I recently read Drs. de la Mora-Levy and Baron's insightful and detailed review, which focused upon endoscopic management of liver transplant patients. 1 In the section dealing with pretransplant lower endoscopy, the authors suggest that screening colonoscopy should be performed, "weighing the risk of peritonitis" in cirrhotic patients with ascites. In this regard, I assume the authors are referring to the possible occurrence of "primary" or spontaneous bacterial peritonitis, as opposed to "secondary"peritonitis related to colonoscopic perforation. To my knowledge, gastrointestinal endoscopic societies, such as the American Society for Gastrointestinal Endoscopy, do not recommend prophylactic antibiotic administration prior to the performance of colonoscopy in cirrhotic patients with ascites. 2 This would presumably relate to there being a very low risk of bacteremia/spontaneous bacterial peritonitis after colonoscopy, in this patient population. I am unaware of any literature that has specifically addressed this issue in a cirrhotic population. What is the actual risk of bacteremia and spontaneous bacterial peritonitis in cirrhotics after screening colonoscopy? How specifically do the authors suggest that this potential risk be "weighed"? As the authors' statement is not referenced, further information and clarification would be welcome.