Percutaneous catheter drainage of uncomplicated amoebic liver abscess: prospective evaluation of a clinical protocol for catheter removal and the significance of residual collections
Introduction Patients with amoebic liver abscess (ALA) may require percutaneous catheter drainage (PCD). Once the PCD output is substantially reduced or has ceased along with clinical recovery, residual collections on radiological evaluation may concern the treating physicians. The prevalence and si...
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| Veröffentlicht in: | Abdominal imaging 2021-06, Vol.46 (6), p.2855-2864 |
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| creator | Goyal, Amandeep Dhaliwal, Harpal S. Nampoothiri, Ram V. Singh, Ripudaman Abraham, John Sharma, Rajan Soloman, Rajat Lahan, Shubham Kaur, Preetraj Bansal, Pankaj Gill, Chiranjiv Singh |
| description | Introduction
Patients with amoebic liver abscess (ALA) may require percutaneous catheter drainage (PCD). Once the PCD output is substantially reduced or has ceased along with clinical recovery, residual collections on radiological evaluation may concern the treating physicians. The prevalence and significance of such collections is unknown, and the subsequent approach how to tackle them is unclear.
Methods
Consecutive patients with one or more uncomplicated ALAs requiring drainage were prospectively enrolled from 3 hospitals and managed based on a standard approach. Catheter removal was attempted after the patients fulfilled all 4 of the following criteria: disappearance of abdominal pain, absence of fever for at least 48 h, an improving trend of TLC (documented on 2 consecutive reports), and catheter drain output of |
| doi_str_mv | 10.1007/s00261-021-02949-5 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_2479419622</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2479419622</sourcerecordid><originalsourceid>FETCH-LOGICAL-c375t-dafb725cda53e81d12916d4e36cded07792baadcb080bd09b676ee4049c4b5263</originalsourceid><addsrcrecordid>eNp9kU9rFjEQxhex2NL2C3iQgBcvq0k2yb7xJqX-gYI9VPAWssnsa0o2eU12C34xP5-z3dqCBw8hYeb3zEzmaZqXjL5llPbvKqVcsZby9WihW_msOeGdUi2lcvf88S2-Hzfntd5SSpmSjHH5ojnuOqG00vSk-X0NxS2zTZCXSpydf8AMhfhiQ7J7IHkkS3J5OsSASfDEThmG4EgMd8jZoTqo9T05lFwP4GaMErizcbFzyGmVW-JiSKiOKzRnlyMZc3nqVWDKqCA2eYIhUsM-hREFyd33L1CDXxBAZVxb5FTPmqPRxgrnD_dp8-3j5c3F5_bq66cvFx-uWtf1cm69HYeeS-et7GDHPOOaKS-gU86Dp32v-WCtdwPd0cFTPaheAQgqtBOD5Ko7bd5sdXH0nwvU2UwBfxzjtjDDRa8F04pzRF__g97mpSScznApcPE93Qmk-EY5XFgtMJpDCZMtvwyjZjXWbMYaNNbcG2skil49lF6GCfyj5K-NCHQbUDGV9lCeev-n7B9dFbMT</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2541127084</pqid></control><display><type>article</type><title>Percutaneous catheter drainage of uncomplicated amoebic liver abscess: prospective evaluation of a clinical protocol for catheter removal and the significance of residual collections</title><source>Springer Nature - Complete Springer Journals</source><creator>Goyal, Amandeep ; Dhaliwal, Harpal S. ; Nampoothiri, Ram V. ; Singh, Ripudaman ; Abraham, John ; Sharma, Rajan ; Soloman, Rajat ; Lahan, Shubham ; Kaur, Preetraj ; Bansal, Pankaj ; Gill, Chiranjiv Singh</creator><creatorcontrib>Goyal, Amandeep ; Dhaliwal, Harpal S. ; Nampoothiri, Ram V. ; Singh, Ripudaman ; Abraham, John ; Sharma, Rajan ; Soloman, Rajat ; Lahan, Shubham ; Kaur, Preetraj ; Bansal, Pankaj ; Gill, Chiranjiv Singh</creatorcontrib><description>Introduction
Patients with amoebic liver abscess (ALA) may require percutaneous catheter drainage (PCD). Once the PCD output is substantially reduced or has ceased along with clinical recovery, residual collections on radiological evaluation may concern the treating physicians. The prevalence and significance of such collections is unknown, and the subsequent approach how to tackle them is unclear.
Methods
Consecutive patients with one or more uncomplicated ALAs requiring drainage were prospectively enrolled from 3 hospitals and managed based on a standard approach. Catheter removal was attempted after the patients fulfilled all 4 of the following criteria: disappearance of abdominal pain, absence of fever for at least 48 h, an improving trend of TLC (documented on 2 consecutive reports), and catheter drain output of < 10 ml/day for at least 2 consecutive days.
Results
A total of 110 patients (mean age 46.6 ± 10.5 years, 93.6% males, 89.1% alcoholics) underwent PCD placement; 69 patients (69/110; 62.7%) met all 4 criteria within 5 days of PCD placement (optimal response) and had an uncomplicated course. Patients with suboptimal responses (41/110; 37.3%) were evaluated for local and systemic complications; the appearance of fresh collections (5/110; 4.5%), abscess rupture (2/110; 1.8%), bile leakage (3/110; 2.7%), cholangitis (2/110; 1.8%), thrombophlebitis (2/110; 1.8%) and hospital-acquired infections (2/110; 1.8%) were diagnosed and treated accordingly. Ultimately, PCD removal (based on the fulfilment of all 4 criteria) was universally successful after a median of 5 days (IQR, 4–9 days). None of the patients had symptom recurrence after PCD removal, although residual collections were still seen in 97.3% of patients at the time of PCD removal and in 92.1% and 84.9% of patients available for follow-up at 1 and 3 months, respectively.
Conclusion
Based on our clinical protocol, PCD removal in ALA can be successfully expedited even in the presence of residual collections. An inability to fulfill all 4 criteria within 5 days of PCD placement warrants further evaluations for local and systemic complications that require additional therapeutic measures.</description><identifier>ISSN: 2366-004X</identifier><identifier>EISSN: 2366-0058</identifier><identifier>DOI: 10.1007/s00261-021-02949-5</identifier><identifier>PMID: 33469690</identifier><language>eng</language><publisher>New York: Springer US</publisher><subject>Abscesses ; Alcoholics ; Bile ; Catheters ; Cholangitis ; Complications ; Criteria ; Evaluation ; Fever ; Gastroenterology ; Hepatobiliary ; Hepatology ; Imaging ; Liver ; Medical instruments ; Medicine ; Medicine & Public Health ; Pain ; Patients ; Physicians ; Placement ; Radiology ; Surgical drains ; Thrombophlebitis ; Wound drainage</subject><ispartof>Abdominal imaging, 2021-06, Vol.46 (6), p.2855-2864</ispartof><rights>The Author(s), under exclusive licence to Springer Science+Business Media, LLC part of Springer Nature 2021</rights><rights>The Author(s), under exclusive licence to Springer Science+Business Media, LLC part of Springer Nature 2021.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c375t-dafb725cda53e81d12916d4e36cded07792baadcb080bd09b676ee4049c4b5263</citedby><cites>FETCH-LOGICAL-c375t-dafb725cda53e81d12916d4e36cded07792baadcb080bd09b676ee4049c4b5263</cites><orcidid>0000-0001-8252-4876</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s00261-021-02949-5$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s00261-021-02949-5$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,776,780,27901,27902,41464,42533,51294</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/33469690$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Goyal, Amandeep</creatorcontrib><creatorcontrib>Dhaliwal, Harpal S.</creatorcontrib><creatorcontrib>Nampoothiri, Ram V.</creatorcontrib><creatorcontrib>Singh, Ripudaman</creatorcontrib><creatorcontrib>Abraham, John</creatorcontrib><creatorcontrib>Sharma, Rajan</creatorcontrib><creatorcontrib>Soloman, Rajat</creatorcontrib><creatorcontrib>Lahan, Shubham</creatorcontrib><creatorcontrib>Kaur, Preetraj</creatorcontrib><creatorcontrib>Bansal, Pankaj</creatorcontrib><creatorcontrib>Gill, Chiranjiv Singh</creatorcontrib><title>Percutaneous catheter drainage of uncomplicated amoebic liver abscess: prospective evaluation of a clinical protocol for catheter removal and the significance of residual collections</title><title>Abdominal imaging</title><addtitle>Abdom Radiol</addtitle><addtitle>Abdom Radiol (NY)</addtitle><description>Introduction
Patients with amoebic liver abscess (ALA) may require percutaneous catheter drainage (PCD). Once the PCD output is substantially reduced or has ceased along with clinical recovery, residual collections on radiological evaluation may concern the treating physicians. The prevalence and significance of such collections is unknown, and the subsequent approach how to tackle them is unclear.
Methods
Consecutive patients with one or more uncomplicated ALAs requiring drainage were prospectively enrolled from 3 hospitals and managed based on a standard approach. Catheter removal was attempted after the patients fulfilled all 4 of the following criteria: disappearance of abdominal pain, absence of fever for at least 48 h, an improving trend of TLC (documented on 2 consecutive reports), and catheter drain output of < 10 ml/day for at least 2 consecutive days.
Results
A total of 110 patients (mean age 46.6 ± 10.5 years, 93.6% males, 89.1% alcoholics) underwent PCD placement; 69 patients (69/110; 62.7%) met all 4 criteria within 5 days of PCD placement (optimal response) and had an uncomplicated course. Patients with suboptimal responses (41/110; 37.3%) were evaluated for local and systemic complications; the appearance of fresh collections (5/110; 4.5%), abscess rupture (2/110; 1.8%), bile leakage (3/110; 2.7%), cholangitis (2/110; 1.8%), thrombophlebitis (2/110; 1.8%) and hospital-acquired infections (2/110; 1.8%) were diagnosed and treated accordingly. Ultimately, PCD removal (based on the fulfilment of all 4 criteria) was universally successful after a median of 5 days (IQR, 4–9 days). None of the patients had symptom recurrence after PCD removal, although residual collections were still seen in 97.3% of patients at the time of PCD removal and in 92.1% and 84.9% of patients available for follow-up at 1 and 3 months, respectively.
Conclusion
Based on our clinical protocol, PCD removal in ALA can be successfully expedited even in the presence of residual collections. An inability to fulfill all 4 criteria within 5 days of PCD placement warrants further evaluations for local and systemic complications that require additional therapeutic measures.</description><subject>Abscesses</subject><subject>Alcoholics</subject><subject>Bile</subject><subject>Catheters</subject><subject>Cholangitis</subject><subject>Complications</subject><subject>Criteria</subject><subject>Evaluation</subject><subject>Fever</subject><subject>Gastroenterology</subject><subject>Hepatobiliary</subject><subject>Hepatology</subject><subject>Imaging</subject><subject>Liver</subject><subject>Medical instruments</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Pain</subject><subject>Patients</subject><subject>Physicians</subject><subject>Placement</subject><subject>Radiology</subject><subject>Surgical drains</subject><subject>Thrombophlebitis</subject><subject>Wound drainage</subject><issn>2366-004X</issn><issn>2366-0058</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2021</creationdate><recordtype>article</recordtype><sourceid>BENPR</sourceid><recordid>eNp9kU9rFjEQxhex2NL2C3iQgBcvq0k2yb7xJqX-gYI9VPAWssnsa0o2eU12C34xP5-z3dqCBw8hYeb3zEzmaZqXjL5llPbvKqVcsZby9WihW_msOeGdUi2lcvf88S2-Hzfntd5SSpmSjHH5ojnuOqG00vSk-X0NxS2zTZCXSpydf8AMhfhiQ7J7IHkkS3J5OsSASfDEThmG4EgMd8jZoTqo9T05lFwP4GaMErizcbFzyGmVW-JiSKiOKzRnlyMZc3nqVWDKqCA2eYIhUsM-hREFyd33L1CDXxBAZVxb5FTPmqPRxgrnD_dp8-3j5c3F5_bq66cvFx-uWtf1cm69HYeeS-et7GDHPOOaKS-gU86Dp32v-WCtdwPd0cFTPaheAQgqtBOD5Ko7bd5sdXH0nwvU2UwBfxzjtjDDRa8F04pzRF__g97mpSScznApcPE93Qmk-EY5XFgtMJpDCZMtvwyjZjXWbMYaNNbcG2skil49lF6GCfyj5K-NCHQbUDGV9lCeev-n7B9dFbMT</recordid><startdate>20210601</startdate><enddate>20210601</enddate><creator>Goyal, Amandeep</creator><creator>Dhaliwal, Harpal S.</creator><creator>Nampoothiri, Ram V.</creator><creator>Singh, Ripudaman</creator><creator>Abraham, John</creator><creator>Sharma, Rajan</creator><creator>Soloman, Rajat</creator><creator>Lahan, Shubham</creator><creator>Kaur, Preetraj</creator><creator>Bansal, Pankaj</creator><creator>Gill, Chiranjiv Singh</creator><general>Springer US</general><general>Springer Nature B.V</general><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>8AO</scope><scope>8FD</scope><scope>8FE</scope><scope>8FG</scope><scope>8FH</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>ARAPS</scope><scope>AZQEC</scope><scope>BBNVY</scope><scope>BENPR</scope><scope>BGLVJ</scope><scope>BHPHI</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FR3</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>HCIFZ</scope><scope>JQ2</scope><scope>K7-</scope><scope>K9.</scope><scope>KB0</scope><scope>LK8</scope><scope>M0S</scope><scope>M1P</scope><scope>M7P</scope><scope>M7Z</scope><scope>NAPCQ</scope><scope>P5Z</scope><scope>P62</scope><scope>P64</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0001-8252-4876</orcidid></search><sort><creationdate>20210601</creationdate><title>Percutaneous catheter drainage of uncomplicated amoebic liver abscess: prospective evaluation of a clinical protocol for catheter removal and the significance of residual collections</title><author>Goyal, Amandeep ; Dhaliwal, Harpal S. ; Nampoothiri, Ram V. ; Singh, Ripudaman ; Abraham, John ; Sharma, Rajan ; Soloman, Rajat ; Lahan, Shubham ; Kaur, Preetraj ; Bansal, Pankaj ; Gill, Chiranjiv Singh</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c375t-dafb725cda53e81d12916d4e36cded07792baadcb080bd09b676ee4049c4b5263</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2021</creationdate><topic>Abscesses</topic><topic>Alcoholics</topic><topic>Bile</topic><topic>Catheters</topic><topic>Cholangitis</topic><topic>Complications</topic><topic>Criteria</topic><topic>Evaluation</topic><topic>Fever</topic><topic>Gastroenterology</topic><topic>Hepatobiliary</topic><topic>Hepatology</topic><topic>Imaging</topic><topic>Liver</topic><topic>Medical instruments</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Pain</topic><topic>Patients</topic><topic>Physicians</topic><topic>Placement</topic><topic>Radiology</topic><topic>Surgical drains</topic><topic>Thrombophlebitis</topic><topic>Wound drainage</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Goyal, Amandeep</creatorcontrib><creatorcontrib>Dhaliwal, Harpal S.</creatorcontrib><creatorcontrib>Nampoothiri, Ram V.</creatorcontrib><creatorcontrib>Singh, Ripudaman</creatorcontrib><creatorcontrib>Abraham, John</creatorcontrib><creatorcontrib>Sharma, Rajan</creatorcontrib><creatorcontrib>Soloman, Rajat</creatorcontrib><creatorcontrib>Lahan, Shubham</creatorcontrib><creatorcontrib>Kaur, Preetraj</creatorcontrib><creatorcontrib>Bansal, Pankaj</creatorcontrib><creatorcontrib>Gill, Chiranjiv Singh</creatorcontrib><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Nursing & Allied Health Database</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma 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Collection</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><jtitle>Abdominal imaging</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Goyal, Amandeep</au><au>Dhaliwal, Harpal S.</au><au>Nampoothiri, Ram V.</au><au>Singh, Ripudaman</au><au>Abraham, John</au><au>Sharma, Rajan</au><au>Soloman, Rajat</au><au>Lahan, Shubham</au><au>Kaur, Preetraj</au><au>Bansal, Pankaj</au><au>Gill, Chiranjiv Singh</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Percutaneous catheter drainage of uncomplicated amoebic liver abscess: prospective evaluation of a clinical protocol for catheter removal and the significance of residual collections</atitle><jtitle>Abdominal imaging</jtitle><stitle>Abdom Radiol</stitle><addtitle>Abdom Radiol (NY)</addtitle><date>2021-06-01</date><risdate>2021</risdate><volume>46</volume><issue>6</issue><spage>2855</spage><epage>2864</epage><pages>2855-2864</pages><issn>2366-004X</issn><eissn>2366-0058</eissn><abstract>Introduction
Patients with amoebic liver abscess (ALA) may require percutaneous catheter drainage (PCD). Once the PCD output is substantially reduced or has ceased along with clinical recovery, residual collections on radiological evaluation may concern the treating physicians. The prevalence and significance of such collections is unknown, and the subsequent approach how to tackle them is unclear.
Methods
Consecutive patients with one or more uncomplicated ALAs requiring drainage were prospectively enrolled from 3 hospitals and managed based on a standard approach. Catheter removal was attempted after the patients fulfilled all 4 of the following criteria: disappearance of abdominal pain, absence of fever for at least 48 h, an improving trend of TLC (documented on 2 consecutive reports), and catheter drain output of < 10 ml/day for at least 2 consecutive days.
Results
A total of 110 patients (mean age 46.6 ± 10.5 years, 93.6% males, 89.1% alcoholics) underwent PCD placement; 69 patients (69/110; 62.7%) met all 4 criteria within 5 days of PCD placement (optimal response) and had an uncomplicated course. Patients with suboptimal responses (41/110; 37.3%) were evaluated for local and systemic complications; the appearance of fresh collections (5/110; 4.5%), abscess rupture (2/110; 1.8%), bile leakage (3/110; 2.7%), cholangitis (2/110; 1.8%), thrombophlebitis (2/110; 1.8%) and hospital-acquired infections (2/110; 1.8%) were diagnosed and treated accordingly. Ultimately, PCD removal (based on the fulfilment of all 4 criteria) was universally successful after a median of 5 days (IQR, 4–9 days). None of the patients had symptom recurrence after PCD removal, although residual collections were still seen in 97.3% of patients at the time of PCD removal and in 92.1% and 84.9% of patients available for follow-up at 1 and 3 months, respectively.
Conclusion
Based on our clinical protocol, PCD removal in ALA can be successfully expedited even in the presence of residual collections. An inability to fulfill all 4 criteria within 5 days of PCD placement warrants further evaluations for local and systemic complications that require additional therapeutic measures.</abstract><cop>New York</cop><pub>Springer US</pub><pmid>33469690</pmid><doi>10.1007/s00261-021-02949-5</doi><tpages>10</tpages><orcidid>https://orcid.org/0000-0001-8252-4876</orcidid></addata></record> |
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| ispartof | Abdominal imaging, 2021-06, Vol.46 (6), p.2855-2864 |
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| source | Springer Nature - Complete Springer Journals |
| subjects | Abscesses Alcoholics Bile Catheters Cholangitis Complications Criteria Evaluation Fever Gastroenterology Hepatobiliary Hepatology Imaging Liver Medical instruments Medicine Medicine & Public Health Pain Patients Physicians Placement Radiology Surgical drains Thrombophlebitis Wound drainage |
| title | Percutaneous catheter drainage of uncomplicated amoebic liver abscess: prospective evaluation of a clinical protocol for catheter removal and the significance of residual collections |
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