Efficacy and Safety of Endoscopic Ultrasound-Guided Drainage in Liver Abscess Management: A Systematic Review and Meta-Analysis.

Purpose Percutaneous drainage is the standard nonsurgical treatment for liver abscess. Recent retrospective studies suggest that endoscopic ultrasound (EUS)-guided drainage may be an effective and safe alternative. We conducted a systematic review and meta-analysis to evaluate the efficacy and safety of EUS-guided drainage as a stand-alone approach and in comparison, with percutaneous drainage. Methods PubMed, EMBASE, and Cochrane databases were searched from inception through November 2025. The primary outcome was clinical success; secondary outcomes included technical success, total adverse events, and abscess relapse. Sensitivity analyses using a treatment-arm continuity correction were performed to address zero-event cells. Results Eleven studies were included (EUS, n = 186; percutaneous drainage, n = 325). In single-arm studies, pooled technical and clinical success rates with EUS were both 1.00 (95% CI, 0.95-1.00 and 0.99-1.00, respectively). Pooled total adverse event and relapse rates were 0.02 (95% CI, 0.00-0.12) and 0.00 (95% CI, 0.00-0.01), respectively. Comparative studies showed no significant differences between EUS and percutaneous drainage in technical success (RR 1.00, 95% CI, 0.83-1.19) or clinical success (RR 1.02, 95% CI, 0.86-1.22). EUS was associated with a significantly lower risk of total adverse events (RR 0.34, 95% CI, 0.15-0.76), while relapse rates were similar (RR 0.83, 95% CI, 0.30-2.33). Sensitivity analyses yielded consistent findings across all outcomes. Conclusion EUS-guided drainage is an effective and safe treatment for liver abscesses primarily involving the left hepatic and caudate lobes. Although EUS was associated with a lower risk for adverse events, larger comparative studies are needed to define its role in right lobe abscesses.