Treatment of ascites: Part II. 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, infections and renal dysfunction are very rare if appropriate techniques and plasma expanders (i.e., intravenous albumin) are used; b) efficacy: compared with diuretics and dietary restrictions, which remain the standard treatment, paracentesis is quicker; and c) cost: paracentesis can be performed in the outpatient setting, thus reducing the length of hospitalization. Intravenous albumin is the recommended plasma expander after paracentesis to avoid circulatory or renal dysfunction as potential complications. New techniques, such as transjugular intrahepatic portosystemic shunt, and modified older procedures (reinfusion) are promising alternatives and should be further investigated for the management of tense or refractory ascites.