Comments on the editorial by Riggio & Ageloni on the ascitic fluid analysis

Online Submissions: wjg. wjgnet.comWorld JGastroenterol 2009 December 28; 15(48): 6137-6138wjg@wjgnet.comWorld Jourmal of Gastroenterology ISSN 1007-9327doi:10.3748/ wjg.15.6137◎2009 The W]G Press and Baishideng All rights reserved.LETTERS TO THE EDITORComments on the editorial by Riggio & Ageloni on theascitic fluid analysisAnastasios KoulaouzidisAnastasios Koulaouzidis, Day Case & Endoscopy Unit,I would like to comment on a few points presented inCentre of Liver and Digestive Disorders, Royal Infirmary ofthis editorial. First of all, I would appreciate if the authorsEdinburgh, 51 Little France Crescent, Edinburgh, EH16 4SA,could clarify the statement on the need for collction ofAuthor contributions: Koulaouzidis A reviewed the literature,10 mL ascitic fuid (AF) in ethylenediaminetetraacetic acidanalyzed the data, and wrote the manuscript.(EDTA) containing tube. Universally, most of the EDTACorrespondence to: Anastasios Koulaouzidis, MD, MRCPtubes ("“purple-top or red-top tubes'", used for blood(UK), FEBG, Day Case & Endoscopy Unit, Centre of Liver andcollection) have a maximum capacity of 2.5-3.0 mL. IfDigestive Disorders, Royal Infirmary of Edinburgh, 51 LittleRiggio & Angeloni meant the universal containers, it is myFrance Crescent, Edinburgh, EH16 4SA,understanding that these tubes, except for being sterile,United Kingdom. akoulaouzidis@hotmail.comthey do not contain any anticoagulant. On top of that,Telephone: +44-131-2421603 Fax: +44-131-2421618lovember 13, 2009 Revised: November 27, 2009only 1 mL of fuid is enough for most laboratories to doAccepted: December 4, 2009the differential diagnosis. I disagree with the statementPublished online: December 28, 2009that“following hospitalization of any cirrhotic patientwith newly diagnosed ascites, a diagnostic paracentesisis advised". In fact, all cirrhosis with ascites should havediagnostic paracentesis on hospital admission月AbstractThere are indeed 4 well-disseminated practicalAngeloni et al published a landmark study on the useguidelines and expert's consensus reports, but many otherof Coulter counters in spontaneous bacterial peritonitisnational guidelines have been produced as well".(SBP) diagnosis. Riggio and Angeloni have recentlyRiggio & Angeloni's comprehensive“Table 2”published an editral on the ascitic fluid analysis in should list 90 AF samples and not 47 in the study bydiagnosis and monitoring of SBP. Herein, some pointsWisniewski et al', 2123 samples and not 1041 in the studyof interest are discussed.by Nousbaum et al", and 78 samples and not 72 in thestudy by Vanbiervliet et al', although three studies have⑤2009 The WJG Press and Baishideng. All rights reserved.not been included. In addition, Castellote et al' in arecently published paper argued that the leucocyte reagentKey words: Peritonitis; Reagent; Dipstick; Paracentesis;strips may have a role in repeated paracentesis and henceGuidelines; Ascitesmanagement of SBP.Koulaouzidis A. Comments on the editorial by Riggio &Ageloni on the ascitic fluid analysis. World J GastroenterolREFERENCES2009; 15(48): 6137-6138 Available from: URL: htp://ww.w1 Riggio O, Angeloni S. Ascitic fluid analysis for diagnosiswjgnet.com/ 1007-9327/15/6137.asp DOI: http://dx.doi.and monitoring of spontaneous bacterial peritonitis. World ]org/10.3748/wjg. 15.6137Gastroenterol 2009; 15: 3845-38502 Angeloni s, Nicolini G, Merli M, Nicolao F, Pinto G, AronneT, Attili AF, Riggio O. Validation of automated blood cellcounter for the determination of polymorphonuclear cellcount in the ascitic fluid of cirrhotic patients with or withoutTO THE EDITORspontaneous bacterial peritonitis. Am J Gastroenterol 2003; 98:I read with great interestthe editorial of Riggio &3 Rimola A, Garcia-Tsao G, Navasa M, Piddock LJ,1844-1848Angeloni on“The ascitic fluid analysis for diagnosisPlanas R, Bernard B, Inadomi JM. Diagnosis, treatmentand monitoring of spontaneous bacterial peritonitis"and prophylaxis of spontaneous bacterial peritonitis: aIn 2003, Angeloni et al- published the landmark paper,consensus dcraumant Intgrnatins! Acritae Club. J Hepatolwhich set a new era in the diagnostic algorithm of2000; 32: 142-中国煤化工spontaneous bacterial peritonitis (SBP), allowing manyKoulaouzidisHCNMHG2.1049eous tbacterialperitonitis. n-1049clinicians and laboratory staff to feel secure in switching5 Wisniewski B, Rautou PE, Al Sirafi Y, Lambare-Narcy B, .from polymorphonuclear (PMN) manual count to theDrouhin F, Constantini D, Fischer D, Labayle D, Denis J.automated one.[Diagnosis of spontaneous ascites infection in patients with.www.wjgnet.com6138 ISSN 1007-9327CN 14-1219/R World J Gastroenterol December 28, 2009 Volume 15 Number 48cirrhosis: reagent strips] Presse Med 2005; 34: 997-1000Hepatol 2005; 11: 243-249i Nousbaum JB, Cadranel JF, Nahon P, Khac EN, Moreau9 Li J, Pan Y, Bao WG, Niu JQ, Wang F. [Multistix10SGR, Thevenot T, Silvain C, Bureau C, Nouel O, Pilette Curine test in diagnosing spontaneous bacterial peritonitis]Paupard T, Vanbiervliet G, Oberti F, Davion T, JouannaudZhonghua Ganzangbing Zazhi 2006; 14: 784-785V, Roche B, Bernard PH, Beaulieu S, Danne O, Thabut D,10 de Araujo A, de Barros Lopes A, Trucollo Michalczuk M,Chagneau-Derrode C, de Ledinghen V, Mathurin P, Pauwels .DerrodeC, (Stifft J, Nardelli Bar G, Rossi G, AlvIvares-dada-SilvaA, Bronowicki JP, Habersetzer F, Abergel A, Audigier JC,MR. Is there yet any place for reagent strips in diagnosingSapey T, Grange JD, Tran A. Diagnostic accuracy of the :spontaneous bacterial peritonitis in cirrhotic patients?Multistix 8 SG reagent strip in diagnosis of spontaneousAn accuracy and cost-effectiveness study in Brazil. JGastroenterol Hepatol 2008; 23: 1895-19007 Vanbiervliet G, Rakotoarisoa C, Filippi J, Guerin O, Calle 1:G, Hastier P, Marine- Barjoan E, Schneider S, Piche T,Gasem J, Tharakan J, Maltezos E, Saeed AA. LeucocyteBroussard JF, Dor JF, Benzaken S, Hebuterne X, Rampal P,esterase reagent strips for the diagnosis of spontaneousTran A. Diagnostic accuracy of a rapid urine- screening testbacterial peritonitis: a systematic review. Eur J Gastroenterol(Multistix8SG) in cirrhotic patients with spontaneous bacterialHepatol 2008; 20: 1055-1060peritonitis. Eur J Gastroenterol Hepatol 2002; 14: 1257-126012 Castellote J, Girbau A, Ariza X, Salord S, Vazquez X, Lobat6n3 Kim DK, Suh D], Kim GD, Choi WB, Kim SH, Lim YS, LeeT, Rota R, Xiol x. Usefulness of reagent strips for checkingHC, Chung YH, Lee YS. [Usefulness of reagent strips forcure in spontaneous bacterial peritonitis after short-coursethe diagnosis of spontaneous bacterial peritonitis ] Korean Jtreatment. Aliment Pharmacol Ther 2009; Epub ahead of printS- Editor TianL L- Editor Wang XL E- Editor Lin YP中国煤化工MYHCNMH G.www.wjgnet.com