Inclusion Criteria

Inclusion Criteria:

(Patients can receive chemotherapy at the discretion of treating oncologist)

1. Patients with recurrent malignant ascites

2. Patients with refractory malignant ascites

3. Proven malignancy

4. Age >= 18 years old

5. Eastern Cooperative Oncology Group (ECOG) performance scale =< 2

6. Ability to understand and willingness to sign a written informed consent

Definitions:

Malignant ascites: One of the following criteria

1. Positive ascitic fluid cytology

2. Histology proven malignancy with imaging studies with evidence of liver metastasis
and ascites

3. Malignant Budd Chiari Syndrome with associated ascites

4. Hepatocellular carcinoma and ascites

5. Chylous ascites due to lymphoma

6. Peritoneal carcinomatosis and concurrent ascites

7. Proven abdominal malignancy with concurrent ascites

Refractory / Recurrent ascites: One of the following criteria

1. Symptomatic ascites that recurred after one paracentesis in a patient with known
malignant ascites.

2. Symptomatic ascites that did not respond clinically to at least two weeks of
diuretics. Use of diuretics at the discretion of the treating physician.

3. Intolerance or relative contraindications to diuretics: (serum sodium (Na)
concentration of <125 mmol per liter or serum creatinine >1.5 mg/dl, hyperkalemia
(potassium >5.2 mEq/L or azotemia Bun/Creatinine ratio > 20).

4. Removal of at least 5 L in the preceding two months for symptoms relief

Exclusion criteria:

1. Life expectancy less than one month

2. Coagulopathy (international normalized ratio [INR] > 2 that does not correct with
fresh frozen plasma)

3. Hepatorenal syndrome

4. Active skin infections at abdomen before procedures

5. Inability to provide inform consent

6. Platelet counts < 50,000/mcL

7. Uncontrolled illness including, but not limited to, ongoing or active infection
requiring intravenous (IV) antibiotics, that the physician feels would increase the
risk of infection with the procedures or white blood cell (WBC) count > 20,000/mcL

8. Absolute neutrophil count <1000 / cu mm

9. Pregnant women

10. Multiloculated ascites