Design: Systematic review and meta-analysis of randomised trials
Population: 12 trials, 1,425 adults with liver abscess
Primary outcome: Treatment success and procedure-related complications
Effect: Success OR 4.12 (95% CI 2.01 to 8.45); complications OR 1.02 (0.30 to 3.50)

A meta-analysis pooled 12 randomised trials of 1,425 adults with liver abscess comparing percutaneous catheter drainage with needle aspiration, both image-guided.

Catheter drainage was associated with higher treatment success (OR 4.12, 95% CI 2.01 to 8.45; I-squared 56%), consistent across subgroups by abscess size and cause. Complication rates did not differ (OR 1.02, 0.30 to 3.50).

Needle aspiration is sometimes chosen for being quicker and avoiding a drain, but repeated aspirations add procedures and delay. These trials favour placing a catheter first time for most abscesses.

This is relevant in India, where amoebic and pyogenic liver abscesses are common. Heterogeneity was moderate and the abstract does not report trial quality, so very small abscesses may still be suitable for aspiration case by case.

Consider catheter drainage as the default percutaneous approach for liver abscess.
Success was higher across abscess sizes and causes in these trials.
Complication rates were similar to needle aspiration.
Agree drain care, flushing and removal criteria with the referring team.

Why it matters

A single catheter may spare patients repeated needle procedures.

The statistics, in plain English

An odds ratio of 4.12 is a large effect, but the wide interval (2.01 to 8.45) and I-squared of 56% show trials differed. The complication interval (0.30 to 3.50) is wide, so a difference in harms cannot be excluded.