There was no significant difference in relation to the resolution of fever , abscess size , and hospital stay .
The beneficial effects of PA were seen with medium-to-large ( > 5 cm ) ALA and not with small ( < 5 cm ) ALA .
Percutaneous aspiration as compared with metronidazole alone results in the early resolution of pain and tenderness in patients with medium-to-large ALA .
Percutaneous catheter drainage is better for larger ALA .
The role of metronidazole alone , percutaneous aspiration ( PA ) , and percutaneous catheter drainage ( PCD ) in the treatment of uncomplicated amebic liver abscess ( ALA ) is still unclear .
This systematic review and meta- analysis evaluated the available evidence s with regard to treatment modalities in such patients .
Percutaneous treatment of liver abscesses: needle aspiration versus catheter drainage.
OBJECTIVE This study was design ed to determine and compare the efficacy of sonographically guided percutaneous needle aspiration and percutaneous catheter drainage in the treatment of liver abscesses . SUBJECTS AND METHODS In a r and omized study , 50 patients ( 38 males and 12 females ; age range , 2 - 72 years ; average age , 35 years ) with liver abscesses ( amebic , 20 ; pyogenic , 11 ; indeterminate , 19 ) underwent either percutaneous needle aspiration ( n = 25 ) or catheter drainage ( n = 25 ) along with appropriate antimicrobial therapy . In patients assigned to the needle aspiration group , an 18-gauge needle was used to aspirate the abscess cavity . Repeated aspiration was attempted only once in each patient not responding to the first aspiration ; nonresponse to the second aspiration was considered failure of treatment , and these patients were given catheter drainage ( however , these patients were not included in the catheter drainage group ) . For catheter drainage , 8- to 12-French catheters were introduced into the abscess cavity using the Seldinger technique . In patients with multiple abscesses ( seven in aspiration group and five in catheter group ) , all the abscesses except those smaller than 3 cm were subjected to percutaneous treatment . Patients were followed up to assess the outcome of the percutaneous treatment , length of hospital stay , and development of any complications .  Sonography was performed every third day during hospitalization . After discharge of the patient , periodic clinical and sonographic examinations were done until total resolution of abscesses was achieved . RESULTS Although percutaneous needle aspiration was successful in only 15 ( 60 % ) of the 25 patients after one ( n = 11 ) or two ( n = 4 ) aspirations , catheter drainage was curative in all 25 patients ( 100 % ) ( p < .05 ) . Among the successfully treated patients , the average time for clinical improvement and the mean hospital stay were similar in the two treatment groups . Although the average time needed for a 50 % reduction in the size of the abscess cavity was significantly ( p < .05 ) greater in the aspiration group than in the catheter group ( 11 days versus 5 days ) , the average time taken for total resolution of abscess was the same ( 15 weeks ) in both groups . No major complications were encountered . No relapse was documented on clinical and sonographic examination during follow-up , which ranged from 8 to 37 weeks . CONCLUSION Our results show that percutaneous catheter drainage is more effective than needle aspiration in the treatment of liver abscesses . Needle aspiration , if limited to two attempts , has a high failure rate
There was no significant difference in relation to the resolution of fever , abscess size , and hospital stay .
The beneficial effects of PA were seen with medium-to-large ( > 5 cm ) ALA and not with small ( < 5 cm ) ALA .
Percutaneous aspiration as compared with metronidazole alone results in the early resolution of pain and tenderness in patients with medium-to-large ALA .
Percutaneous catheter drainage is better for larger ALA .
The role of metronidazole alone , percutaneous aspiration ( PA ) , and percutaneous catheter drainage ( PCD ) in the treatment of uncomplicated amebic liver abscess ( ALA ) is still unclear .
This systematic review and meta- analysis evaluated the available evidence s with regard to treatment modalities in such patients .