Percutaneous catheter drainage versus percutaneous needle aspiration for liver abscess: a systematic review, meta-analysis and trial sequential analysis

ObjectiveTo compare the effectiveness and safety of percutaneous catheter drainage (PCD) against percutaneous needle aspiration (PNA) for liver abscess.DesignSystematic review, meta-analysis and trial sequential analysis.Data sourcesPubMed, Web of Science, Cochrane Library, Embase, Airiti Library an...

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Published in:BMJ open 2023-07, Vol.13 (7), p.e072736-e072736
Main Authors: Lin, Jin-Wei, Chen, Chung-Ting, Hsieh, Ming-Shun, Lee, I-Hsin, Yen, David Hung-Tsang, Cheng, Hao-Min, Hsu, Teh-Fu
Format: Article
Language:English
Subjects:
Abscesses
Anti-Bacterial Agents - therapeutic use
Bias
Biopsy, Needle
Catheters
Drainage
Gastroenterology and Hepatology
Hospitals
Humans
Hypothesis testing
Liver
Liver Abscess - drug therapy
Meta-analysis
Mortality
public health
Software
Statistical analysis
Suction
Systematic review
Ultrasonic imaging
Variables
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cited_by cdi_FETCH-LOGICAL-b540t-76f59c185079b1d657f935b8192438f6137423c34ef92e480e9f07b71300ebe33
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creator Lin, Jin-Wei
Chen, Chung-Ting
Hsieh, Ming-Shun
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Yen, David Hung-Tsang
Cheng, Hao-Min
Hsu, Teh-Fu
description ObjectiveTo compare the effectiveness and safety of percutaneous catheter drainage (PCD) against percutaneous needle aspiration (PNA) for liver abscess.DesignSystematic review, meta-analysis and trial sequential analysis.Data sourcesPubMed, Web of Science, Cochrane Library, Embase, Airiti Library and ClinicalTrials.gov were searched from their inception up to 16 March 2022.Eligibility criteriaRandomised controlled trials that compared PCD to PNA for liver abscess were considered eligible, without restriction on language.Data extraction and synthesisPrimary outcome was treatment success rate. Depending on heterogeneity, either a fixed-effects model or a random-effects model was used to derive overall estimates. Review Manager V.5.3 software was used for meta-analysis. Trial sequential analysis was performed using the Trial Sequential Analysis software. Certainty of evidence was evaluated using the Grading of Recommendations, Assessment, Development and Evaluation system.ResultsTen trials totalling 1287 individuals were included. Pooled analysis revealed that PCD, when compared with PNA, enhanced treatment success rate (risk ratio 1.16, 95% CI 1.07 to 1.25). Trial sequential analysis demonstrated this robust finding with required information size attained. For large abscesses, subgroup analysis favoured PCD (test of subgroup difference, p
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Depending on heterogeneity, either a fixed-effects model or a random-effects model was used to derive overall estimates. Review Manager V.5.3 software was used for meta-analysis. Trial sequential analysis was performed using the Trial Sequential Analysis software. Certainty of evidence was evaluated using the Grading of Recommendations, Assessment, Development and Evaluation system.ResultsTen trials totalling 1287 individuals were included. Pooled analysis revealed that PCD, when compared with PNA, enhanced treatment success rate (risk ratio 1.16, 95% CI 1.07 to 1.25). Trial sequential analysis demonstrated this robust finding with required information size attained. For large abscesses, subgroup analysis favoured PCD (test of subgroup difference, p&lt;0.001). In comparison to PNA, pooled analysis indicated a significant benefit of PCD on time to achieve clinical improvement or complete clinical relief (mean differences (MD) −2.53 days; 95% CI −3.54 to –1.52) in six studies with 1000 patients; time to achieve a 50% reduction in abscess size (MD −2.49 days; 95% CI −3.59 to –1.38) in five studies with 772 patients; and duration of intravenous antibiotic use (MD −4.04 days, 95% CI −5.99 to −2.10) in four studies with 763 patients. In-hospital mortality and complications were not different.ConclusionIn patients with liver abscess, ultrasound-guided PCD raises the treatment success rate by 136 in 1000 patients, improves clinical outcomes by 3 days and reduces the need for intravenous antibiotics by 4 days.PROSPERO registration numberCRD42022316540.</description><identifier>ISSN: 2044-6055</identifier><identifier>EISSN: 2044-6055</identifier><identifier>DOI: 10.1136/bmjopen-2023-072736</identifier><identifier>PMID: 37518084</identifier><language>eng</language><publisher>England: British Medical Journal Publishing Group</publisher><subject>Abscesses ; Anti-Bacterial Agents - therapeutic use ; Bias ; Biopsy, Needle ; Catheters ; Drainage ; Gastroenterology and Hepatology ; Hospitals ; Humans ; Hypothesis testing ; Liver ; Liver Abscess - drug therapy ; Meta-analysis ; Mortality ; public health ; Software ; Statistical analysis ; Suction ; Systematic review ; Ultrasonic imaging ; Variables</subject><ispartof>BMJ open, 2023-07, Vol.13 (7), p.e072736-e072736</ispartof><rights>Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.</rights><rights>2023 Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. http://creativecommons.org/licenses/by-nc/4.0/ This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/ . Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. 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Depending on heterogeneity, either a fixed-effects model or a random-effects model was used to derive overall estimates. Review Manager V.5.3 software was used for meta-analysis. Trial sequential analysis was performed using the Trial Sequential Analysis software. Certainty of evidence was evaluated using the Grading of Recommendations, Assessment, Development and Evaluation system.ResultsTen trials totalling 1287 individuals were included. Pooled analysis revealed that PCD, when compared with PNA, enhanced treatment success rate (risk ratio 1.16, 95% CI 1.07 to 1.25). Trial sequential analysis demonstrated this robust finding with required information size attained. For large abscesses, subgroup analysis favoured PCD (test of subgroup difference, p&lt;0.001). In comparison to PNA, pooled analysis indicated a significant benefit of PCD on time to achieve clinical improvement or complete clinical relief (mean differences (MD) −2.53 days; 95% CI −3.54 to –1.52) in six studies with 1000 patients; time to achieve a 50% reduction in abscess size (MD −2.49 days; 95% CI −3.59 to –1.38) in five studies with 772 patients; and duration of intravenous antibiotic use (MD −4.04 days, 95% CI −5.99 to −2.10) in four studies with 763 patients. In-hospital mortality and complications were not different.ConclusionIn patients with liver abscess, ultrasound-guided PCD raises the treatment success rate by 136 in 1000 patients, improves clinical outcomes by 3 days and reduces the need for intravenous antibiotics by 4 days.PROSPERO registration numberCRD42022316540.</description><subject>Abscesses</subject><subject>Anti-Bacterial Agents - therapeutic use</subject><subject>Bias</subject><subject>Biopsy, Needle</subject><subject>Catheters</subject><subject>Drainage</subject><subject>Gastroenterology and Hepatology</subject><subject>Hospitals</subject><subject>Humans</subject><subject>Hypothesis testing</subject><subject>Liver</subject><subject>Liver Abscess - drug therapy</subject><subject>Meta-analysis</subject><subject>Mortality</subject><subject>public health</subject><subject>Software</subject><subject>Statistical analysis</subject><subject>Suction</subject><subject>Systematic review</subject><subject>Ultrasonic imaging</subject><subject>Variables</subject><issn>2044-6055</issn><issn>2044-6055</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2023</creationdate><recordtype>article</recordtype><sourceid>9YT</sourceid><sourceid>PIMPY</sourceid><sourceid>DOA</sourceid><recordid>eNp9kstu1DAUhiMEotXQJ0BCltiwINTX2GGDqqqFSpVgAWvrxDmZepTEg50ZNG_C4-JppmXKAm9s-XznPxf9RfGa0Q-Mieq8GVZhjWPJKRcl1VyL6llxyqmUZUWVen70PinOUlrRfKSqleIvixOhFTPUyNPi9zeMbjPBiGGTiIPpDieMpI3gR1gi2WJMObA-pkbEtkcCae0jTD6MpAuR9D6zBJrkMKWPBEjapQmHDDgScevx13sy4AQljNDvkk8ExpZM0UNPEv7c4Djtnw_RV8WLDvqEZ4d7Ufy4vvp--aW8_fr55vLitmyUpFOpq07VjhlFdd2wtlK6q4VqDKu5FKarmNCSCyckdjVHaSjWHdWNZoJSbFCIRXEz67YBVnYd_QBxZwN4e_8R4tJCzDP0aB134IQD1iomjaC1qV3FtG5bJZvKqKz1adZab5oBW5dHitA_EX0aGf2dXYatZVQYXeVmF8W7g0IMeSVpsoPPC-37efWWGympUbzeF3v7D7oKm5i3d0-JSnKm95SYKRdDShG7x24YtXsn2YOT7N5JdnZSznpzPMhjzoNvMnA-Azn7b93_Sf4B1j7YAQ</recordid><startdate>20230730</startdate><enddate>20230730</enddate><creator>Lin, Jin-Wei</creator><creator>Chen, Chung-Ting</creator><creator>Hsieh, Ming-Shun</creator><creator>Lee, I-Hsin</creator><creator>Yen, David Hung-Tsang</creator><creator>Cheng, Hao-Min</creator><creator>Hsu, Teh-Fu</creator><general>British Medical Journal Publishing Group</general><general>BMJ Publishing Group LTD</general><general>BMJ Publishing Group</general><scope>9YT</scope><scope>ACMMV</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>88G</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>BTHHO</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>K9-</scope><scope>K9.</scope><scope>KB0</scope><scope>M0R</scope><scope>M0S</scope><scope>M1P</scope><scope>M2M</scope><scope>NAPCQ</scope><scope>PIMPY</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PSYQQ</scope><scope>Q9U</scope><scope>7X8</scope><scope>5PM</scope><scope>DOA</scope><orcidid>https://orcid.org/0000-0003-4747-2710</orcidid><orcidid>https://orcid.org/0000-0001-5845-0547</orcidid></search><sort><creationdate>20230730</creationdate><title>Percutaneous catheter drainage versus percutaneous needle aspiration for liver abscess: a systematic review, meta-analysis and trial sequential analysis</title><author>Lin, Jin-Wei ; Chen, Chung-Ting ; Hsieh, Ming-Shun ; Lee, I-Hsin ; Yen, David Hung-Tsang ; Cheng, Hao-Min ; Hsu, Teh-Fu</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-b540t-76f59c185079b1d657f935b8192438f6137423c34ef92e480e9f07b71300ebe33</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2023</creationdate><topic>Abscesses</topic><topic>Anti-Bacterial Agents - therapeutic use</topic><topic>Bias</topic><topic>Biopsy, Needle</topic><topic>Catheters</topic><topic>Drainage</topic><topic>Gastroenterology and Hepatology</topic><topic>Hospitals</topic><topic>Humans</topic><topic>Hypothesis testing</topic><topic>Liver</topic><topic>Liver Abscess - drug therapy</topic><topic>Meta-analysis</topic><topic>Mortality</topic><topic>public health</topic><topic>Software</topic><topic>Statistical analysis</topic><topic>Suction</topic><topic>Systematic review</topic><topic>Ultrasonic imaging</topic><topic>Variables</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Lin, Jin-Wei</creatorcontrib><creatorcontrib>Chen, Chung-Ting</creatorcontrib><creatorcontrib>Hsieh, Ming-Shun</creatorcontrib><creatorcontrib>Lee, I-Hsin</creatorcontrib><creatorcontrib>Yen, David Hung-Tsang</creatorcontrib><creatorcontrib>Cheng, Hao-Min</creatorcontrib><creatorcontrib>Hsu, Teh-Fu</creatorcontrib><collection>BMJ Open Access Journals</collection><collection>BMJ Journals:Open Access</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Proquest Nursing &amp; 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Depending on heterogeneity, either a fixed-effects model or a random-effects model was used to derive overall estimates. Review Manager V.5.3 software was used for meta-analysis. Trial sequential analysis was performed using the Trial Sequential Analysis software. Certainty of evidence was evaluated using the Grading of Recommendations, Assessment, Development and Evaluation system.ResultsTen trials totalling 1287 individuals were included. Pooled analysis revealed that PCD, when compared with PNA, enhanced treatment success rate (risk ratio 1.16, 95% CI 1.07 to 1.25). Trial sequential analysis demonstrated this robust finding with required information size attained. For large abscesses, subgroup analysis favoured PCD (test of subgroup difference, p&lt;0.001). In comparison to PNA, pooled analysis indicated a significant benefit of PCD on time to achieve clinical improvement or complete clinical relief (mean differences (MD) −2.53 days; 95% CI −3.54 to –1.52) in six studies with 1000 patients; time to achieve a 50% reduction in abscess size (MD −2.49 days; 95% CI −3.59 to –1.38) in five studies with 772 patients; and duration of intravenous antibiotic use (MD −4.04 days, 95% CI −5.99 to −2.10) in four studies with 763 patients. In-hospital mortality and complications were not different.ConclusionIn patients with liver abscess, ultrasound-guided PCD raises the treatment success rate by 136 in 1000 patients, improves clinical outcomes by 3 days and reduces the need for intravenous antibiotics by 4 days.PROSPERO registration numberCRD42022316540.</abstract><cop>England</cop><pub>British Medical Journal Publishing Group</pub><pmid>37518084</pmid><doi>10.1136/bmjopen-2023-072736</doi><orcidid>https://orcid.org/0000-0003-4747-2710</orcidid><orcidid>https://orcid.org/0000-0001-5845-0547</orcidid><oa>free_for_read</oa></addata></record>
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subjects Abscesses
Anti-Bacterial Agents - therapeutic use
Bias
Biopsy, Needle
Catheters
Drainage
Gastroenterology and Hepatology
Hospitals
Humans
Hypothesis testing
Liver
Liver Abscess - drug therapy
Meta-analysis
Mortality
public health
Software
Statistical analysis
Suction
Systematic review
Ultrasonic imaging
Variables
title Percutaneous catheter drainage versus percutaneous needle aspiration for liver abscess: a systematic review, meta-analysis and trial sequential analysis
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