title: Computerized Tomography-Guided Paracentesis: An Effective Alternative to Bedside Paracentesis?
abstract: BACKGROUND
  Ascites remains the most common cause of hospitalization among patients with decompensated cirrhosis. Paracentesis is a relatively safe procedure with low complication rates. Computerized tomography (CT)-guided therapeutic paracentesis could be a safe and effective alternative to unaided or aided (ultrasonogram-guided) bedside paracentesis. In this retrospective study, we aimed to compare the efficacy, safety, and cost-effectiveness of CT-guided paracentesis with bedside paracentesis.
  
  
  METHODS
  The period of study was from 2002 to 2012. All patients with cirrhosis who underwent therapeutic paracentesis were included in the study. These patients were divided into two groups. Group I consisted of patients who underwent CT-guided pigtail catheter insertion with ascitic fluid drainage. Group II consisted of patients who underwent beside therapeutic paracentesis after localization of fluid either by physical examination or sonographic localization. We measured the efficacy of CT-guided paracentesis and bedside paracentesis in terms of volume of fluid removed, length of stay, discharge doses of diuretics (spironolactone and furosemide) and number of days to readmission for symptomatic ascites. We also computed the cost-effectiveness of CT-guided therapeutic paracentesis when compared to a bedside procedure. Fischer exact test was used to analyze the distribution of categorical data and unpairedt-test was used for comparison of means.
  
  
  RESULTS
  There were a total of 546 unique patients with diagnosed cirrhosis who were admitted to the hospital with symptomatic ascites and underwent therapeutic paracentesis. Two hundred and forty-seven patients underwent CT-guided paracentesis, while 272 patients underwent bedside paracentesis. There was significant inverse correlation between the amount of ascitic fluid removed and total length of stay in the hospital. We found that the volume of fluid removed via a CT-guided pigtail insertion and drainage (2.72 ± 2.02 L) is significantly higher when compared to fluid removed via bedside paracentesis (1.94 ± 1.69). We also found that the interval time period between two successive therapeutic paracenteses was significantly longer for CT group (106.56 ± 75.2 days) when compared to the bedside group (25.57 ± 7.68 days).
  
  
  CONCLUSIONS
  CT-guided paracentesis with pigtail catheter insertion and drainage is a clinically effective, cheap and safe alternative to conventional bedside paracentesis.
authors.affiliation: Department of Medicine, Bronx Lebanon Hospital Center, 1650 Selwyn Ave., Suite #10C, Bronx, NY 10457, USA.
authors.forename: Vinaya
authors.initials: V
authors.lastname: Gaduputi
authors.affiliation: Department of Medicine, Bronx Lebanon Hospital Center, 1650 Selwyn Ave., Suite #10C, Bronx, NY 10457, USA.
authors.forename: Hassan
authors.initials: H
authors.lastname: Tariq
authors.affiliation: Department of Medicine, Bronx Lebanon Hospital Center, 1650 Selwyn Ave., Suite #10C, Bronx, NY 10457, USA.
authors.forename: Chaitanya
authors.initials: C
authors.lastname: Chandrala
authors.affiliation: Department of Medicine, Bronx Lebanon Hospital Center, 1650 Selwyn Ave., Suite #10C, Bronx, NY 10457, USA.
authors.forename: Sailaja
authors.initials: S
authors.lastname: Sakam
authors.affiliation: Department of Medicine, Bronx Lebanon Hospital Center, 1650 Selwyn Ave., Suite #10C, Bronx, NY 10457, USA.
authors.forename: Naeem
authors.initials: N
authors.lastname: Abbas
authors.affiliation: Department of Medicine, Bronx Lebanon Hospital Center, 1650 Selwyn Ave., Suite #10C, Bronx, NY 10457, USA.
authors.forename: Sridhar
authors.initials: S
authors.lastname: Chilimuri
keywords: Ascites in cirrhosis; Bedside paracentesis; CT-guided bedside paracentesis; CT-guided paracentesis; Complications of paracentesis; Management of ascites; Therapeutic paracentesis