Comparative study of catheter drainage and needle aspiration in management of large liver abscesses.

Objective: To compare the effectiveness of percutaneous catheter drainage (PCD) and percutaneous needle aspiration (PNA) in the management of large (>10 cm diameter) liver abscesses.

Methods: Seventy-two patients with liver abscess (amebic 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 at least 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 large liver abscesses of size >10 cm, in terms of duration to attain clinical relief and duration for which parenteral antibiotics are needed.