Optimal timing of pyogenic liver abscess evacuation: The role of early ultrasound-guided intervention

Abstract

In this editorial, we comment on the article published by Qiu et al. Pyogenic liver abscess is a serious clinical condition requiring timely and effective intervention. Ultrasound (US)-guided techniques - whether needle aspiration (NA) or catheter drainage - are key minimally invasive treatments, especially in patients with multiple or deep-seated abscesses where conventional surgery is often impractical. The timing and choice of evacuation method significantly influence clinical outcomes. Although catheter drainage may be necessary for larger or refractory collections, NA represents a less invasive alternative that is often sufficient for smaller abscesses - particularly multiloculated ones - and can avoid multiple catheter placements. This consideration is especially important in the early phase of the disease, when the abscess collection is poorly demarcated from surrounding tissue and more prone to bleeding during or after intervention. Traditional practice delays intervention until liquefaction occurs; however, emerging evidence supports early US-guided evacuation - even in partially liquefied or non-liquefied abscesses - as both safe and effective. Early intervention, particularly via NA when feasible, is associated with faster symptom resolution, shorter hospitalization, and fewer complications. This editorial explores the role of US-guided interventions in pyogenic liver abscess manaement, emphasizing the importance of individualized, timely approaches that optimize disease outcomes while minimizing procedural risk.

Keywords: Pyogenic liver abscess; Ultrasound-guided drainage; Early intervention; Minimally invasive surgery; Image-guided procedures; Hepatobiliary infection; Clinical management; Percutaneous drainage

Core Tip: Timely and individualized treatment of pyogenic liver abscess is essential for optimal outcomes and complication prevention. This editorial highlighted ultrasound (US)-guided procedures as safe, effective, and minimally invasive therapeutic strategies. Emerging evidence supports early US-guided interventions - even in partially or non-liquefied abscesses - challenging the traditional preference for delayed drainage. Needle aspiration is particularly suited for smaller or multiloculated abscesses, as it avoids unnecessary catheter placement and reduces procedural risks. Tailoring US-guided interventions to abscess characteristics and the patient’s clinical status is key to successful management of pyogenic liver abscess.