Spontaneous portosystemic shunts in cirrhosis: Detection, implications, and clinical associations

Rathi, Sahaj; Brocco, Silvia; Formentin, Chiara; Zarantonello, Lisa; Mangini, Chiara; Meneghello, Gianluca; Merkel, Carlo; Angeli, Paolo; Stramare, Roberto; Montagnese, Sara; Amodio, Piero

doi:10.1016/j.dld.2020.11.020

Cited by 12 publications

(10 citation statements)

References 30 publications

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“…By contrast, Saks et al reported that SSRS was associated with a lower risk of developing ascites in liver transplantation candidates, and the presence of ascites could not predict the risk of death in such patients [ 22 ]. Fourth, SPSS is associated with a higher risk of developing portal vein thrombosis in general patients with liver cirrhosis and liver transplantation recipients, probably due to its secondary reduction in portal blood flow [ 6 , 9 , 24 ]. Fifth, nearly all recent studies have found that SPSS had a lower transplantation-free survival and was an independent predictor for death in liver cirrhosis [ 1 , 6 , 7 , 12 ].…”

Section: Clinical Significancementioning

confidence: 99%

Computed Tomography Images of Spontaneous Portosystemic Shunt in Liver Cirrhosis

Xingshun

Guo

Zeng

et al. 2022

Canadian Journal of Gastroenterology and Hepatology

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Spontaneous portosystemic shunt (SPSS) refers to collateral vessels that communicate between the portal vein system and systemic circulation. SPSS mainly includes esophageal varices, gastric varices, left gastric vein, recanalized paraumbilical vein, abdominal wall varices, and spontaneous splenorenal shunt. SPSS contributes to the development of hepatic encephalopathy caused by portal vein inflow bypassing and carries a higher risk of death in liver cirrhosis. Abdominal contrast-enhanced computed tomography is a major imaging approach to establish a diagnosis of SPSS and evaluate its location and feature. This review primarily describes the main contrast-enhanced CT features of SPSS in liver cirrhosis.

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Section: Clinical Significancementioning

confidence: 99%

Computed Tomography Images of Spontaneous Portosystemic Shunt in Liver Cirrhosis

Xingshun

Guo

Zeng

et al. 2022

Canadian Journal of Gastroenterology and Hepatology

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“…It has been previously reported that portal hypertension persists in a substantial proportion of cirrhotic patients after SVR [4]. In populations with relatively well-preserved liver function, like our cohort, presence of spontaneous portosystemic shunts has been associated with hyperammonemia and minimal and overt hepatic encephalopathy [15]. In the present study, we used well-established but indirect criteria for diagnosis of CSPH.…”

Section: Discussionmentioning

confidence: 89%

Frequency and predictive factors of minimal hepatic encephalopathy before and after sustained virological response in HCV cirrhosis

Piedade¹,

Guimarães²,

Duarte³

et al. 2022

ceh

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Introduction: Data of minimal hepatic encephalopathy (MHE) before and after hepatitis C virus (HCV) treatment remain scarce. We aimed to describe the prevalence, evolution and predictive factors of MHE before and after a sustained virological response (SVR). Material and methods: It was a prospective study that included adults with cirrhosis due to HCV treated by direct-acting agents (DAA). MHE was assessed using the Psychometric Hepatic Encephalopathy Score (PHES). Results: 104 patients (65% female, age 60 ±10 years; 69% with diabetes, 47% with hypertension; 82% Child-Pugh A) were included. MHE was assessed just before therapy and 12 (IQR 7-15) months after SVR. Prevalence of MHE before HCV treatment and after SVR were 16% and 22%, respectively (p = 0.18). Resolution of MHE after SVR occurred in a few patients (n = 4/17) and 10 of 87 patients (11.5%) without MHE before treatment developed this condition after SVR. MHE after SVR was more common in patients with MHE before treatment (57% vs. 5%, p < 0.001). In multivariate analysis, older age, hypertension and hypoalbuminemia after treatment were predictors of MHE after SVR. In the absence of all these variables, none of the patients had MHE. In contrast, the prevalence of MHE was 42% and 70% in the case of presence of any 2 of these factors and all these conditions, respectively. Conclusions: MHE is frequent in patients with cirrhosis who achieved SVR after DAA. SVR is associated with low probability of resolution of MHE and may not entirely protect patients from developing de novo MHE. Presence of MHE before DAA, older age, hypertension and hypoalbuminemia after SVR were independently associated with this condition.

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“…Several studies have evaluated the relationship between SPSS and the evolution of cirrhotic patients with different results [3–10]. The association between SPSS and PSE is commonly found in almost all studies with some exceptions [5], but the association with survival has not been analyzed to the same extent.…”

Section: Discussionmentioning

confidence: 99%

Massive spontaneous portosystemic shunt is a solid, easily identifiable prognostic factor in patients with cirrhosis

García-Villarreal,

Ortega-Quevedo,

Pérez-Aguado

et al. 2023

European Journal of Gastroenterology &Amp; Hepatology

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Objectives Spontaneous portosystemic shunts (SPSSs) are associated with complications and death in cirrhosis. We evaluated chronic portosystemic encephalopathy (CPSE) and survival in cirrhotic patients with massive (>10 mm diameter) SPSS (MSPSS). Methods We have retrospectively compared 77 cirrhotic patients with MSPSS and 77 paired-matched patients without SPSS. Results More patients with MSPSS presented with CPSE (40.3% vs. 20.8%, P = 0.010) or died (33.8% vs. 18.2%, P = 0.039). Model for Endstage Liver Disease (MELD) score [hazard ratio (HR) 1.146, 95% confidence interval (CI) 1.099–1.195], follow-up (FU) ascites (HR 5.128, 95% CI 2.396–10.973) and age (HR 1.048, 95% CI 1.017–1.080) were associated with CPSE; and MELD score (HR 1.082, 95% CI 1.035–1.131), FU renal failure (HR 9.319, 95% CI 3.595–24.158), and FU ascites (HR 4.320, 95% CI 1.615–11.555) were associated with death. Liver function worsened faster in the MSPSS group. Among patients with better liver function (MELD < 11.5), MSPSS patients presented worse survival (P = 0.048, Breslow test). Comparing patients by the Child-Pugh group, we did not find differences in survival; in patients from Child-Pugh group B + C, the MSPSS group presented less time free of CPSE (P < 0.05, log-rank test). Patients with splenorenal MSPSS presented better survival (P = 0.04, log-rank test), and patients with umbilical MSPSS had shorter time free of CPSE (P < 0.016, log-rank test). Conclusion MSPSS increased CPSE and death risks during long FU. Even with better liver function (MELD < 11.5), MSPSS was associated with lower survival. Splenorenal MSPSS presented better survival and the umbilical type was associated with shorter time free of CPSE.

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Spontaneous portosystemic shunts in cirrhosis: Detection, implications, and clinical associations

Cited by 12 publications

References 30 publications

Computed Tomography Images of Spontaneous Portosystemic Shunt in Liver Cirrhosis

Computed Tomography Images of Spontaneous Portosystemic Shunt in Liver Cirrhosis

Frequency and predictive factors of minimal hepatic encephalopathy before and after sustained virological response in HCV cirrhosis

Massive spontaneous portosystemic shunt is a solid, easily identifiable prognostic factor in patients with cirrhosis

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