Ultrasonically Guided Insertion of a Peritoneo-Gastric Shunt in Patients with Malignant Ascites

Purpose: A new method for internal drainage of malignant ascites is presented in 5 patients with symptomatic malignant ascites. Material and Methods: US-guided percutaneous gastrostomy and paracentesis were performed using the Seldinger technique. A 2.5-mm Cope-loop catheter was inserted in the fluid-filled stomach. In the lower abdomen the proximal part of a Denver peritoneo—venous shunt was introduced after dilation up to 4.8 mm. The pump chamber was sutured to the skin. The distal part of the Denver shunt was cut a few cm from the pump chamber and connected to the gastrostomy catheter. When pumping, ascites is shunted to the stomach lumen. Results: The insertion presented no complications, and all shunt systems initially functioned well. However, the shunts had to be removed within the first 2 weeks because of mechanical problems such as clotting, leakage, and peritoneal septum formation. No infections were reported. Conclusion: The peritoneo—gastric shunt may present a therapeutic alternative in selected patients, but the mechanical problems have first to be solved.