Paracentesis: a re-evaluated procedure in the management of cirrhotic patients with ascites

Paracentesis is the oldest method for treating patients with ascites, but the fear of serious side-effects and the coincident introduction of effective non-toxic diuretic drugs led to its abandonment during the fifties. In recent years, several studies have investigated whether abdominal evacuation of ascitic fluid is truly dangerous for cirrhotic patients. The results of some randomized controlled trials comparing paracentesis with a traditional diuretic therapy showed that the rate of complications after paracentesis, particularly when the procedure was combined with a sufficient plasma expansion, was equal to or lower than that of diuretic treatment. Moreover, the ability of paracentesis to resolve tense ascites, both in terms of number of successes and of time required to obtain ascites resolution, was similar or even higher. These data and the recent new interest of several investigators in employing ascitic fluid examination for diagnostic purposes have increased the use of this procedure in the clinical practice.