Management of liver abscess from intervention radiologists' perspective

BackgroundWith the development of interventional radiology, the management of liver abscess (LA) has changed dramatically. The management practice now includes nonsurgical interventions, both for diagnostic and therapeutic purposes.PurposeThe purpose of the study was to report our experience of treating LA patients along with outcomes and comparison of two percutaneous intervention techniques in their respective indication window.Materials and methodsA prospective cohort study of all consecutive adult in-patient cases of LA managed based on a standard approach was performed.ResultsOf 80 LA patients, amoebic LA (57.5%) was the most common aetiology, followed by pyogenic LA (27.5%). More than 50% LA were solitary and 77.5% were localized to the right lobe, and large LA had more frequent abscess-related complications. Compared to amoebic LA, pyogenic LA are multiple, bilobar with more parenchymal damage. A significantly lesser duration of IV antibiotic was required in the percutaneous catheter drainage (PCD) group than the percutaneous needle aspiration (PNA) group (p = 0.03). The PCD group achieved early clinical improvement (p = 0.01) and reduction in the size of cavity (p & LE; 0.001) as compared to the PNA group. Treatment success rate was found to be better in the PCD group.ConclusionsAbout 2/3rd patients with amoebic LA require percutaneous interventions, which significantly reduced the antibiotic requirement with excellent outcome. PCD was more efficient and can be used as the primary mode of treatment in large LA or abscesses with local complications, along with systemic antibiotics. Following standardized treatment protocol for treatment of LA may help in excluding unnecessary investigation and in reducing the time to treatment or decision making.