Comparative Study of Percutaneous Catheter Drainage versus Percutaneous Needle Aspiration in Treatment of Medium to Large Size Liver Abscess

Background: Modern management of liver abscesses includes a combination of percutaneous needle aspiration or percutaneous catheter drainage along with intravenous antibiotics. Liver abscess is a common disease in India, if not treated properly can lead to hazardous complication. Still, there is not much data regarding the support of percutaneous methodology in the management of medium to large size liver abscess. The study was aimed to compare percutaneous catheter drainage versus percutaneous needle aspiration in the treatment of medium to large size liver abscess.

Materials and Methods: This was a comparative study of 100 patients from august 2017 to august 2019, presented in outpatient and emergency department at MGM Medical College and M.Y. Hospital, Indore (M.P.) randomization was done and divide into two groups of 50 each and assigned two groups as percutaneous catheter drainage and percutaneous needle aspiration. Both groups were given intravenous antibiotic at least for 7 days. Both modalities were performed under the guidance of ultrasonography. Percutaneous needle aspiration was repeated up to three times and after that, if the size of the abscess cavity was not reduced to half, is considered as the failure of treatment. The effectiveness of either treatment was measured in terms of days to achieve clinical improvement, total/near-total resolution of abscess cavity and duration of hospital stay. Independent t-test was used to analyse these parameters.

Results: PNA was successful in 43 of 50 (86%) patients (one aspiration in 15, two in 24, and three in 11 patients), whereas PCD was successful in 49 (98%) patients (p=0.027). Duration of parenteral antibiotics needed (9.02 [2.48] vs. 10.90 [2.22] days; p=0.001) was significantly lower in the PCD group. Duration of hospital stay was (9.54 [3.36] vs. 11.40 [2.15] days; p=0.001) were significantly lower in the PCD group. Four patients with PNA had a subcapsular hematoma and three with PCD had continuous bile leakage which stopped spontaneously. No patient in the study died.

Conclusion: From our prospective study, we can conclude that the percutaneous continuous catheter drainage is better modality as compared to percutaneous intermittent needle aspiration in medium to large size liver abscess. The duration of hospital stay is comparatively lower in percutaneous catheter drainage and days of clinical relief were earlier in percutaneous catheter drainage. This study also verifies that both the percutaneous modalities were adequately effective in the treatment of liver abscess in terms of improvement in clinical features and laboratory investigations.