Ascites – the Old, the Current, and the Future Ways of Management

Abstract Purpose of Review Reviewing the current and future management options for patients with refractory ascites (RA) related to end-stage liver disease and resultant portal hypertension. Recent Findings RA can be curtailed with the creation of a TIPS (trans-jugular intrahepatic portosystemic) shunt in selective patients due to the risk of exacerbating hepatic encephalopathy (HE) and heart failure. Ongoing trails investigating optimization of the procedure and best selection of patients. The Alfapump® system, a novel innovation, is an investigational therapy for ascites management currently undergoing FDA review. It is a remotely rechargeable, battery-operated, subcutaneously implantable device that is designed to continuously divert intraperitoneal ascites into the bladder without external components. Summary Careful patients’ selection is the key to provide an acceptable risk/benefit for every ascites management option. Compared to LVP or TIPS the new innovative device is aimed to significantly improve the QOL for patients with ascites. However, cost consideration may impact wide clinic use until cost-effectiveness has been proven.