A Randomized Controlled Trial of Procedural Techniques for Large Volume Paracentesis

Area of Science:

• Gastroenterology and Hepatology
• Interventional Procedures
• Medical Devices

Background:

• Large volume paracentesis is a common procedure for managing ascites in cirrhosis patients.
• Traditional paracentesis techniques can be associated with complications such as leakage and patient discomfort.
• Optimizing needle insertion techniques is crucial for improving patient outcomes and procedural efficiency.

Purpose of the Study:

• To compare the efficacy and safety of the z-tract versus the coaxial needle insertion technique for large volume therapeutic paracentesis in patients with cirrhosis.
• To evaluate differences in ascites leakage, patient-reported pain, and operator-reported procedural difficulty between the two techniques.

Main Methods:

• A randomized, single-blind controlled trial was conducted involving patients with cirrhosis undergoing outpatient therapeutic paracentesis.
• Participants were randomized to either the z-tract or the modified angular (coaxial) needle insertion technique.
• Primary endpoint was ascites leakage; secondary endpoints included procedural discomfort and operator preference.

Main Results:

• A total of 61 paracenteses were analyzed (30 z-tract, 31 coaxial).
• No significant difference in post-procedural ascites leakage was observed between the groups (13% in both).
• The coaxial technique resulted in significantly lower patient-reported pain scores (17.2 vs. 26.4) and reduced physician-rated procedural difficulty (1.5 vs. 2.1) compared to the z-tract technique (p=0.04 for both).

Conclusions:

• The coaxial needle insertion technique is superior to the z-tract technique for large volume therapeutic paracentesis in patients with cirrhosis.
• The coaxial technique offers improved patient comfort and procedural ease without compromising efficacy in preventing ascites leakage.