[Management of refractory ascites by the automated low flow pump system (Alfapump)]

Refractory ascites affects 10% of patients with advanced cirrhosis. Recurrent ascites is commonly managed by repeat large volume paracentesis with volume expansion, and in selected patients, by the implantation of a transjugular intrahepatic portosystemic shunt (TIPS). Both approaches are associated with potential complications, including vascular traumatic injuries in the setting of paracentesis. A new automatic pump has been developed to mechanically remove ascites from the peritoneal cavity to the bladder. The benefit of this pump in terms of reduced frequency of paracentesis should be balanced by the risk of adverse events that include infection, catheter dysfunction, and renal insufficiency. The place of this new device in the management of ascites due either to portal hypertension or to cancer remains to be determined.