Retrospective Analysis of 411 Cases of Spontaneous Portosystemic Shunt Complicated With Oesophageal and Gastric Variceal Bleeding in Cirrhotic Patients

This study is aimed at evaluating the incidence and clinical characteristics of spontaneous portosystemic shunts (SPSSs) in cirrhotic patients with oesophageal and gastric variceal bleeding (EGVB) and investigating the impact of SPSSs on the course of EGVB. A retrospective analysis of 1110 cirrhotic patients with EGVB was conducted to determine SPSS incidence and characteristics and evaluate the impact of SPSS size and endoscopic treatments. The SPSS incidence was 94.26% (411/436), with gastric renal shunts (78.89%) being the most common. SPSSs were categorized by diameter as follows: S-SPSS (≤ 5 mm), M-SPSS (5-8 mm), and L-SPSS (≥ 8 mm). A larger SPSS diameter was correlated with higher model for end-stage liver disease (MELD) scores, international normalized ratios (INRs), total bilirubin (TB) levels, and portal vein thrombosis. During the 12-month follow-up, the L-SPSS group had a lower rebleeding rate (3.38%) than the S-SPSS (14.64%) and M-SPSS (16.88%) groups. A larger SPSS diameter was associated with a 77% reduction in rebleeding risk (HR = 0.23, p = 0.016). In summary, a larger SPSS diameter is linked to worse liver function but reduced rebleeding risk in cirrhotic patients with EGVB.