Doxycycline Pleurodesis in Hepatic Hydrothorax

Abstract

Background/Aim: Hepatic hydrothorax (HHyd) is usually recurrent and remains a difficult clinical problem. Transjagular Intrahepatic Portosystemic shunt (TIPSS) is commonly used in the treatment of HHyd. While it is highly effective, it is more expensive and more difficult to perform and needs more experience, especially in mixed postviral and bilharzial cirrhosis, which is common in Egypt. The aim ofthis study is to evaluate the effectiveness of the simpler, easier, cheaper and less invasive procedure of doxycycline pleurodesis in critically ill patients with recurrent symptomatic HHyd not responding to conservative treatment and thoracocentesis.

Patients and Methods: This study was done on 20 adult cirrhotic patients. According to child classification, 10 patients were class Band 10 were class C. Eighteen patients had right hydrothorax and 2 patients had left hydrothorax. All patients underwent a full medical history and thorough clinical examination with strict follow up, abdominal sonar, liver function tests before and after pleurodesis, repeated chest X-rays before and after pleurodesis at 3 days, 1 week, 1 month and 6 months, paracentesis, pleurocentesis with analysis of aspirate, CBC and electrocytes. All patients received 500 mg of doxycycline in 50 cc of normal saline via thoracostomy.

Results: The success rate was (85%, 17 out of 20 cases) comparable to TIPSS (100%) after the first instillation with no recurrence up to a median of9 months follow up. The success rate of reinstillation, in three cases of continued high volume tube output, was 66.6%. The overall success rate was 95%. Mean duration of hospitalization for the first instillation was 5 days, and 10 days for the second instillation. There was no significance difference in liver function tests, electrolytes and abdominal sonar findings before and after pleurodesis. Fever and pleural pain were the most common adverse effects but were mild in degree and short in duration.

Conclusion: Doxycycline pleurodesis is an easy, safe, inexpensive, and highly effective (85%) treatment comparable to TIPSS in critically ill patients with recurrent HHyd not responding to treatment. It is a good alternative to TIPPS in poor developing countries.