Non-surgical treatment of biliary liver abscesses: efficacy of endoscopic drainage and local antibiotic lavage with nasobiliary catheter

Background: It is universally recognized that the most frequent cause of he patic abscess is biliary disease. The aim of this study was to determine th e efficacy of endoscopic drainage and local antibiotic lavage via nasobilia ry catheter in the treatment of liver abscesses of biliary origin. Method: From January 1994 to December 1995, twenty-two cases of pyogenic li ver abscess were treated. Diagnosis was established with ultrasound, comput ed tomography, endoscopic retrograde cholangiography, and laboratory tests. All patients were assigned prospectively to endoscopic or other non-surgic al forms of therapy, depending on the etiology of the pyogenic process. Pat ients in whom this treatment failed underwent surgical drainage. Twenty pat ients had hepatic abscesses of biliary origin. In this subgroup, a nasobili ary catheter was placed into the biliary tree for continuous antibiotic lav age (infusion technique: 1 to 1.5 mL/min for 8 to 10 days) after endoscopic sphincterotomy. Two patients had hepatic abscesses of hematogenous and ame bic origin, respectively. They were treated only with the appropriate syste mic antibiotics. Results: Nineteen patients of the biliary subgroup (95%) and the two patien ts with non-biliary disease (100%) had complete resolution of the abscesses . "Salvage" surgical drainage was required in only one patient (4.5%). Ther e was no treatment related mortality. Conclusion: Endoscopic sphincterotomy and local antibiotic ravage via an en doscopically placed nasobiliary catheter is a safe and effective treatment for biliary liver abscesses. It should be considered as first-line treatmen t in this subgroup of patients with liver abscesses. Percutaneous or surgic al drainage modalities should be reserved for patients in whom endoscopic t reatment fails.