Understanding the long-term evolution of estuarine shoals given natural variations and human modifications is a key issue for wetland protection and shoal management. Here, the multi-decadal morpho-sedimentary dynamics of the Nanhui Shoal (NHS), the largest Changjiang estuarine marginal shoal, are studied using a suite of hydrological, sedimentological, and bathymetric data. The results show that the tidal flow regime and sedimentary mode around the NHS changed slightly after the 1980s. Moreover, the NHS experienced a siltation-induced volume increase of 4.1 × 10 8 m 3 , concentrated in the landward region, and seaward progradation, producing an increase in gross area of 33 km 2 , during 1958-2013. Even so, the actual tidal flat resource decreased by 29% due to the reclamation of 202 km 2 . Transition in the development of the NHS is detected: a planar geometry transformation from a triangular cusp to an arcuate cusp during 1958-1989; vertical siltation in the landward region under a stable arcuate-shaped geometry thereafter. Furthermore, a steeply sloping profile with grades of 2-11‰ formed in the northern section, which limits future reclamation to 80 km 2 there. Estuarine regime adjustment, inducing hydrodynamic alterations in the South Passage, dominated the geometric changes in the NHS during 1958-1989, whereas substantial siltation promotion projects led to the landward siltation after 1989. The decrease in sediment input downstream of the Three Gorges Dam has played a minor role in the shoal evolution. This work provides new insights into the long-term morpho-sedimentary responses of estuarine shoals to natural and artificial forcings and their implications for shoal exploitation.