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• W3122334992 abstract "Introduction Ascites is a leading cause of hospital admission in patients with cirrhosis, with up to a third developing refractory ascites (RA.) RA has a median transplant free survival of 6 months,1 yet palliation remains sub-optimal and practice varies widely. Long term ascitic drains (LTAD) are standard of care in malignant ascites but there is a paucity of data to support use in advanced cirrhosis. Our aim was to establish current views and practices of gastroenterologists and hepatologists towards LTAD as a palliative intervention in advanced cirrhosis. Methods An electronic survey of 10 questions was designed by a focus group of four hepatologists with a special interest in palliative management of advanced cirrhosis. The survey included seven questions with fixed quantitative options and three exploratory questions with free text space. The survey was logged on survey monkey and distributed electronically via the BASL website and also to relevant departments in Brighton and North East London, with reminder emails in four and eight weeks. Results The survey was completed by 210 respondents over 16 weeks with 99% completion rates for all questions with quantitative endpoints. Respondents included Hepatologists (36.8%,) specialist nurses (24.4%,) gastroenterologists (16.3%) and trainees (15.3%.) Ninety-six percent of respondents looked after patients with RA and 70% had experience of LTAD. All respondents had access to large volume paracentesis, 86.1% to TIPSS, 67% to LTAD and 6% to the Alpha pump. The commonest deterrent to use of LTAD was infection risk (90%), followed by community management of LTAD in these complex patients (56.5%). Patient/carer dissatisfaction (as reported by clinicians) did not seem to be a major cause of concern. Fifty-six percent of those with experience reported clinical consequences (bleeding, infection, renal impairment) 41.4% reported technical issues and 35.8% inadequate community support. Additional themes emerged, including: lack of clear guidance on use of LTAD in advanced cirrhosis, the role of human albumin solution, monitoring of renal function and funding. Conclusions This national survey of clinicians managing RA in the setting of advanced cirrhosis shows that the majority would be willing to consider LTAD, the main deterrent being infection risk. Additional concerns identified were: lack of training, funding concerns and absence of clear guidelines on community management of LTAD. Our survey highlights the need for a robustly designed randomised controlled trial to assess palliative interventions for the management of RA in advanced cirrhosis. Reference Macken, et al. Trials ( 2018) 19:401" @default.
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• W3122334992 date "2021-01-01" @default.
• W3122334992 modified "2023-10-14" @default.
• W3122334992 title "P169 Long term abdominal drain for palliation in advance liver cirrhosis: survey of risks & barriers" @default.
• W3122334992 doi "https://doi.org/10.1136/gutjnl-2020-bsgcampus.244" @default.
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