Objective: To determine the value of needle aspiration in uncomplicated amoebic liver abscess.
Design: Randomised case-control study with a minimum follow up of one year, comparing patients treated with drugs alone with those treated with additional needle aspiration.
Setting: Referral based gastroenterology clinic.
Patients: 39 Consecutive patients with amoebic liver abscess in the right lobe, of whom 37 completed the study.
Intervention: Metronidazole 2.4 g/day was given to all patients for 10 days. Needle aspiration of the abscess was performed in 19 patients on the day of admission to hospital.
Main outcome measures: Abdominal pain, fever, anorexia, and hepatomegaly were measured. Erythrocyte sedimentation rate, serum aspartate, and alanine aminotransferase activities, and alkaline phosphatase activity were also measured.
Results: Clinical improvement was similar in both groups of patients. Improvement in haematological and biochemical variables and rates of healing of cavities were also similar.
Conclusions: Chemotherapy with potent tissue amoebicidal drugs such as metronidazole is optimally effective in treating amoebic liver abscess, and in uncomplicated cases routine aspiration is not required.