The management of cirrhotic ascites

✍ Scribed by Gin-ho Lo

• Publisher: John Wiley and Sons
• Year: 2009
• Tongue: English
• Weight: 41 KB
• Volume: 50
• Category: Article
• ISSN: 0270-9139
• DOI: 10.1002/hep.23140

✦ Synopsis

We read with interest the recent article by Runyon on diagnosis and treatment of ascites. 1 Surprisingly, determination of cholesterol in ascitic fluid was classified as being unhelpful (table 3 of the article). The value of cholesterol in the differentiation between cirrhotic and malignant ascites was first demonstrated in this journal. 2 Consequently, we compared cholesterol with other ascitic fluid parameters including the serum-ascites albumin gradient and found it superior. 3 Furthermore, we suggested a pathomechanism for the increase of ascitic cholesterol in malignant ascites. 4 The diagnostic value of this simple and cheap parameter was confirmed by several groups. [5][6][7][8] Thus, according to the grading system used in this article, cholesterol should be recommended as Class I, Level B. In our opinion, guidelines should be based on a careful review of the existing literature and free of personal bias. May we suggest that the guidelines be corrected accordingly.