Percutaneous Catheter Drainage Group Research Articles

The impact of liver abscess formation on prognosis of patients with malignant liver tumors after transarterial chemoembolization.

Liver abscess is a rare and serious complication after transarterial chemoembolization (TACE) for liver cancer; however, its impact on the prognosis is unclear. This retrospective study examined the outcomes of patients with liver abscess formation following TACE for malignant liver tumors to elucidate the impact of liver abscess formation on the prognosis of thesepatients. From January 2017 to January 2022, 1,387 patients with malignant tumors underwent 3,341 sessions of TACE at our hospital. Clinical characteristics of patients at baseline and follow-up were examined, including treatment and outcome of liver abscess, tumor response to the TACE leading to liver abscess, and overall survival time. Of 1,387 patients, 15 (1.1%) patients with liver abscess complications after TACE resulted in a total of 16 (0.5%) cases of liver abscess after 3,341 TACE sessions (including one patient with two events). After antibiotic or percutaneous catheter drainage (PCD) treatment, all the infections associated with liver abscesses were controlled. In the PCD group, eight patients died before drainage tube removal, one retained the drainage tube until the end of follow-up, and five underwent drainage tube removal; the mean drainage tube removal time was 149.17 ± 134.19 days. The efficacy of TACE leading to liver abscess was evaluated as partial response (18.75%), stable disease (37.5%), and progressive disease (43.75%). Eleven patients died during the follow-up period owing to causes unrelated to infections caused by liver abscesses. The survival rates at 3 months, 6 months, 1 year, and 5 years were 86.7%, 50.9%, 25.5%, and 17%,respectively. Patients with liver abscess formation following TACE for malignant liver tumors experienced prolonged drainage tube removal time after PCD; while this condition did not directly cause death, it indirectly contributed to a poor prognosis in these patients.

EUS-guided versus percutaneous liver abscess drainage: A multicenter collaborative study

ABSTRACT Background and Objectives Management of hepatic abscesses has traditionally been performed by image-guided percutaneous techniques. More recently, EUS drainage has been shown to be efficacious and safe. The aim of this study is to compare EUS-guided versus percutaneous catheter drainage (PCD) of hepatic abscesses. Methods Patients who underwent EUS-guided drainage or PCD of hepatic abscesses from January 2018 through November 2021 from 4 international academic centers were included in a dedicated registry. Demographics, clinical data preprocedure and postprocedure, abscess characteristics, procedural data, adverse events, and postprocedure care were collected. Results Seventy-four patients were included (mean age, 63.9 years; 45% male): EUS-guided (n = 30), PCD (n = 44). Preprocedure Charlson Comorbidity Index scores were 4.3 for the EUS group and 4.3 for the PCD group. The median abscess size was 8.45 × 6 cm (length × width) in the EUS group versus 7.3 × 5.5 cm in the PCD group. All of the abscesses in the EUS group were left-sided, whereas the PCD group contained both left- and right-sided abscesses (29 and 15, respectively). Technical success was 100% in both groups. Ten-millimeter-diameter stents were used in most cases in the EUS group, and 10F catheters were used in the PCD group. The duration to resolution of symptoms from the initial procedure was 10.9 days less in the EUS group compared with the PCD group (P < 0.00001). Hospital length of stay was shorter in the EUS group by 5.2 days (P = 0.000126). The EUS group had significantly fewer number of repeat sessions: mean of 2 versus 7.7 (P < 0.00001) and trended toward fewer number of procedure-related readmissions: 10% versus 34%. The PCD group had a significantly higher number of adverse events (n = 27 [61%]) when compared with the EUS group (n = 5 [17%]; P = 0.0001). Conclusions EUS-guided drainage is an efficacious and safe intervention for the management of hepatic abscesses. EUS-guided drainage allows for quicker resolution of symptoms, shorter length of hospital stay, fewer adverse events, and fewer procedural sessions needed when compared with the PCD technique. However, EUS-guided drainage may not be feasible in right-sided lesions.

Laparoscopic cholecystectomy versus percutaneous catheter drainage for acute cholecystitis in high risk patients

Aim: To assess which treatment modality, Patients with AC who are at a high risk should have a cholecystectomy performed using or percutaneous catheter drainage. Methodology: Sixty people were included in this study because they got diagnosed with acute calculous cholecystitis. Both the procedure of laparoscopic cholecystectomy and percutaneous catheter drainage were offered to them at random. Results: In terms of the need for further surgery, there was a statistically significant difference between the groups as there were 2 (6.7%) who needed re-intervention in laparoscopic cholecystectomy group and 14 (46.7%) in percutaneous catheter drainage group (p=0.001*), recurrent biliary disease as there were 2 (6.7%) in laparoscopic cholecystectomy group and 17 (56.7%) in percutaneous catheter drainage group (p<0.001*) and total length of hospital stay as the mean of laparoscopic cholecystectomy group was 4.9 (±2.77 SD) while in percutaneous catheter drainage group was 10.67 (±6.62 SD).Conclusion: Cholecystectomy with laparoscopic is favored over percutaneous drainage for high-risk individuals with acute cholecystitis. When compared to percutaneous catheter drainage, laparoscopic cholecystectomy decreased significant complications but did not affect fatality rates.

Comparison of endoscopic ultrasound-guided drainage and percutaneous catheter drainage of postoperative fluid collection after pancreaticoduodenectomy.

Postoperative fluid collection is a common complication of pancreatic resection without clear management guidelines. This study aimed to compare outcomes of endoscopic ultrasound (EUS)-guided trans-gastric drainage and percutaneous catheter drainage (PCD) in patients who experienced this adverse event after pancreaticoduodenectomy (PD). Demographic and clinical data and intervention outcomes of 53 patients who underwent drainage procedure (EUS-guided, n = 32; PCD, n = 21) for fluid collection after PD between January 2015 and June 2019 in our tertiary referral center were retrospectively analyzed. Prior to drainage, 83.0% had leukocytosis and 92.5% presented with one or more of the following signs or symptoms: fever (69.8%), abdominal pain (69.8%), and nausea/vomiting (17.0%). Within 8 weeks of drainage, 77.4% showed a diameter decrease of more than 50% (87.5% in EUS vs. 66.7% in PCD, p = 0.09). Post-procedural intravenous antibiotics were used for an average of 8.1 ± 4.3 days and 12.4 ± 7.4 days for EUS group and PCD group, respectively (p = 0.01). The EUS group had a shorter post-procedural hospital stay than the PCD group (9.8 ± 1.1 vs. 15.8 ± 2.2 days, p < 0.01). However, the two groups showed no statistically significant difference in technical or clinical success rate, reintervention rate, or adverse event rate. EUS-guided drainage and PCD are both safe and effective methods for managing fluid collection after PD. However, EUS-guided drainage can shorten hospital stay and duration of intravenous antibiotics use.

Endoscopic drainage versus percutaneous drainage for the management of infected walled-off necrosis: a comparative analysis

ABSTRACT Background Comparative data on percutaneous catheter drainage (PCD) vs EUS-guided drainage (EUS-D) for management of symptomatic walled-off-necrosis (WON), specially infected WON with/without organ failure(OF) is limited. Methods Patients with symptomatic WON were divided into two groups of PCD and EUS-D, depending on the modality of drainage. Resolution of OF, adverse events, and other outcome measures were recorded. The two modalities were compared among infected WON sub-cohort and also degree of solid component (SC). Results 218 patients (175 males; 80.3%) were included who underwent either PCD (n = 102) or EUS-D (n = 116). Clinical success was significantly higher in the EUS-D group (92.1% vs 64.6%; p < 0.0001) and even for infected WON (n = 128) (p = 0.004), with higher (p = 0.007) and faster (p < 0.0001) OF resolution. Other outcome measures including mortality were significantly higher in the PCD group. Among subgroups, PCD with >40% SC had the worst clinical success/OF resolution rates, while EUS-D with <40% SC had the best outcomes. Conclusion EUS-D should be preferred over PCD in the management of WON, infected or otherwise, for higher clinical success, and higher/faster resolution of OF. PCD should be avoided in WON with>40% SC.

Trocar Puncture With a Sump Drain for Crohn's Disease With Intra-Abdominal Abscess: A 10-Year Retrospective Cohort Study

BackgroundTraditional percutaneous catheter drainage (PCD) and surgical intervention could not always achieve satisfactory results for patients with Crohn's disease (CD) who have complications with intra-abdominal abscess. We proposed a trocar puncture with sump drainage for the treatment of CD with intra-abdominal abscess and compared it with the conventional PCD and surgical intervention.MethodsCrohn's disease patients with intra-abdominal abscess and admitted to our hospital from 2011 to 2020 were identified by reviewing the electronic medical records. We divided them into Trocar, PCD, and fecal diverting (FD) groups, according to the ways of treating an abscess. Outcomes, risk factors for abscess recurrence, and postoperative complications were compared among the three groups.ResultsA total of 69 patients were included and they were divided into Trocar (n = 18), PCD (n = 29), and FD (n = 22) groups. Four patients in the PCD group were transferred to receive the FD surgery due to the failure of initial treatment. The incidence of abscess recurrence was significantly higher in the PCD (48%) and FD (50%) groups compared to the patients using the trocar puncture with the sump drain (Trocar group) (16.7%). There were 8 patients in Trocar, 22 in PCD, and 20 s in the FD group who received enterectomy. None of the patients in the Trocar had an ultimate stoma and the incidence of postoperative complications was statistically lower [0% (Trocar) vs. 31.8% (PCD) vs. 45% (FD), P < 0.05]. The way of initial treating of the abscess was significantly correlated with the abscess recurrence and postoperative complications.ConclusionsTrocar puncture with a sump drain had a lower incidence of abscess recurrence, abdominal adhesions, postdrainage, and postoperative complications compared to the conventional PCD or surgical intervention.

Drainage procedures for postoperative fluid collection after pancreaticoduodenectomy: A comparison of endoscopic ultrasound guided and percutaneous drainage

Postoperative fluid collection (POFC) is a common complication of pancreas resection with no clear management guidelines and high morbidity rates. This study aims to analyze clinical features of patients with POFC and compare outcomes of endoscopic ultrasound (EUS) guided and percutaneous drainage in patients with POFC after pancreaticoduodenectomy (PD). We analyzed demographic data, clinical data and intervention outcomes of 53 (EUS guided = 32, percutaneous = 21) patients who underwent PD between January 1, 2015 and June 30, 2019 at our center. Prior to drainage, 83.0% had leukocytosis and 92.5% presented with one or more of the following signs or symptoms: fever (69.8%), abdominal pain (79.2%), and nausea/vomiting (17.0%). Fluid collection diameters showed a mean of 95 mm (range, 33 to 191 mm), of which 77.4% showed a diameter decrease of more than 50% within 8 weeks of drainage (EUS = 87.5% vs. PCD = 61.9%, p = 0.085). Eighty-two percent of sampled fluid collections showed positive culture results and post procedural IV antibiotics were used for an average of 8.1 ± 4.3 and 12.4 ± 7.4 days for EUS group (EG) and PCD group (PG) respectively (p = 0.012). EG had a shorter post-procedural hospital stay than PG (9.8 ± 1.1 vs. 15.8 ± 2.2 days, p = 0.004) with no statistically significant differences in technical and clinical success rates, reintervention rates and adverse event rates. EUS guided drainage (EUSD) and percutaneous catheter drainage (PCD) are both equally safe and effective in managing POFC after PD. However, EUSD was associated with shorter IV antibiotic treatment and shorter hospital stay.

A Prospective Cohort Study of Catheter Drainage versus Percutaneous Needle Aspiration in Treatment of Liver Abscess

Introduction: India has second highest incidence of liver abscess worldwide. Image guided drainage methods are increasingly used to treat liver abscesses with fairly high success rates and with low cost and patient preference. But to choose a preferred one among these two methods of Percutaneous Catheter Drainage (PCD) and Percutaneous Needle Aspiration (PNA) still is a dilemma. Aim: To compare the effectiveness and outcome of PCD and PNA in treatment of liver abscess. Materials and Methods: A prospective cohort study was conducted on 150 liver abscess patients in Shyam Shah Medical College in Vindhya region Rewa, Madhya Pradesh, India, from June 2019 to May 2020. They were divided into two groups PNA (n=75) and PCD (n=75) by simple randomisation. Patient outcome was on the basis of duration to attain clinical relief (assessed subjectively), duration of hospital stay and days required for reduction in cavity size below 50%, death, and success rates were assessed in terms of number of attempts for adequate pus drainage. Chi-square test, non-paired Student’s t-test and ANOVA tests were used. Results: In this study mean age was 40.57 years with 92.67% males. Most common lobe to involved was right lobe (87.3%). E.coli was the most common organism. All patients in PCD group were successfully treated in a single attempt. PNA group had a success rate of 84%. Mean number of days of clinical improvement were less for PCD (mean was 5.27 days) than PNA group (mean was 7.49 days) p-value=0.002. Mean days required for reduction in cavity size to less than 50% was lower in PCD (mean was 7.20 days) than PNA group (mean was 8.75 days) p-value=0.01. Total duration of hospital stay was higher in PNA (mean was 11.59 days) than in PCD group (mean was 9.28 days) p-value=0.03. All multiloculated cavities in PNA group were failures. Conclusion: PCD method was found to be more efficacious than needle aspiration method in this study.

Prospective randomized comparative study of percutaneous catheter drainage and percutaneous needle aspiration in the treatment of liver abscess.

This study aimed to assess the effectiveness and safety of percutaneous needle aspiration (PNA) and percutaneous catheter drainage (PCD) in the treatment of liver abscess. A prospective randomized study was conducted in the Department of Surgery, JN Medical College, Aligarh Muslim University, Aligarh, UP, India, between February 2018 and August 2019, after getting approval from the institutional ethics committee. A total of 543 patients with liver abscess were randomized into two groups using computer-generated randomization method. Appropriate details regarding patients' clinico-demographic profile and investigations were also collected. The effectiveness of either treatment was measured in terms of duration of intravenous antibiotic, clinical improvement, reduction in the size of cavity, treatment success rate, duration of hospital stay including long-term outcomes such as sonographic resolution of cavity and recurrence rate at 6 months post-treatment. The PCD group had statistically significant rate of duration of antibiotics need, days for clinical improvement and time for 50% reduction in abscess cavity and treatment success rate with comparable long-term outcomes. PCD is more efficient than PNA and can be used primarily in the treatment of both amoebic and pyogenic liver abscesses along with systemic antibiotics. However, PNA can serve as a safe alternative when PCD is not available.

Study of ultrasound-guided needle aspiration and catheter drainage in the management of liver abscesses.

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 22-74years) with liver abscess(es) and having abscess size more than 5cm, 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 6.8days [PNA] vs 10.5days [PCD]; p value: 0.011) and the average duration between intervention and discharge (5.9days [PNA] vs 10.2days [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 5cm). Catheter drainage should be reserved for cases that do not respond to a second attempt of aspiration.

Aggressive Percutaneous Catheter Drainage Protocol for Necrotic Pancreatic Collections.

Percutaneous catheter drainage (PCD) performed pro-actively for collections in acute pancreatitis (AP) is associated with better outcomes. However, there are onlya few studies describing this protocol. We aimed to evaluate an aggressive PCD protocol. Consecutive patients with AP who underwent PCD with an aggressive protocol between January 2018 and January 2019 were included. This protocol involved catheter upsizing at a pre-specified interval (every 4-6days) as well as drainage of all the new collections. The indications and technical details of PCD and clinical outcomes were compared with patients who underwent standard PCD. Out of the 185 patients with AP evaluated during the study period, 110 (59.4%) underwent PCD, all with the aggressive protocol. The historical cohort of standard PCD comprised of 113 patients. There was no significant difference in the indication of PCD and interval from pain onset to PCD between the two groups. The mean number of catheters was significantly higher in the aggressive PCD group (1.86 ± 0.962 vs. 1.44 ± 0.667, p = 0.002). Additional catheters were inserted in 54.2% of patients in aggressive group vs. 36.2% in the standard group (p = 0.006). Length of hospital stay and intensive care unit (ICU) stay were significantly longer in the standard PCD group (34.3 ± 20.14 vs. 27.45 ± 14.2days, p < 0.001 and 10.46 ± 12.29 vs. 4.12 ± 8.5, p = 0.009, respectively). There was no significant difference in mortality and surgery between the two groups. Aggressive PCD protocol results in reduced length of hospital stay and ICU stay and can reduce hospitalization costs.

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

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.

Prospective randomized comparison of ultrasound-guided percutaneous needle aspiration with percutaneous catheter drainage of liver abscesses

Background and Aims: Modern treatment of liver abscesses comprises combination of antibiotics and image-guided percutaneous needle aspiration (PNA) or percutaneous catheter drainage (PCD). However, there is debate regarding the choice of these interventions as the first line of management. Our aim was to compare the results of ultrasound-guided PCD with PNA in the management of liver abscesses. Materials and Methods: A total of 66 patients (55 males; 11 females, 18–65 years) who were diagnosed with liver abscesses were randomly divided into two groups of 33 patients each, namely ultrasound-guided PNA group (with a maximum of three attempts) and the PCD group. The outcomes of the treatment of the patients of these groups were documented and analyzed. Results: PNA was effective in 20 (61%) of the 33 patients after one (n = 14), two (n = 4), or three (n = 2) aspirations while PCD was therapeutic in all 33 patients after one (n = 29) or two (n = 4) procedures and without any major complications in both groups. All abscesses 45 mm or less in longest dimension were efficaciously managed, by both PCD as well as PNA while the later failed in case of multiloculated abscesses. The mean duration of intravenous antibiotics and time to clinical relief were significantly lesser in the PCD group. However, a period of hospital stay and time to complete resolution of abscess cavities did not differ significantly between the groups. Conclusions: Overall, PCD is more effective than PNA in the management of liver abscesses; the later, however, can be employed for smaller and simple abscesses.

A meta-analysis and systematic review of percutaneous catheter drainage in treating infected pancreatitis necrosis.

Background:In the current meta-analysis, we focus on the exploration of percutaneous catheter drainage (PCD) in terms of its overall safety as well as efficacy in the treatment of infected pancreatitis necrosis based on qualified studies.Methods:The following electronic databases were searched to identify eligible studies through the use of index words updated to May 2018: PubMed, Cochrane, and Embase. Relative risk (RR) or mean difference (MD) along with 95% confidence interval (95% CI) were utilized for the main outcomes.Results:A total of 622 patients in the PCD group and 650 patients in the control group from 13 studies were included in the present meta-analysis. The aggregated results indicated that the incidence of bleeding was decreased significantly (RR: 0.42, 95% CI: 0.25–0.70) in the PCD group as compared with the control group. In addition, PCD decreased the mortality (RR: 0.76, 95% CI: 0.41–1.42), hospital duration (SMD: −0.22, 95% CI: −0.77 to –0.33), duration in intensive care unit (ICU) (SMD: −0.13, 95% CI: −0.30 to –0.04), pancreatic fistula (RR: 0.73, 95% CI: 0.46–1.17), and organ failure (RR: 0.91, 95% CI: 0.45–1.82) in comparison with the control group, but without statistical significance.Conclusion:Our findings provide evidence for the treatment effect of PCD in the decrease of bleeding, mortality, duration in hospital and ICU, pancreatic fistula, organ failure as compared with the surgical treatment. In conclusion, further studies based on high-quality RCTs with larger sample size and long-term follow-ups are warranted for the confirmation of PCD efficacy in treating infected pancreatitis necrosis.

Laparoscopic cholecystectomy versus percutaneous catheter drainage for acute cholecystitis in high risk patients (CHOCOLATE): multicentre randomised clinical trial

ObjectiveTo assess whether laparoscopic cholecystectomy is superior to percutaneous catheter drainage in high risk patients with acute calculous cholecystitis.DesignMulticentre, randomised controlled, superiority trial.Setting11 hospitals in the Netherlands, February 2011 to...

Early ultrasound-guided percutaneous catheter drainage in the treatment of severe acute pancreatitis with acute fluid accumulation.

The clinical effect of early percutaneous ultrasound guided percutaneous catheter drainage (PCD) in treating severe acute pancreatitis complicated with acute fluid accumulation in the abdominal cavity was analyzed. A total of 178 patients with severe acute pancreatitis complicated with acute fluid accumulation in peritoneal cavity admitted from January, 2011 to January, 2015 to Chuiyangliu Hospital were retrospectively analyzed. Based on the treatment, patients were divided into the following groups: PCD group and conservative treatment control group. Time-period of systemic inflammatory response (SIRS), time-period of abdominal pain, bowel sounds recovery time, dietary recovery time, hospitalization days, white blood cell count, serum amylase, C-reactive protein, serum calcium and complications in both groups were observed and compared. The measurement data between the two groups were presented as mean ± standard deviation (±SD), and analyzed by t-test. Classification data were analyzed by the Chi-square test, with P<0.05 indicating a statistically significant difference. Time-period of systemic inflammatory response (SIRS), time-period of abdominal pain, bowel sounds recovery time, dietary recovery time and hospitalization days were shorter in the PCD group than those in the control group (P=0.001). Improvements of white blood cell count, serum amylase, C-reactive protein and serum calcium were better than those of the control group (P<0.001), the rate of transferring to surgical department in the PCD group was lower than that of the control group (P=0.042), and complications of severe acute pancreatitis were not significantly different in the two groups (P>0.05). In this study, 6 adverse events occurred in the PCD group, accounting for 7.9% (6/76), including 1 case of puncture bleeding and 5 cases of obstruction. In conclusion, early ultrasound-guided PCD in treating severe acute pancreatitis is effective and safe.

A Comparative Study of Percutaneous Catheter Drainage Versus Percutaneous Needle Aspiration In The Treatment of Medium to Large Sized Liver Abscess

Objective: To compare the effectiveness of percutaneous catheter drainage (PCD) and percutaneous needle aspiration (PNA) in the management of medium to large (>5 cm diameter) sized liver abscesses. Method: Seventy-two patients with liver abscess (amoebic 48, pyogenic 24) were randomly allocated to PCD or PNA (36 each), which were done within 24 hours of admission. Both groups received parenteral antibiotics for atleast 10 days. PNA was repeated every third day if the cavity size had not declined to 50% of the original for up to three times. Persistence of cavity or of clinical symptoms was considered failure of treatment. Duration to attain clinical relief, duration of hospital stay, complications, treatment failure, and deaths were recorded. Results PNA was successful in 31 of 36 (86%) patients (one aspiration in 10, two in 18, and three in 3 patients), whereas PCD was successful in 35 (97%) patients (p=ns). Duration to attain clinical relief (10.2 [2.0] vs. 8.1 [2.7] days; p=0.02) and parenteral antibiotics needed (15.5 [1.1] vs. 10.9 [2.7] days; p=0.04) were significantly lower in PCD group. Duration of hospital stay was similar in the two groups. One patient with PNA had a subcapsular hematoma and one with PCD had continuous bile leakage which stopped spontaneously .One patient in PCD group died. Conclusion: PCD is a better treatment option than PNA for the management of medium to large liver abscesses of size >5 cm in terms of duration to attain clinical relief and duration for which parenteral antibiotics are needed.

Minimally invasive percutaneous catheter drainage versus open laparotomy with temporary closure for treatment of abdominal compartment syndrome in patients with early-stage severe acute pancreatitis

This study aimed to examine the clinical efficacy of minimally invasive percutaneous catheter drainage (PCD) versus open laparotomy with temporary closure in the treatment of abdominal compartment syndrome (ACS) in patients with early-stage severe acute pancreatitis (SAP). Clinical data of 212 patients who underwent PCD and 61 patients who were given open laparotomy with temporary closure in our hospital over the last 10-year period were retrospectively analyzed, and outcomes were compared, including total and post-decompression intensive care unit (ICU) and hospital stays, physiological data, organ dysfunction, complications, and mortality. The results showed that the organ dysfunction scores were similar between the PCD and open laparotomy groups 72 h after decompression. In the PCD group, 134 of 212 (63.2%) patients required postoperative ICU support versus 60 of 61 (98.4%) in the open laparotomy group (P<0.001). Additionally, 87 (41.0%) PCD patients experienced complications as compared to 49 of 61 (80.3%) in the open laparotomy group (P<0.001). There were 40 (18.9%) and 32 (52.5%) deaths, respectively, in the PCD and open laparotomy groups (P<0.001). In conclusion, minimally invasive PCD is superior to open laparotomy with temporary closure, with fewer complications and deaths occurring in PCD group.

A study of the different treatment modalities used in the management of amoebic liver abscesses

Background: Amoebic liver abscess (ALA) is the most common extra intestinal manifestation of amoebiasis and is very common in the Indian subcontinent. ALA occurs in 3%-9% of patients with Entamoeba histolytica infection. Treatment modalities offered along with anti-amoebic medications are Guided percutaneous aspiration, Guided percutaneous drainage and Surgery. To study the indications and outcomes viz. symptomatic relief and resolution of clinical signs, resolution of the abscess, morbidity and mortality of the treatment modalities used for management of amoebic liver abscesses.Methods: This observational study included 100 patients diagnosed to harbour amoebic liver abscess. All the patients received metronidazole orally or intravenously in appropriate dose. Percutaneous aspiration (PCA) was used for impending rupture on ultasonography (rim &lt;10 mm), left lobe abscess, failure of medical management. Percutaneous catheter drainage (PCD) was performed for abscesses more than 150 cc, abscess with localised rupture and failure of medical management. Surgery was treatment offered in generalised peritonitis. Analysis pertaining to reduction of volume, duration of stay, morbidity and mortality was done for each modality.Results: Of the 100 patients, 33 were treated conservatively with medications alone with failure in 5 patients, 18 treated by percutaneous aspiration, 48 by percutaneous insertion of drain and 6 by surgery for ruptured abscess with generalised peritonitis. The mean duration of hospital stay in PCA group was 5.8 days while it was 9.12 days in PCD group. Bleeding (n=4) and bile leak (n=2) while bile leak (n=4) and death (n=2) were the complications reported in patients undergoing PCD and surgery, respectively.Conclusions: In Amoebic liver abscess PCA or PCD offers better and accelerated reduction in volume of abscess cavity with treatable morbidity and without fear of mortality and surgery can be avoided in these patients.

Predictive factors for successful ultrasound-guided percutaneous drainage in necrotizing pancreatitis.

Percutaneous catheter drainage (PCD) is now regarded as an initial minimal access technique of step-up approach for necrotizing pancreatitis. Factors that led to surgical intervention after initial management with PCD have rarely been reported. This study was to evaluate the safety and efficacy of ultrasound-guided PCD in patients with necrotizing pancreatitis and identify a subgroup of patients where PCD alone would be effective. We performed a retrospective review of patients with necrotizing pancreatitis who underwent intervention in West China Hospital from January 1, 2009, to March 31, 2013. Patients who underwent initial PCD therapy had lower intra-abdominal bleeding rate (41/235 vs. 1/51, P=0.002), lower enterocutaneous fistula rate (28/235 vs. 0/51, P=0.004), and lower mortality rate (46/235 vs. 3/51, P=0.001) when compared with the patients who underwent operative intervention. The successful PCD group had lower computed tomography (CT) mean density of necrotic fluid collection (18 HU vs. 25 HU, P=0.01) and higher prevalence of walled-off necrosis (20/35 vs. 5/16, P=0.04) when compared with failed PCD group. Multivariate analysis of the predictors of surgery showed that only CT mean density of necrotic fluid collection [odd ratio (OR) 1.63, 95% confidence interval (CI) 1.04-2.94, P=0.006] was identified as significant factor. CT mean density of necrotic fluid collection and the existence of acute necrotic collection could influence the success rate of PCD.