Aims: Investigating the prevalance and characteristics of spontaneous portosystemic shunts(SPSS) in hepatitis B-related cirrhotic patients with acute variceal bleeding(AVB) after repeated endotherapy.
Methods: 442 hepatitis B-related cirrhotic patients with AVB, who were treated with repeated endotherapy were included in the final analysis. We collected data on demographic features, laboratory and clinical variables, complications, treatment options and Child/MELD scores. The contrast-enhanced abdominal computed tomography(CT) were reviewed to search for the presence and classification of SPSS. SPSS were divided into large or small size according to its maximum diameter. The primary outcome was 3 and 5-years survival.
Results: SPSS were identified in 174 patients(39.37%), including 97 large-SPSS(21.95%) and 77 small-SPSS (17.42%). the median survival time was significantly longer in SPSS patients (99.4 months, [95% CI: 94.7-104.1]) compared with non-SPSS patients (83.5months, [95% CI: 78.1-88.8])(P＜0.001). The 3-years, and 5-years survival rates were significantly higher in SPSS group(87.4% vs 70.9%, P＜0.001; 65.5% vs 37.0%, P＜0.001). Age, antiviral therapy, variceal rebleeding, Child/MELD-score and the presence of SPSS were independent predictors of survival.
Conclusions: SPSS is not rare in cirrhotic patients, for patients with AVB who underwent repeated endotherapy, and received fine aetiological treatment, SPSS was likely to be a protective factor for survival.