A dilemma over percutaneous catheter drainage or percutaneous needle aspiration as first-line management of liver abscess

Abstract

Background: The aim of the study was to evaluate the clinical presentation and to investigate the effectiveness of percutaneous catheter drainage in comparison to needle aspiration in the treatment of liver abscesses of size more than 5 cm in diameter. Material and Methods: This was a prospective randomized comparative study of 60 patients, presented in outpatient and admitted at the hospital, randomized equally into two groups, percutaneous needle aspiration and percutaneous catheter drainage. The effectiveness of either treatment was measured in terms of duration of hospital stay, days to achieve clinical improvement and total/near total resolution of abscess cavity. Independent t- test was used to analyze these parameters. Results: Percutaneous catheter drainage was successful in all the 30 cases. On the other hand, USG guided percutaneous needle aspiration was successful only in 24 of 30 patients (P=0.005). Out of these 24 patients successfully treated, 6 patients required only one aspiration, 12 required two aspirations, and 6 required three aspirations. The 6 patients who did not show clinical improvement and / or decrease in cavity size despite 3 aspirations were taken as failures. In the PNA group, on comparing the cavity volumes the mean cavity volume in those who were successfully treated was 200 ml which was significantly less than those failing treatment; the mean volume being 400 ml. The patients in PCD group showed earlier clinical improvement (P=0.043) and decrease in abscess cavity volume (P=0.001) as compared to those who underwent PNA. In the present study, the success rate was significantly better in percutaneous catheter drainage group (P=0.005) than needle aspiration. The patients in percuaneous catheter drainage group showed earlier clinical improvement (P=0.043) as compared to those who underwent percutaneous needle aspiration. Conclusion: In the present study, percutaneous catheter drainage is found to be more effective than percutaneous needle aspiration for large liver abscesses of size 5 cm or more in diameter. The clinical improvement is also faster in PCD group than PNA group of the present study.