Volume : 5, Issue : 3, March - 2016

PERCUTANEOUS NEEDLE ASPIRATION VERSUS CATHETER DRAINAGE IN THE MANAGEMENT OF LIVER ABSCESS: A SYSTEMATIC REVIEW AND META-ANALYSIS

Dr Shashank Desai, Dr Dhruv Gosai, Dr Bhavik Chauhan

Abstract :

<p>&nbsp;Objective: The aim of this study was to compare the effectiveness of percutaneous needle aspiration (PNA) and percutaneous catheter drainage (PCD) in the management of liver abscess. Methods: Electronic searches (Cochrane Liary, MEDLINE, EMBASE, SCIE) were conducted to identify randomized controlled trials (RCTs) comparing PNA and PCD. A meta-analysis was subsequently performed. Results: A total of five RCTs covering 306 patients were included. The meta-analysis showed that outcomes in patients treated with PCD were superior to those in patients treated with PNA in terms of success rate [relative risk (RR): 0.81, 95% confidence interval (CI) 0.66&ndash;0.99; P = 0.04], clinical improvement [standardized mean difference (SMD): &minus;0.73, 95% CI 0.36&ndash;1.11; P = 0.0001] and days to achieve a 50% reduction in abscess cavity size (SMD: &minus;1.08, 95% CI 0.64&ndash;1.53; P &lt; 0.00001). No significant differences were found in duration of hospitalization (mean difference: &minus;0.17, 95% CI &minus;2.10 to 1.75; P = 0.86) or procedure-related complications (RR: 0.50, 95% CI 0.10&ndash;2.63; P = 0.41). Days to achieve the total or near total resolution of the abscess cavity and mortality were not calculated because data in the RCTs in the meta-analysis were insufficient. Conclusions: Both PNA and PCD are safe methods of draining liver abscesses. However, PCD is more effective than PNA because it facilitates a higher success rate, reduces the time required to achieve clinical relief and supports a 50% reduction in abscess cavity size. However, among successfully treated patients, the outcomes of PNA are comparable with those of PCD.</p>