjugular intrahepatic portosystemic shunt, and modified older procedures (reinfusion) are p romising alternatives and should be further investigated for the manag ement of tense or refractory ascites.