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Heo, Hong, Kim, Moon, Yang, Park, Park, Choi, Kim, Yoon, Cho, and Oh: The Prevalence of Colonic Neoplasm in Cryptogenic Pyogenic Liver Abscess: A Prospectively Enrolled Cross-sectional Study
Original Article

Korean J Gastroenterol 2016;68(4):195-201.

Published online: 4 October 2016

DOI: https://doi.org/10.4166/kjg.2016.68.4.195

The Prevalence of Colonic Neoplasm in Cryptogenic Pyogenic Liver Abscess: A Prospectively Enrolled Cross-sectional Study

Nae-Yun Heo*, Young Mi Hong1, 2, *, Tae Oh Kim, Young Soo Moon, Sung Yeun Yang, Seung Ha Park, Jongha Park, Joon Hyuk Choi, Sung-Min Kim, Ki Tae Yoon1, 2, Mong Cho1, 2, Minkyung Oh3, 4

Department of Internal Medicine, Inje University Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea

1Department of Internal Medicine, Pusan National University College of Medicine, Busan, Korea

2Liver Center, Pusan National University Yangsan Hospital, Yangsan, Korea

3Department of Pharmacology, Inje University College of Medicine, Busan, Korea

4Clinical Trial Center, Inje University Busan Paik Hosptial, Busan, Korea

Correspondence to: Tae Oh Kim, Department of Internal Medicine, Inje University Haeundae Paik Hospital, 875 Haeun-daero, Haeundae-gu, Busan 48108, Korea. Tel: +82-51-797-1533, Fax: +82-51-797-0941, E-mail: kto0440@paik.ac.kr

* These two authors have equally contributed to this work.

Received 19 July 2016       Revised 11 September 2016       Accepted 25 September 2016

Copyright © 2016 Korean Ophthalmological Society

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background/Aims

Several studies suggest that pyogenic liver abscess (PLA) is associated with colon neoplasm. A colonoscopic exam for cryptogenic PLA might detect a hidden colon neoplasm, through which intestinal flora can be transmitted into the liver. However, there are no prospectively enrolled cross-sectional data for colonic neoplasm in cryptogenic PLA.

Methods

Patients with PLA were prospectively enrolled from two university hospitals. Among them, all the patients with cryptogenic PLA were recommended for colonoscopic exam to check for colonic neoplasm.

Results

One hundred eighty-three patients with PLA were enrolled in the study for 22 months. One hundred and one (55.2%) patients did not have a definite cause of liver abscess at initial evaluation. The median diameter of the largest lesion was 5.7 cm (1.0–14.0 cm), and 74.3% of the patients were treated by percutaneous abscess drainage. Ninety-one percent of the patients who had an identified pathogen yielded Klebsiella. Sixty-two patients underwent colonoscopic exams, and no one had a colonic cancer, one had an adenomatous polyp with high grade dysplasia (1.6%), and 27 had adenomatous polyps with low grade dysplasia (43.5%; 41.0% in male and 43.5% in female). Of fifty patients who underwent an esophagogastroduodenoscopic exam, nine had gastric ulcers, one had an esophageal ulcer, and one had hemorrhagic gastritis.

Conclusions

The prevalence of colonic neoplasm among the patients with cryptogenic PLA was not as high as that in previous studies. Further well-designed, large-scale studies are required to assess the association of the colon neoplasm and cryptogenic PLA.

Keywords: Liver abscess, pyogenic, Colonic neoplasms, Prevalence

References

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Fig. 1.
Colonoscopic findings for the patients with cryptogenic pyogenic liver abscess. PLA, pyogenic liver abscess; CFS, colonoscopy; LGD, low grade dysplasia; HGD, high grade dysplasia.
kjg-68-195f1.tif
Table 1.
Pyogenic Liver Abscess Etiologies
Causes Liver abscess (n=183)
Cryptogenic 101 (55.2)
Biliary a 71 (38.8)
Gastrointestinal b 2 (1.1)
Others c 9 (4.9)

Values are presented as n (%).

a Cholangitis due to bile duct stone or previous biliary operation.

b One patient had a microperforation of the stomach, the other had a stomach cancer.

c Six patients had a post-TACE hepatic infarction, and the other three had a complicated hepatic cyst, a liver metastasis of gastric cancer, and hepatocellular carcinoma.

Table 2.
Baseline Characteristics of Patients with Cryptogenic Pyogenic Liver Abscess
Characteristic Cryptogenic liver abscess (n=101)
Age (yr) 62 (20–94)
Male 64 (63.4)
White blood cell (/mm3) 13,190 (1,950–36,480)
Hemoglobin (g/dL) 12.3 (8.4–16.6)
Platelet (/mm3) 170,000 (9,000–759,000)
AST (IU/L) 63 (15–4,336)
ALT (IU/L) 66 (11–1,685)
ALP (IU/L)  
 Hospital 1 a 331 (120–2,201)
 Hospital 2, phase I b 457 (181–2,093)
 Hosptial 2, phase II b 172 (37–1,293)
GGT (IU/L) 100 (17–831)
Total bilirubin (mg/dL) 1.0 (0.2–6.6)
Albumin (g/dL) 3.2 (2.0–4.6)
Creatinine (mg/dL) 0.89 (0.40–5.65)
Glucose (mg/dL) 132 (74–503)
PT INR 1.19 (0.95–3.22)
CRP (mg/dL) 17.8 (0.5–40.9)
HBsAg c (%) 6 (6.1)
Anti-HCV c (%) 0
Anti-HIV c (%) 0
Diabetes mellitus 38 (37.6)
Immune suppressant use 1 (1.0)
Colonoscopic procedure within 1 month 1 (1.0)
Number of abscess pockets  
 1 75 (74.3)
 2 18 (17.8)
 3 4 (4.0)
 ≥4 4 (4.0)
Maximal diameter of largest lesion (cm) 5.7 (1.0–14.0)
Percutaneous drainage use 75 (74.3)

Values are presented as median (range) or n (%).

a Hospital 1 is Inje University Haeundae Paik Hospital, in which the reference range of ALP is 104–338 IU/L.

b Hospital 2 is Pusan National Universtiy Yangsan Hospital, in which the reference range of ALP was changed into phase I (95–280 IU/L) and II (30–120 IU/L) before and after March 1, 2015, respectively.

c Missing data is 3, 3, and 8 in HBsAg, anti-HCV, and anti-HIV, respectively.

Table 3.
Esophagogastroduodenoscopic Findings for Cryptogenic Pyogenic Liver Abscess Patients
Endoscopic finding Patient (n=50)
Normal 10 (20.0)
Gastric ulcer 9 (18.0)
Atrophic gastritis±intestinal metaplasia 20 (40.0)
Erosive gastritis 4 (8.0)
Erythematous gastritis 6 (12.0)
Gastric polyp or adenoma 3 (6.0)
Hemorrhagic gastritis 1 (2.0)
Ampullary adenoma 1 (2.0)
Esophageal ulcer 1 (2.0)
Reflux esophagitis, LA-A 1 (2.0)

Values are presented as n (%).

Three cases had atrophic gastritis with erosive gastritis, and one had atrophic gastritis with nonspecific esophageal ulcer.

Table 4.
Causative Bacteria of Cryptogenic Pyogenic Liver Abscess (PLA)
Bacteria Cryptogenic PLA (n=101) PLA with known cause (n=82)
No growth 31 (30.7) 33 (40.2)
Klebsiella a 63 (62.4) 22 (26.8)
Streptococcus 3 b (2.9) 6 c (7.3)
Escherichia coli 1 (1.0) 14 (17.1)
Enterobacter 1 (1.0) 4 (4.9)
Pseudomonas 1 (1.0)  
Gemella morbillorum 1 (1.0)  
Enterococcus   16 (19.5)
Proteus   2 (2.4)
Citrobacter   2 (2.4)
Serratia   1 (1.2)
Provotella   1 (1.2)
Shewanella   1 (1.2)

Among the patients with PLA with known cause, 8 had 2 pathogens, 5 had 3 pathogens, 1 had 4 pathogens.

a One patient presented Klebsiella oxytoca, and those remaining had K. pneumoniae.

b This group included Streptococcus gordonii, S. sanguis, and S. constellatus ssp. pharyngis.

c This group included S. anginosus, S. sanguinis, S. intermedius, and viridans streptococci.

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