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Percutaneous catheter drainage versus percutaneous needle aspiration for liver abscess: a systematic review, meta-analysis and trial sequential analysis.
Lin, Jin-Wei; Chen, Chung-Ting; Hsieh, Ming-Shun; Lee, I-Hsin; Yen, David Hung-Tsang; Cheng, Hao-Min; Hsu, Teh-Fu.
Afiliação
  • Lin JW; Department of Emergency Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.
  • Chen CT; Institute of Emergency and Critical Care Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.
  • Hsieh MS; Center for Evidence-based Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.
  • Lee IH; Department of Emergency Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.
  • Yen DH; School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.
  • Cheng HM; Institute of Health Policy and Management, National Taiwan University, Taipei, Taiwan.
  • Hsu TF; Department of Emergency Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.
BMJ Open ; 13(7): e072736, 2023 07 30.
Article em En | MEDLINE | ID: mdl-37518084
ABSTRACT

OBJECTIVE:

To compare the effectiveness and safety of percutaneous catheter drainage (PCD) against percutaneous needle aspiration (PNA) for liver abscess.

DESIGN:

Systematic review, meta-analysis and trial sequential analysis. DATA SOURCES PubMed, Web of Science, Cochrane Library, Embase, Airiti Library and ClinicalTrials.gov were searched from their inception up to 16 March 2022. ELIGIBILITY CRITERIA Randomised controlled trials that compared PCD to PNA for liver abscess were considered eligible, without restriction on language. DATA EXTRACTION AND

SYNTHESIS:

Primary 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.

RESULTS:

Ten 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<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.

CONCLUSION:

In 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 NUMBER CRD42022316540.
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Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Drenagem / Abscesso Hepático Tipo de estudo: Clinical_trials / Guideline / Prognostic_studies / Systematic_reviews Limite: Humans Idioma: En Ano de publicação: 2023 Tipo de documento: Article

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Drenagem / Abscesso Hepático Tipo de estudo: Clinical_trials / Guideline / Prognostic_studies / Systematic_reviews Limite: Humans Idioma: En Ano de publicação: 2023 Tipo de documento: Article