Evidence-based therapeutic dilemma in the management of uncomplicated amebic liver abscess: A systematic review and meta-analysis.

BACKGROUND

The role of metronidazole alone, percutaneous aspiration (PA), and percutaneous catheter drainage (PCD) in the treatment of uncomplicated amebic liver abscess (ALA) is still unclear. This systematic review and meta-analysis evaluated the available evidences with regard to treatment modalities in such patients.

METHODS

The database was searched for relevant randomized controlled trials (RCTs) published until May 2019. All studies were assessed for risk of bias. The relevant data were pooled in a random or fixed-effect model to calculate the mean difference (MD) or relative risks.

RESULTS

After the detailed screening, 570 patients from 10 RCTs comparing metronidazole alone with metronidazole + PA were included. Most studies had uncertain risk of biases. Days to resolution of abdominal pain (MD - 1.59, 95% confidence interval [CI] - 2.77, - 0.42, I2 = 89%) and tenderness (MD - 1.76, 95% CI - 2.93, - 0.58, I2 = 72%) were significantly shorter in the metronidazole + PA group. There was no significant difference in relation to the resolution of fever, abscess size, and hospital stay. The beneficial effects of PA were seen with medium-to-large (> 5 cm) ALA and not with small (< 5 cm) ALA. Addition of PCD to metronidazole therapy was better than metronidazole alone in one low-quality RCT. Two RCTs found PCD to be better than PA for large ALA.

CONCLUSIONS

Percutaneous aspiration as compared with metronidazole alone results in the early resolution of pain and tenderness in patients with medium-to-large ALA. Percutaneous catheter drainage is better for larger ALA. However, discrepancies in RCTs create therapeutic dilemmas necessitating further efforts to generate more reliable data.