Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Apr 21, 2020; 26(15): 1726-1732
Published online Apr 21, 2020. doi: 10.3748/wjg.v26.i15.1726
Spontaneous porto-systemic shunts in liver cirrhosis: Clinical and therapeutical aspects
Silvia Nardelli, Oliviero Riggio, Stefania Gioia, Marta Puzzono, Giuseppe Pelle, Lorenzo Ridola
Silvia Nardelli, Oliviero Riggio, Stefania Gioia, Marta Puzzono, Lorenzo Ridola, Department of Translational and Precision Medicine, “Sapienza” University of Rome, Rome 00185, Italy
Giuseppe Pelle, Department of Interventional Radiology, Santa Maria Goretti Hospital, Latina 04100, Italy
Author contributions: Nardelli S and Ridola L drafted the article; Nardelli S, Riggio O and Ridola L contributed to critical revision of the article for important intellectual content; Nardelli S, Puzzono M and Gioia S contributed to conception and design; Pelle G contributed to shunts figures; Riggio O and Ridola L contributed to final approval of the article.
Conflict-of-interest statement: All authors have nothing to disclose and no conflict of interest.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Corresponding author: Lorenzo Ridola, MD, PhD, Doctor, Department of Translational and Precision Medicine, “Sapienza” University of Rome, viale dell’Università 37, Rome 00185, Italy.
Received: February 15, 2020
Peer-review started: February 15, 2020
First decision: March 15, 2020
Revised: March 21, 2020
Accepted: March 27, 2020
Article in press: March 27, 2020
Published online: April 21, 2020

Spontaneous porto-systemic shunts (SPSS) are frequent in liver cirrhosis and their prevalence increases as liver function deteriorates, probably as a consequence of worsening portal hypertension, but without achieving an effective protection against cirrhosis' complications. Several types of SPSS have been described in the literature, each one associated with different clinical manifestations. In particular, recurrent or persistent hepatic encephalopathy is more frequent in patients with splenorenal shunt, while the presence of gastric varices and consequently the incidence of variceal bleeding is more common in gastrorenal shunt. In the advanced stage, the presence of large SPSS can lead to the so called “portosystemic shunt syndrome”, characterized by a progressive deterioration of hepatic function, hepatic encephalopathy and, sometimes, portal vein thrombosis. The detection of SPSS in patients with liver cirrhosis is recommended in order to prevent or treat recurrent hepatic encephalopathy or variceal bleeding.

Keywords: Porto-systemic shunts, Liver cirrhosis, Variceal bleeding, Hepatic encephalopathy, Portal vein thrombosis, Porto-systemic shunt syndrome

Core tip: Liver cirrhosis is characterized by a progressive increase in portal hypertension and the consequent formation of porto-systemic shunts, that act as “release valves” to reduce the portal pressure, but also act as bypasses to normal liver flow. As the shunt becomes large enough, the complications appear including hepatic encephalopathy, variceal bleeding, portal vein thrombosis and the deterioration of liver function.