Hepatic Hydrothorax: single centre’s experience in Malaysia on the utility of Octreotide - A case series
INTRODUCTION: Hepatic hydrothorax (HH) leads to significant morbidity and short-term mortality. Till date, transjugular intrahepatic portosystemic shunt (TIPS) and liver transplantation (LT) are the only definitive treatment for HH. OBJECTIVE: To determine the efficacy of octreotide infusion for m...
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| Main Authors: | , , , , , , , , |
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| Format: | Proceeding Paper |
| Language: | English English English |
| Published: |
2023
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| Subjects: | |
| Online Access: | http://irep.iium.edu.my/108740/1/666.jpg http://irep.iium.edu.my/108740/6/Cert%20of%20Att%20GUT23.pdf http://irep.iium.edu.my/108740/7/GUT%20Souviner.pdf http://irep.iium.edu.my/108740/ |
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| Summary: | INTRODUCTION: Hepatic hydrothorax (HH) leads to significant morbidity and short-term mortality. Till date, transjugular
intrahepatic portosystemic shunt (TIPS) and liver transplantation (LT) are the only definitive treatment for HH.
OBJECTIVE: To determine the efficacy of octreotide infusion for management of HH.
METHODOLOGY: Single-center retrospective case-series of decompensated liver cirrhosis patients with hepatic
hydrothorax between March 2018 and March 2020. Apart from standard medical therapy, patients were subjected to pleural
drainage and intravenous octreotide infusion over seven days (25mcg/hour day one, 50mcg/hour day two, 100 mcg/hour
days three to seven). Resolution of HH was confirmed with repeat chest X-ray.
RESULTS: Median age of patients in this case series was 69 years old [interquartile range (IQR) 62-74]; three males and
five females. The median Child-Pugh Score was 8 (IQR 7-10) and model for end-stage liver disease (MELD-Na) score
was 19 (IQR 14-22). All patients had concurrent ascites requiring peritoneal drainage. Seven had significant right-sided
pleural effusion, whereas one had left-sided pleural effusion. Portal-vein thrombosis present in one patient and two had
hepatocellular carcinoma. Four patients achieved clinical resolution of HH with octreotide at the end of treatment, and
at one-, three-, six- and twelve-months post-treatment. Chemical pleurodesis done for one patient and another required
repeat infusion of octreotide within one month with subsequent clinical resolution of HH. The remaining four patients did not
achieve clinical remission; two patients required repeated thoracentesis during follow-ups, one patient had indwelling pleural
catheter placement, and another transferred out to another hepatology center.
CONCLUSION: Octreotide infusion in tandem with pleural drainage resulted in clinical resolution of HH in 50% of our
patients and may be an alternative treatment for selected patients with HH when both TIPS and LT are non-viable. |
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