The Reply

Abstract

We appreciate Dr Jolobe's interest in our recent article about pyogenic liver abscess.1Uehara K Harada Y Misdiagnosis of liver abscess resulting from misunderstood culture results.Am J Med. 2020; 133: e44-e45Abstract Full Text Full Text PDF Scopus (2) Google Scholar We agree with his argument that a gastrointestinal investigation should be considered in patients with pyogenic liver abscess because of the high risk of colorectal cancer.2Mohan BP Meyyur Aravamudan V Khan SR et al.Prevalence of colorectal cancer in cryptogenic pyogenic liver abscess patients. Do they need screening colonoscopy? A systematic review and meta-analysis.Dig Liver Dis. 2019; 51: 1641-1645Abstract Full Text Full Text PDF Scopus (7) Google Scholar, 3Kao W-Y Hwang C-Y Chang Y-T et al.Cancer risk in patients with pyogenic liver abscess: a nationwide cohort study.Aliment Pharmacol Ther. 2012; 36: 467-476Crossref Scopus (30) Google Scholar, 4Lai HC Lin CC Cheng KS et al.Increased incidence of gastrointestinal cancers among patients with pyogenic liver abscess: a population-based cohort study.Gastroenterology. 2014; 146: 129-137.e1Abstract Full Text Full Text PDF PubMed Scopus (56) Google Scholar However, because the case involved an 83-year-old man, performing a colonoscopy seemed controversial. Our patient had already undergone a gastroscopy and colonoscopy 2 years before the pyogenic liver abscess diagnosis. The colonoscopy detected 2 low-grade tubular adenomas, which were 10 mm and 5 mm in size, and both were completely resected. According to United States Preventive Services Task Force guidelines, our patient was within the safety interval of colonoscopy surveillance at the time of the pyogenic liver abscess diagnosis.5Lieberman DA Rex DK Winawer SJ Giardiello FM Johnson DA Levin TR Guidelines for colonoscopy surveillance after screening and polypectomy: a consensus update by the US Multi-Society Task Force on Colorectal Cancer.Gastroenterology. 2012; 143: 844-857Abstract Full Text Full Text PDF PubMed Scopus (1300) Google Scholar In addition, because the status of colorectal cancer screening before the diagnosis of pyogenic liver abscess has not been reported in previous studies, there is no data supporting the benefit of active surveillance of colorectal cancer in patients with pyogenic liver abscess who have already undergone a gastrointestinal investigation.2Mohan BP Meyyur Aravamudan V Khan SR et al.Prevalence of colorectal cancer in cryptogenic pyogenic liver abscess patients. Do they need screening colonoscopy? A systematic review and meta-analysis.Dig Liver Dis. 2019; 51: 1641-1645Abstract Full Text Full Text PDF Scopus (7) Google Scholar, 3Kao W-Y Hwang C-Y Chang Y-T et al.Cancer risk in patients with pyogenic liver abscess: a nationwide cohort study.Aliment Pharmacol Ther. 2012; 36: 467-476Crossref Scopus (30) Google Scholar, 4Lai HC Lin CC Cheng KS et al.Increased incidence of gastrointestinal cancers among patients with pyogenic liver abscess: a population-based cohort study.Gastroenterology. 2014; 146: 129-137.e1Abstract Full Text Full Text PDF PubMed Scopus (56) Google Scholar Moreover, the United States Preventive Services Task Force recommends against continuing routine screening of colorectal cancer in individuals aged 75 to 85 years.5Lieberman DA Rex DK Winawer SJ Giardiello FM Johnson DA Levin TR Guidelines for colonoscopy surveillance after screening and polypectomy: a consensus update by the US Multi-Society Task Force on Colorectal Cancer.Gastroenterology. 2012; 143: 844-857Abstract Full Text Full Text PDF PubMed Scopus (1300) Google Scholar Therefore, we believe that the colonoscopy was not warranted in our case at the time of the pyogenic liver abscess diagnosis. Although pyogenic liver abscess can be associated with a high risk of colorectal cancer, clinicians should carefully assess the necessity for a colonoscopy case by case, based on the status of routine colorectal cancer screening.