Catheter drainage versus needle aspiration in management of large (>10 cm diameter) amoebic liver abscesses

OBJECTIVES: To compare the effectiveness of percutaneous catheter drainage (PCD) and percutaneous needle aspiration (PNA) in the management of large (>10 cm diameter) amoebic liver abscesses. METHODS: Eighty-two patients with amoebic liver abscess were randomly allocated to PCD (n = 42) or PNA (n = 40). Intervention was done under ultrasonography (US) [mainly] or computed tomography guidance within 24 h of admission. PNA was repeated every 3rd day if the cavity size had not reduced to 50% of the original size, 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 32 (80%) patients (one aspiration in 4, two in 18 and three in 10 patients), while PCD was successful in 38 (90.5%) patients. Durations to attain clinical relief and parentral antibiotics required were significantly lesser in the PCD group. Hospital stay, although did not differ significantly, was lesser for PCD group. The only procedure-related complication due to PCD was rupture of abscess in two cases, leading to sepsis and death of one patient. Complications of PNA included pleural injury in one patient, and haemorrhage leading to subcapsular hematoma in another. CONCLUSION: PCD is a better treatment option than PNA for the management of large (>10 cm diameter) amoebic liver abscess, in terms of duration to attain clinical relief and duration for which parentral antibiotics were needed.