To evaluate and compare the efficacy of intermittent needle aspiration and continuous catheter drainage in ultrasound-guided management of liver abscesses.
This was a prospective, randomised study conducted on 100 patients (88 males and 12 females; age range 22–74 years) with liver abscess(es) and having abscess size more than 5 cm, divided into two groups: Percutaneous needle aspiration (PNA) (n = 50) and percutaneous catheter drainage (PCD) (n = 50). Criteria of exclusion were: rupture of abscess before intervention; prior intervention; uncorrectable coagulopathy; concomitant biliary tract malignancy. In the PNA group, pus was aspirated by an 18-gauge needle using freehand technique and the number of aspirations was limited to two. Failure of abscess size to decline below 50% of the original diameter or of clinical improvement after second aspiration was considered as failure of aspiration. In the PCD group, drainage was done by 12-French catheters using Seldinger technique. Drainage was considered as failure if abscess cavity did not resolve and laparotomy was needed to evacuate the pus cavity.
The success rate in the PNA group was 88% and 92% in the PCD group; however, this difference was statistically not significant, suggesting that both are equally efficacious. The total duration of hospital stay (mean 6.8 days [PNA] vs 10.5 days [PCD]; p value: 0.011) and the average duration between intervention and discharge (5.9 days [PNA] vs 10.2 days [PCD]; p value:0.026) were significantly less in the PNA group. One major complication was seen in our study: peritonitis due to peri-catheter leak in PCD group.
Both procedures are equally efficacious in the management of liver abscesses; however in view of less duration of hospital stay, patient safety and comfort, procedure simplicity, and the reduced cost, needle aspiration should be used as the first-line procedure in the treatment of liver abscess (even in abscesses more than 5 cm). Catheter drainage should be reserved for cases that do not respond to a second attempt of aspiration.
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Conflict of interest
The authors declare no conflict of interest.
The authors also declare that all human studies have been approved by the appropriate ethics committee and have therefore been performed in accordance with the ethical standards of the Helsinki Declaration of 1975 and its later amendments. CTRI (Clinical trial registry of India) No. REF/2015/04/008824. Institutional ethical committee approval: DRPGMC/Ethics/2012/53.
Informed consent was taken from all patients included in the study.
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Ultrasound images showing S1) two abscesses in the liver S2, S3) both of which were aspirated by approaching the posterior abscess by passing the needle through the more anterior one. S4) Ultrasound image on day 3 showing near complete resolution of the posterior abscess and residual anterior abscess
Video- ultrasound clip showing two abscesses in the liver, both of which were aspirated by approaching the posterior abscess by passing the needle through the more anterior one
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Surya, M., Bhoil, R. & Sharma, Y.P. Study of ultrasound-guided needle aspiration and catheter drainage in the management of liver abscesses. J Ultrasound 23, 553–562 (2020). https://doi.org/10.1007/s40477-020-00440-3