A Simple Method for Measuring Adenosine Triphosphate in Acute Cholangitis Patients to Determine the Need for Emergency Biliary Drainage.

Objective Acute cholangitis is occasionally life-threatening and requires immediate treatment. For the management of acute cases, globally accepted diagnostic criteria and the use of severity grading, as defined in the Tokyo Guidelines 2018 (TG18), are recommended. This study was performed to explore the association between acute cholangitis and the level of adenosine 5'-triphosphate (ATP) in blood as determined with a simple measurement method. Methods Twenty-three consecutive patients admitted for acute cholangitis and 14 healthy individuals were enrolled. Based on the TG18, the patients were categorized according to the degree of severity as Grade I, II, or III. We measured the amount of ATP in blood samples using a bioluminescence meter and evaluated the correlation with the degree of severity. Results The ATP/total hemoglobin (tHgb) level showed a significant decline in association with an increase in severity, as that in the healthy controls was 236.60 ± 8.10 and in the Grade I, II, and III groups was 238.56 ± 6.98, 186.88 ± 7.62, and 154.60 ± 11.01, respectively (p<0.01). While no significant difference was observed between the healthy controls and Grade I patients (p=0.649), there was a statistically significant difference between Grade I and Grade II (p<0.01) in the ATP/tHgb level. According to a receiver operating characteristic analysis, the area under the curve for ATP/tHgb, used as an index for predicting the need for emergency biliary drainage (Grade II, III cases), was the highest among various examined factors. Conclusion The present novel measurement method was found to be simple to perform and useful for detecting acute cholangitis patients with a low ATP level who may require emergency biliary drainage.

Measurement of Adenosine Deaminase in Ascitic Fluid Contributed to the Diagnosis in a Case of Tuberculous Peritonitis.

A diagnosis of tuberculous peritonitis (TBP) is difficult because of nonspecific manifestation and limited effectiveness of conventional diagnostic tools. Recently, the usability of measurement of ascitic adenosine deaminase (ADA) was shown. We report here a case of TBP in which measurement of ascitic ADA contributed to the diagnosis. A 93-year-old male developed a large amount of ascites. Analyses of the ascitic fluid revealed exudation, though antibiotics treatment was ineffective. Using paracentesis, the ADA level in the ascites was measured and shown to be high. Under suspicion of TBP, an exploratory laparoscopy was performed and a definitive diagnosis of TBP was made.