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Stirnimann G, Berg T, Spahr L, Zeuzem S, McPherson S, Lammert F, Storni F, Banz V, Babatz J, Vargas V, Geier A, Engelmann C, Herber A, Trepte C, Capel J, De Gottardi A. Final safety and efficacy results from a 106 real-world patients registry with an ascites-mobilizing pump. Liver Int 2022; 42:2247-2259. [PMID: 35686702 PMCID: PMC9543940 DOI: 10.1111/liv.15337] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 05/02/2022] [Accepted: 05/16/2022] [Indexed: 02/13/2023]
Abstract
BACKGROUND AND AIMS Patients with cirrhotic refractory ascites ineligible for transjugular intrahepatic shunt (TIPSS) have limited treatment options apart from repeated large volume paracentesis. The alfapump® is an implantable device mobilizing ascites from the peritoneal cavity to the bladder, from where it can be excreted. The aim of this observational cohort study was to prospectively investigate safety and efficacy of the device in a real-world cohort with cirrhotic refractory ascites and contraindications for TIPSS. METHODS A total of 106 patients received an implant at 12 European centres and were followed up for up to 24 months. Complications, device deficiencies, frequency of paracentesis, clinical status and survival were recorded prospectively. RESULTS Approximately half of the patients died on-study, about a quarter was withdrawn because of serious adverse events leading to explant, a sixth were withdrawn because of liver transplant or recovery, and nine completed follow-up. The most frequent causes of on-study death and complication-related explant were progression of liver disease and infection. The device reduced the requirement for large-volume paracentesis significantly, with more than half of patients not having required any post-implant. Survival benefits were not observed. Device-related reinterventions were predominantly caused by device deficiencies. A post-hoc comparison of the first 50 versus the last 50 patients enrolled revealed a decreased reintervention rate in the latter, mainly related to peritoneal catheter modifications. CONCLUSIONS The device reduced paracentesis frequency in a real-world setting. Technical complications were successfully decreased by optimization of management and device modification (NCT01532427).
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Affiliation(s)
- Guido Stirnimann
- University Clinic for Visceral Surgery and Medicine, Inselspital University HospitalUniversity of BernBernSwitzerland
| | - Thomas Berg
- Division of Hepatology, Department of Medicine IILeipzig University Medical CenterLeipzigGermany
| | - Laurent Spahr
- Department of Medical Specialties, Service of GastroenterologyGeneva University HospitalsGenevaSwitzerland
| | - Stefan Zeuzem
- Department of MedicineUniversity HospitalFrankfurtGermany
| | - Stuart McPherson
- Liver Unit, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, and Translational and Clinical Research InstituteNewcastle UniversityNewcastleUK
| | - Frank Lammert
- Department of Medicine IISaarland University Medical CenterHomburgGermany,Medizinische Hochschule HannoverHannoverGermany
| | - Federico Storni
- University Clinic for Visceral Surgery and Medicine, Inselspital University HospitalUniversity of BernBernSwitzerland
| | - Vanessa Banz
- University Clinic for Visceral Surgery and Medicine, Inselspital University HospitalUniversity of BernBernSwitzerland
| | - Jana Babatz
- Medizinische Klinik IUniversitätsklinikum Carl Gustav CarusDresdenGermany
| | - Victor Vargas
- Liver Unit, Hospital Vall d'HebronUniversitat Autònoma Barcelona, CIBERehdBarcelonaSpain
| | - Andreas Geier
- Division of Hepatology, Department of Medicine IIUniversity Hospital WürzburgWürzburgGermany
| | - Cornelius Engelmann
- Division of Hepatology, Department of Medicine IILeipzig University Medical CenterLeipzigGermany,Medical Department, Division of Hepatology and GastroenterologyCharité—Universitätsmedizin BerlinBerlinGermany
| | - Adam Herber
- Division of Hepatology, Department of Medicine IILeipzig University Medical CenterLeipzigGermany
| | | | | | - Andrea De Gottardi
- University Clinic for Visceral Surgery and Medicine, Inselspital University HospitalUniversity of BernBernSwitzerland,Servizio di Gastroenterologia e Epatologia, Ente Ospedaliero CantonaleLuganoSwitzerland,Facoltà di Scienze BiomedicheUniversità della Svizzera ItalianaLuganoSwitzerland
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Weil-Verhoeven D, Di Martino V, Stirnimann G, Cervoni JP, Nguyen-Khac E, Thévenot T. Alfapump ® implantable device in management of refractory ascites: An update. World J Hepatol 2022; 14:1344-1356. [PMID: 36158913 PMCID: PMC9376776 DOI: 10.4254/wjh.v14.i7.1344] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 05/30/2022] [Accepted: 06/27/2022] [Indexed: 02/06/2023] Open
Abstract
Refractory ascites (RA) is a frequent and life-threatening complication of cirrhosis. In selected patients with RA, transjugular intrahepatic portosystemic shunt (TIPS) placement and liver transplantation (LT) are currently considered the best therapeutic alternatives to repeated large volume paracentesis. In patients with a contraindication to TIPS or LT, the alfapump® system (Sequana Medical, Ghent, Belgium) has been developed to reduce the need for iterative paracentesis, and consequently to improve the quality of life and nutritional status. We report here recent data on technical progress made since the first implantation, the efficacy and tolerance of the device, the position of the pump in the therapeutic arsenal for refractory ascites, and the grey areas that remain to be clarified regarding the optimal selection of patients who are potential candidates for this treatment.
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Affiliation(s)
- Delphine Weil-Verhoeven
- Service d’Hépatologie Et Soins Intensifs Digestifs, CHRU Jean Minjoz, Besançon 25030, France
- EA 4266 EPILAB, Université de Bourgogne Franche-Comté, Besançon 25030, France
| | - Vincent Di Martino
- Service d’Hépatologie Et Soins Intensifs Digestifs, CHRU Jean Minjoz, Besançon 25030, France
- EA 4266 EPILAB, Université de Bourgogne Franche-Comté, Besançon 25030, France
| | - Guido Stirnimann
- Department of Visceral Surgery and Medicine, Inselspital University Hospital and University of Bern, Bern 3010, Switzerland
| | - Jean Paul Cervoni
- Service d’Hépatologie Et Soins Intensifs Digestifs, CHRU Jean Minjoz, Besançon 25030, France
| | - Eric Nguyen-Khac
- Service d’Hépato-Gastroentérologie, CHU Amiens-Picardie, Amiens 80080, France
| | - Thierry Thévenot
- Service d’Hépatologie Et Soins Intensifs Digestifs, CHRU Jean Minjoz, Besançon 25030, France
- EA 4266 EPILAB, Université de Bourgogne Franche-Comté, Besançon 25030, France
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Aagaard NK, Malago M, De Gottardi A, Thomas M, Sauter G, Engelmann C, Aranovich D, Cohen M, Thévenot T, Ehmann T, Capel J, Angeli P, Jalan R, Stirnimann G. Consensus care recommendations for alfapump ® in cirrhotic patients with refractory or recurrent ascites. BMC Gastroenterol 2022; 22:111. [PMID: 35260086 PMCID: PMC8905806 DOI: 10.1186/s12876-022-02173-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 02/04/2022] [Indexed: 12/26/2022] Open
Abstract
Background The alfapump® is an implantable class III medical device that pumps ascitic fluid from the peritoneal space to the urinary bladder from where it is excreted. The pump reduces or abrogates the need for repeated paracentesis in patients with recurrent or refractory ascites.
Aims To improve outcomes for alfapump® implantation and pre- and post-implant patient management in both clinical trial and real-world settings by development of consensus recommendations.
Methods The alfapump® working group consisting of hepatologists and surgeons with extensive experience in implantation of the alfapump® and patient management met on two occasions: (1) to determine the key areas where recommendations should be made; and (2) to discuss the experiences of the working group within those areas and formulate draft statements. Developed statements were submitted to the group and consensus sought on relevance and wording through a collaborative iterative approach in order to consolidate the recommendations into consensus statements. Only recommendations agreed upon unanimously were included. Results Twenty-three consensus recommendations were developed in the areas of pre-implantation procedure, (three statements), surgical implant procedure (11 statements), immediate post-implant care (three statements) and long-term management (six statements). Conclusions The consensus statements are a valuable reference resource for physicians managing patients with the alfapump® and for those considering management strategies for patients with refractory ascites. Supplementary Information The online version contains supplementary material available at 10.1186/s12876-022-02173-5.
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Affiliation(s)
- Niels Kristian Aagaard
- Department of Hepatology and Gastroenterology, Aarhus University Hospital, Aarhus, Denmark
| | - Massimo Malago
- Hepato-Pancreatic-Biliary and Liver Transplantation Surgery, Royal Free Hospital, University College London, London, UK
| | - Andrea De Gottardi
- Servizio di Gastroenterologia e Epatologia, Ente Ospedaliero Cantonale, Lugano, Switzerland.,Faculty of Biomedical Sciences, Università Della Svizzera Italiana, Lugano, Switzerland
| | - Michael Thomas
- Department of General, Visceral, Tumour and Transplant Surgery, University Hospital of Cologne, Cologne, Germany
| | - Gerd Sauter
- Department of Internal Medicine II, LMU University Hospital, Munich, Germany
| | - Cornelius Engelmann
- Department of Hepatology and Gastroenterology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - David Aranovich
- Hepatology and Bile Duct Surgery Service, Surgery B Department, Hillel Yaffe Medical Centre, Hadera, Israel
| | - Michal Cohen
- The Liver Institute, Rabin Medical Centre, Beilinson Hospital, Petah Tikva, Israel
| | - Thierry Thévenot
- Service d'Hépatologie, Hôpital Universitaire Jean Minjoz, Besançon, France
| | - Thomas Ehmann
- Department of General and Visceral Surgery, St. Josef Krankenhaus Haan, Haan, Germany
| | | | - Paolo Angeli
- Facoltà di Medicina e Chirurgia, Università degli Studi di Padova, Padova, Italy
| | - Rajiv Jalan
- Liver Failure Group, Institute for Liver and Digestive Health, Division of Medicine, UCL Medical School, Royal Free Campus, London, UK
| | - Guido Stirnimann
- University Clinic for Visceral Surgery and Medicine, University Hospital Inselspital Bern and University of Bern, Freiburgstrasse 18, 3010, Bern, Switzerland.
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Combined treatment of refractory ascites with an alfapump® plus hernia repair in the same surgical session: A retrospective, multicentre, European pilot study in cirrhotic patients. J Visc Surg 2020; 158:27-37. [PMID: 32553558 DOI: 10.1016/j.jviscsurg.2020.06.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
INTRODUCTION The treatment of symptomatic hernia in cirrhotic patients with refractory ascites is critical but challenging. The objective of this study was to assess the feasibility and safety of the implantation of alfapump® combined with concomitant hernia repair in cirrhotic patients with refractory ascites. METHODS Using data from six European centres, we retrospectively compared patients treated with alfapump® system implantation and concomitant hernia repair [the combined treatment group (CT group, n=12)] or with intermittent paracentesis hernia repair [the standard treatment group (ST group, n=26)]. Some patients of the ST group had hernia repair in an elective setting (STel group) and others in emergency (STem group). The endpoints were requirement of peritoneal drainage, the rate of infectious complications, the in-hospital mortality, the length of stay, paracentesis-free survival. RESULTS Postoperatively, none of the patients in the CT group and 21 patients (80%) in the ST group underwent peritoneal drainage for the evacuation of ascites fluid (P<0.0001). The overall incidence of infectious complications was not different between groups but there were fewer infections in the CT group than in the STem group (33% vs. 81%; P=0.01). There was no difference for in-hospital mortality. The length of stay was shorter in the CT group (P=0.03). Paracentesis-free survival was significantly better (P=0.0003) in the CT group than in the ST group. CONCLUSION Implantation of alfapump combined with concomitant hernia repair seems feasible and safe in cirrhotic patients; however, larger and randomized study are required.
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