Diagnostic Accuracy of Peritoneoscopy to Determine the Cause of Low Serum Ascites Albumin Gradient

  • Pawan Parajuli
  • Ramesh S Bhandari
  • Rahul Pathak
  • Shashi Sharma
  • Prem K Khadga
  • Anurag Jha
  • Rabin Hamal
  • Brindeswari Kafle


Ascites, a common entity in practice of gastroenterology is pathophysiologically divided into high SAAG and
low SAAG category, to rapidly classify, formulate a workup plan and expedite the diagnosis. The cause of low
SAAG ascites is often due to local peritoneal cause e.g peritoneal tuberculosis, peritoneal carcinomatosis etc,
mandating the need of peritoneoscopy for definitive diagnosis. This study aims to present the peritoneoscopy
and peritoneal biopsy result of patients with low SAAG ascites of uncertain etiology.
Peritoneoscopy was prospectively performed in 12 patients with low SAAG ascites of unclear etiology. Patients
with low SAAG ascites and willing to give consent for peritoneoscopy were enrolled in the study. Patients
underwent laparoscopic peritoneoscopy under general anesthesia and appropriate biopsies were taken during
the procedure for histopathological analysis.
Of the twelve patients with low SAAG enrolled in the study, 3 (25%) were male and 75% (9) were female. The
success rate of the procedure was 100% and there was no procedure related complications. Specific findings were
seen in all patients undergoing peritoneoscopy. Of the twelve patients, 9 (75%) patients has metastatic deposits
in the peritoneum, 3 (25%) had benign etiology, 2/3rd (2) of whom had granulomatous deposits suggestive of
tuberculosis and 1/3rd (1) had extensive dense adhesions and peritoneal fibrosis. Primary focus was revealed
(ovary) in only 1 patient undergoing peritoneoscopy.
Peritoneoscopy with simultaneous biopsy is safe, efficient and accurate diagnostic method due to its high
diagnostic capacity and low complication rate in selected patients who have low SAAG ascites of uncertain
Ascites, peritoneal carcinomatosis, peritoneoscopy