Percutaneous catheter drainage versus needle aspiration for liver abscess management: an updated systematic review, meta-analysis, and meta-regression of randomized controlled trials

Abstract

Background Liver abscess is a life-threatening condition. Percutaneous catheter drainage (PCD) and percutaneous needle aspiration (PNA) are both minimally invasive techniques used to manage liver abscess. We aim to compare both techniques’ efficacy and safety. Methods We performed a systematic review and meta-analysis involving randomized controlled trials (RCTs) from PubMed, Embase, Scopus, WOS, Cochrane, and Google scholar until July 22 nd , 2022. We pooled dichotomous outcomes using risk ratio (RR) presented with a 95% confidence interval (CI) and continuous outcomes using mean difference (MD) with 95% CI. We registered our protocol with ID: CRD42022348755. Results We included 15 RCTs with 1,626 patients. Pooled RR favored PCD (RR: 1.21 with 95% CI: 1.11, 1.31, P<0.00001) in success rate and recurrence after six months (RR: 0.41 with 95% CI: 0.22, 0.79, P=0.007). We found no difference in adverse events (RR: 2.2 with 95% CI: 0.51, 9.54, P=0.29). Pooled MD favored PCD in time to clinical improvement (MD: −1.78 with 95% CI: −2.50, −1.06, P<0.00001), time to achieve 50% reduction (MD: −2.83 with 95% CI: −3.36, −2.30], P<0.00001) and duration of antibiotic needed (MD: −2.13 with 95% CI: −3.84, −0.42, P=0.01). We found no difference in the duration of hospitalization (MD: −0.72 with 95% CI: −1.48, 0.03, P=0.06). The results were heterogeneous for all the continuous outcomes which were all measured in days. Conclusions Our updated meta-analysis concluded that PCD is more effective than PNA in liver abscess drainage. However, evidence is still uncertain, and more high-quality trials are still required to confirm our results.

Percutaneous catheter drainage versus percutaneous needle aspiration for liver abscess: a systematic review, meta-analysis and trial sequential analysis

“…In terms of PCD treatment efficacy, complications and clinical improvement, two additional recently published meta-analyses yielded similar results to our study 35 36. Based on abscess size and pus volume, Mahmoud et al performed meta-regression analysis 36. Our meta-regression analysis supported their conclusion regarding the association between abscess size and treatment efficacy.…”

“…In terms of PCD treatment efficacy, complications and clinical improvement, two additional recently published meta-analyses yielded similar results to our study 35 36. Based on abscess size and pus volume, Mahmoud et al performed meta-regression analysis 36.…”

Demographics and prognosis of patients with pyogenic liver abscess due to Klebsiella pneumonia or other species

“…In addition to antibiotic treatment, percutaneous intervention is also an important intervention for patients with PLA, because rapid removal of pus can significantly shorten the hospital stay, improve patient prognosis, and reduce hospitalization costs [ 1 ]. Over the past two decades, PNA and PCD have played increasingly important roles in treating liver abscesses, although there is still considerable debate as to which is superior [ 27 , 28 ]. Our KPPLA and non-KPPLA groups both had higher prevalences of infections in the right liver, possibly because of the larger size of the right hepatic lobe and because this lobe receives a greater portal blood supply.…”

“…Our overall treatment success rate (from PNA or PCD) was 89.61 %, and was unrelated to the causative pathogen. Some recent studies suggested were some differences in the efficacy of PCD and PNA depending on abscess size and pathogen species [ 1 , 27 , 28 ]. We also compared the effects of different modalities of pus removal in the KPPLA and non-KPPLA groups; there was no difference for the non-KPPLA group, but PNA was superior to PCD in the KPPLA group in terms of hospital stay and hospital costs, although both modalities provided good safety and efficacy.…”

Updates on the Causes, Diagnosis, and Management of Peritoneal Abscesses: A Systematic Review

“…Under imaging guidance, usually ultrasound or CT, abscesses can be drained percutaneously. This minimally invasive approach has become a first-line treatment for many abscesses, especially when they are easily accessible and not complicated by fistulas or multi-loculated collections [ 17 ]. Some abscesses, especially those that are multi-loculated, associated with a fistula, or not amenable to percutaneous drainage (PD), require surgical intervention.…”