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Outcomes of a conservative approach to management in amoebic liver abscess

CONTEXT: Unfortunately, there is confusion among the medical community regarding the management of amoebic liver abscess (ALA). Therapeutic options range from simple pharmacotherapy to use of interventions like a needle or catheter aspiration under ultrasound guidance to surgical intervention. There...

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Autores principales: Kale, S, Nanavati, AJ, Borle, N, Nagral, S
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Medknow Publications & Media Pvt Ltd 2017
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5394811/
https://www.ncbi.nlm.nih.gov/pubmed/27652983
http://dx.doi.org/10.4103/0022-3859.191004
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author Kale, S
Nanavati, AJ
Borle, N
Nagral, S
author_facet Kale, S
Nanavati, AJ
Borle, N
Nagral, S
author_sort Kale, S
collection PubMed
description CONTEXT: Unfortunately, there is confusion among the medical community regarding the management of amoebic liver abscess (ALA). Therapeutic options range from simple pharmacotherapy to use of interventions like a needle or catheter aspiration under ultrasound guidance to surgical intervention. There is a plethora of thresholds for parameters such as the maximum diameter of the abscess and volume on ultrasound examination suggested by various authors to serve as a criterion to help to decide when to use which modality in these cases. AIMS: To assess the outcome of patients with uncomplicated ALA treated using a conservative approach. Moreover, to identify factors associated with its failure. SETTINGS AND DESIGN: A prospective, observational study was carried out at a large municipal urban health care center over a period of 3-year (2011–2014) in India. MATERIALS AND METHODS: Patients with uncomplicated ALA were recruited. All patients were managed with pharmacotherapy initially for a period of 72 h. Response to treatment was assessed by resolution of symptoms within the given time frame. Failure to respond was considered an indication for intervention. Needle aspiration was offered to these patients and response assessed within 72 h. Failure to respond to aspiration was considered an indication for catheter drainage. Statistical Analysis Used: Data recorded were entered in a Microsoft Office Excel Sheet and analyzed using the SPSS version 16.0 (IBM). RESULTS: Sixty patients with ALA were included in the study over its duration. Forty-nine (81.67%) patients were managed conservatively, while 11 (18.33%) patients needed an intervention for relief. Patients who required intervention had deranged liver function at presentation, a larger abscess diameter (10.09 ± 2.23 vs. 6.33 ± 1.69 cm P < 0.001) and volume (399.73 ± 244.46 vs. 138.34 ± 117.85 ml, P < 0.001) compared to those who did not need it. Patients that required intervention had a longer length of hospital stay (7.1 ± 2.4 vs. 4.8 ± 0.9 days, P < 0.001). On post hoc analysis, a maximum diameter of >7.7 cm was found to be the optimal criterion to predict the need of intervention in cases of ALA. CONCLUSIONS: A conservative approach is effective in the management of ALA for a majority of patients. Failure of conservative management was predicted by the size of the abscess (maximum diameter >7.7 cm). Even in the cases of failure, a gradual step-up with interventions was found to be safe and effective.
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spelling pubmed-53948112017-05-09 Outcomes of a conservative approach to management in amoebic liver abscess Kale, S Nanavati, AJ Borle, N Nagral, S J Postgrad Med Original Article CONTEXT: Unfortunately, there is confusion among the medical community regarding the management of amoebic liver abscess (ALA). Therapeutic options range from simple pharmacotherapy to use of interventions like a needle or catheter aspiration under ultrasound guidance to surgical intervention. There is a plethora of thresholds for parameters such as the maximum diameter of the abscess and volume on ultrasound examination suggested by various authors to serve as a criterion to help to decide when to use which modality in these cases. AIMS: To assess the outcome of patients with uncomplicated ALA treated using a conservative approach. Moreover, to identify factors associated with its failure. SETTINGS AND DESIGN: A prospective, observational study was carried out at a large municipal urban health care center over a period of 3-year (2011–2014) in India. MATERIALS AND METHODS: Patients with uncomplicated ALA were recruited. All patients were managed with pharmacotherapy initially for a period of 72 h. Response to treatment was assessed by resolution of symptoms within the given time frame. Failure to respond was considered an indication for intervention. Needle aspiration was offered to these patients and response assessed within 72 h. Failure to respond to aspiration was considered an indication for catheter drainage. Statistical Analysis Used: Data recorded were entered in a Microsoft Office Excel Sheet and analyzed using the SPSS version 16.0 (IBM). RESULTS: Sixty patients with ALA were included in the study over its duration. Forty-nine (81.67%) patients were managed conservatively, while 11 (18.33%) patients needed an intervention for relief. Patients who required intervention had deranged liver function at presentation, a larger abscess diameter (10.09 ± 2.23 vs. 6.33 ± 1.69 cm P < 0.001) and volume (399.73 ± 244.46 vs. 138.34 ± 117.85 ml, P < 0.001) compared to those who did not need it. Patients that required intervention had a longer length of hospital stay (7.1 ± 2.4 vs. 4.8 ± 0.9 days, P < 0.001). On post hoc analysis, a maximum diameter of >7.7 cm was found to be the optimal criterion to predict the need of intervention in cases of ALA. CONCLUSIONS: A conservative approach is effective in the management of ALA for a majority of patients. Failure of conservative management was predicted by the size of the abscess (maximum diameter >7.7 cm). Even in the cases of failure, a gradual step-up with interventions was found to be safe and effective. Medknow Publications & Media Pvt Ltd 2017 /pmc/articles/PMC5394811/ /pubmed/27652983 http://dx.doi.org/10.4103/0022-3859.191004 Text en Copyright: © 2017 Journal of Postgraduate Medicine http://creativecommons.org/licenses/by-nc-sa/3.0 This is an open access article distributed under the terms of the Creative Commons Attribution NonCommercial ShareAlike 3.0 License, which allows others to remix, tweak, and build upon the work non commercially, as long as the author is credited and the new creations are licensed under the identical terms.
spellingShingle Original Article
Kale, S
Nanavati, AJ
Borle, N
Nagral, S
Outcomes of a conservative approach to management in amoebic liver abscess
title Outcomes of a conservative approach to management in amoebic liver abscess
title_full Outcomes of a conservative approach to management in amoebic liver abscess
title_fullStr Outcomes of a conservative approach to management in amoebic liver abscess
title_full_unstemmed Outcomes of a conservative approach to management in amoebic liver abscess
title_short Outcomes of a conservative approach to management in amoebic liver abscess
title_sort outcomes of a conservative approach to management in amoebic liver abscess
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5394811/
https://www.ncbi.nlm.nih.gov/pubmed/27652983
http://dx.doi.org/10.4103/0022-3859.191004
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