Percutaneous catheter drainage for liver abscesses reduces IV antibiotics need

A new study published in BMJ Gastroenterology and Hepatology suggests that ultrasound-guided percutaneous catheter drainage (PCD) increases the treatment success rate in patients with liver abscesses by 136 in 1000 patients, enhances clinical outcomes by 3 days, and decreases the requirement for IV antibiotics by 4 days.

An intrahepatic infectious condition called a liver abscess is brought on by bacteria or amoebas. Patients with pyogenic liver abscesses might have death rates of up to 7.4% and 28% at one month and in intensive care units, respectively. The two main ultrasound-guided percutaneous therapeutic procedures used to treat liver abscesses are percutaneous catheter drainage and percutaneous needle aspiration (PNA). It's still unclear which of the two liver abscess therapies is preferable under various clinical circumstances. In order to examine the effectiveness and safety of ultrasound-guided PCD against PNA for liver abscess therapy, Jin-Wei Lin and colleagues carried out this study.

This was a systematic review, meta-analysis, and examination of the order of the trials. From their creation to March 16, 2022, PubMed, Web of Science, Cochrane Library, Embase, Airiti Library, and ClinicalTrials.gov were all searched. Without regard to language, randomized controlled studies comparing PCD versus PNA for liver abscess were accepted. Treatment success rate was the main result. To get overall estimates, either a fixed-effects model or a random-effects model was applied, depending on heterogeneity. 

The key findings of this study were:

There were 10 trials with 1287 participants in all.

A combined study showed that PCD improved treatment success rate when compared to PNA.

This solid conclusion was shown by trial-and-error sequential analysis when the necessary information size was obtained.

The subgroup analysis recommended PCD for big abscess.

In six studies with a total of 1000 patients, pooled analysis showed a significant advantage of PCD over PNA for the duration of intravenous antibiotic use, time to achieve a 50% reduction in abscess size, and time to achieve clinical improvement or complete clinical relief.

Complications and in-hospital mortality did not differ.

Reference:

Lin, J.-W., Chen, C.-T., Hsieh, M.-S., Lee, I.-H., Yen, D. H.-T., Cheng, H.-M., & Hsu, T.-F. (2023). Percutaneous catheter drainage versus percutaneous needle aspiration for liver abscess: a systematic review, meta-analysis and trial sequential analysis. In BMJ Open (Vol. 13, Issue 7, p. e072736). BMJ. https://doi.org/10.1136/bmjopen-2023-072736