Percutaneous catheter drainage versus percutaneous needle aspiration for liver abscess: a systematic review, meta-analysis and trial sequential analysis

Abstract

Objective: To compare the effectiveness and safety of percutaneous catheter drainage (PCD) against percutaneous needle aspiration (PNA) for liver abscess.

Design: Systematic review, meta-analysis and trial sequential analysis.

Data sources: PubMed, Web of Science, Cochrane Library, Embase, Airiti Library and ClinicalTrials.gov were searched from their inception up to 16 March 2022.

Eligibility criteria: Randomised controlled trials that compared PCD to PNA for liver abscess were considered eligible, without restriction on language.

Data extraction and synthesis: Primary outcome was treatment success rate. Depending on heterogeneity, either a fixed-effects model or a random-effects model was used to derive overall estimates. Review Manager V.5.3 software was used for meta-analysis. Trial sequential analysis was performed using the Trial Sequential Analysis software. Certainty of evidence was evaluated using the Grading of Recommendations, Assessment, Development and Evaluation system.

Results: Ten trials totalling 1287 individuals were included. Pooled analysis revealed that PCD, when compared with PNA, enhanced treatment success rate (risk ratio 1.16, 95% CI 1.07 to 1.25). Trial sequential analysis demonstrated this robust finding with required information size attained. For large abscesses, subgroup analysis favoured PCD (test of subgroup difference, p<0.001). In comparison to PNA, pooled analysis indicated a significant benefit of PCD on time to achieve clinical improvement or complete clinical relief (mean differences (MD) -2.53 days; 95% CI -3.54 to -1.52) in six studies with 1000 patients; time to achieve a 50% reduction in abscess size (MD -2.49 days; 95% CI -3.59 to -1.38) in five studies with 772 patients; and duration of intravenous antibiotic use (MD -4.04 days, 95% CI -5.99 to -2.10) in four studies with 763 patients. In-hospital mortality and complications were not different.

Conclusion: In patients with liver abscess, ultrasound-guided PCD raises the treatment success rate by 136 in 1000 patients, improves clinical outcomes by 3 days and reduces the need for intravenous antibiotics by 4 days.

Prospero registration number: CRD42022316540.

Keywords: public health; systematic review.

Figure 1

Forest plots showing the effect of percutaneous catheter drainage (PCD) and percutaneous needle aspiration (PNA) on success rate.

Figure 2

Forest plots showing subgroup analysis of success rate between percutaneous catheter drainage (PCD) and percutaneous needle aspiration (PNA) based on actual mean abscess size.

Figure 3

Trial sequential analysis of percutaneous catheter drainage (PCD) versus percutaneous needle aspiration (PNA) for success rate. The blue line (Z-curve) shows the cumulative meta-analysis adding the results of individual trials based on the year of publication. The horizontal red line represents the conventional boundary with a 5% level of significance. The monitoring boundary (black sloping lines) shows the significance level after adjusting for the cumulative analysis. The black vertical line shows the required information size (RIS). After diversity adjustment, the estimated information size required was 1191 participants.