Percutaneous catheter drainage versus needle aspiration for liver abscess management: an updated systematic review, meta-analysis, and meta-regression of randomized controlled trials

BACKGROUND: Liver abscess is a life-threatening condition. Percutaneous catheter drainage (PCD) and percutaneous needle aspiration (PNA) are both minimally invasive techniques used to manage liver abscess. We aim to compare both techniques’ efficacy and safety. METHODS: We performed a systematic review and meta-analysis involving randomized controlled trials (RCTs) from PubMed, Embase, Scopus, WOS, Cochrane, and Google scholar until July 22(nd), 2022. We pooled dichotomous outcomes using risk ratio (RR) presented with a 95% confidence interval (CI) and continuous outcomes using mean difference (MD) with 95% CI. We registered our protocol with ID: CRD42022348755. RESULTS: We included 15 RCTs with 1,626 patients. Pooled RR favored PCD (RR: 1.21 with 95% CI: 1.11, 1.31, P<0.00001) in success rate and recurrence after six months (RR: 0.41 with 95% CI: 0.22, 0.79, P=0.007). We found no difference in adverse events (RR: 2.2 with 95% CI: 0.51, 9.54, P=0.29). Pooled MD favored PCD in time to clinical improvement (MD: −1.78 with 95% CI: −2.50, −1.06, P<0.00001), time to achieve 50% reduction (MD: −2.83 with 95% CI: −3.36, −2.30], P<0.00001) and duration of antibiotic needed (MD: −2.13 with 95% CI: −3.84, −0.42, P=0.01). We found no difference in the duration of hospitalization (MD: −0.72 with 95% CI: −1.48, 0.03, P=0.06). The results were heterogeneous for all the continuous outcomes which were all measured in days. CONCLUSIONS: Our updated meta-analysis concluded that PCD is more effective than PNA in liver abscess drainage. However, evidence is still uncertain, and more high-quality trials are still required to confirm our results.