Uncomplicated amebic liver abscess: prospective evaluation of percutaneous therapeutic aspiration.

Abstract

The performance of therapeutic aspiration in the treatment of amebic liver abscess, advocated and practiced in many centers, is controversial. Previously, this practice has been evaluated in retrospective analyses. To test the potential benefit of therapeutic aspiration, the authors undertook a prospective randomized trial in 57 patients admitted for suspected amebic liver abscess during a 15-month period. Sixteen patients were excluded from the trial. The remaining 41 patients were randomly included in one of two study groups to receive amebicidal therapy alone or amebicidal therapy coupled with image-guided percutaneous therapeutic aspiration. All patients in the trial recovered. No statistically significant benefit was demonstrated in the aspiration group for the two objective parameters evaluated: length of hospitalization and duration of time to becoming afebrile. Subjective improvement in symptoms after aspiration was greater in the aspiration group at a marginally statistically significant level. These data do not support the adjunctive performance of percutaneous therapeutic aspiration in the treatment of uncomplicated amebic liver abscess. Amebicidals alone were equally efficacious in treating the group studied.

Efficacy of aspiration in amebic liver abscess

“…2 Van Allan et al (1992) undertook a prospective randomized trial in 41 patients of ALA to test the potential benefit of therapeutic aspiration. 9 The authors Sharma et al 1989 found that chemotherapy alone was as effective as routine needle aspiration and concluded that chemotherapy alone should be the preferred mode of therapy for ALA. 10 However, Ramani et al reported more rapid clinical response in the aspirated group, particularly in uncomplicated ALA with larger (>6cm) abscess cavities. 12 Freeman et al (1990) conducted a study in 36 patients to study the effect of percutaneous needle aspiration on healing or resolution time.…”

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

“…[14][15][16][17] In our study, medical management was successful in 28 out of 33 patients. All these patients had smaller abscesses or large unliquified abscesses.…”

Therapie von Tropenkrankheiten bei Reiserückkehrern

“…Die vorliegenden klinischen Studien zum Wert einer zusätzlichen Abzesspunktion sind methodisch unzureichend [19,25,29,60,69,75].Es ist Konsens,dass eine Abszesspunktion nur dann indiziert ist, wenn in den bildgebenden Verfahren eine Abszessruptur kurz bevor steht (⊡ Abb. 3), insbesondere bei Abszessen im linken Leberlappen (Gefahr der Herzbeuteltamponade).…”