ERCP and pyogenic liver abscess

Background: Liver abscess is commonly biliary in origin. We assessed the ro le of endoscopic retrograde cholangiopancreatography (ERCP) in patients wit h pyogenic liver abscesses. Methods: Between January 1986 and December 1997, 63 patients with pyogenic liver abscesses were referred for ERCP. Twenty-one patients had a history o f previous biliary procedures including cholecystectomy (21), biliary-enter ic bypass (9), surgical sphincteroplasty (5), and endoscopic sphincterotomy (2). Demographic data, clinical features, biochemical parameters, treatmen t, clinical progress, and follow-up were recorded and analyzed. Results: Two patients required laparotomy and 61 patients underwent guided aspiration and/or drainage at a median interval of 3 days after presentatio n. ERCP was performed at a median of 8 days (range 1 to 69 days) after init ial treatment and succeeded in 90% of cases with no associated complication or death. Abnormalities were shown in 29 (46%) patients: biliary obstructi on due to stones or strictures (15), ductal dilatation alone (7), spontaneo us choledochoduodenal fistula (3), communication between abscesses and bili ary tree (3), and splaying of biliary ducts by space-occupying effect (2). No abnormality was found in 34 patients. Eight patients underwent endoscopi c therapy including sphincterotomy (5), stone extraction (6), and nasobilia ry drainage (2). Overall mortality rate from liver abscesses was 6%. Conclusions: ERCP is useful in the treatment of patients with pyogenic live r abscesses.