Percutaneous needle aspiration in uncomplicated amebic liver abscess: a randomized trial

Amoebic liver abscess develops in less than 1% of patients with amoebaisis and metronidazole is the drug of choice for the treatment of amebic liver abscess. Abscesses of less than 5 cm can be treated with metronidazole alone. However, abscesses of more than 10 cm must undergo ultrasound guided percutaneous needle aspiration along with metronidazole. The role of percutaneous needle aspiration in abscesses of 5 to 10 cm is not clear. Fifty-seven patients with a solitary, right lobe, uncomplicated amoebic liver abscess of 5-10 cm were randomized to receive either metronidazole alone (control group; n = 29) or ultrasound guided percutaneous needle aspiration along with metronidazole (intervention group; n = 28). Although the resolution of pain and fever occurred earlier in the intervention group (27 h and 17 h, respectively) than the control group (48 h and 30 h, respectively), the difference was not statistically significant (P = 0.16 and 0.48, respectively). There were no deaths during the study period and treatment failure, complications (rupture of abscess), days to normalization of leukocytosis and duration of hospitalization were similar in both groups. Ultrasound guided percutaneous needle aspiration along with metronidazole was no better than metronidazole alone in the management of uncomplicated, solitary, right lobe amoebic liver abscess of 5 to 10 cm.