A multi-center retrospective cohort study of sclerosing encapsulating peritonitis across the full etiological spectrum in China

Abstract Sclerosing encapsulating peritonitis (SEP) is a rare condition causing intestinal obstruction. This multi‑center retrospective study (5 Chinese hospitals, 2013‑2025) enrolled 353 SEP patients to characterize the etiological spectrum, treatment outcomes, and prognostic factors. The cohort comprised 324 peritoneal dialysis (PD)‑associated (91.8%), 11 cirrhosis‑associated (3.1%), 8 idiopathic (2.3%), and 10 other secondary cases. PD duration > 8 years (OR 8.94), high‑transporter PET status (OR 2.36), and glucose‑based dialysate (OR 3.12) were independent risk factors. All 11 cirrhosis‑associated SEP patients used long‑term non‑selective β‑blockers; their mortality was 45.5% (vs. 12.3% in PD‑associated and 0% in idiopathic SEP, P < 0.001). Overall, 52 of 353 patients (14.7%) died during follow‑up. Conservative management was the initial strategy in 43.3% of patients, while 56.7% underwent surgery. Postoperative morbidity was 31.5% (Wernicke’s encephalopathy 4.5%). Independent mortality predictors included cirrhosis (HR 4.12), conservative treatment failure requiring emergency surgery (HR 2.87), PD duration > 8 years (HR 1.92), and albumin < 30 g/L (HR 1.78). In conclusion, prolonged PD duration is the key modifiable risk factor. Cirrhosis‑associated SEP carries a poor prognosis and is universally linked to β‑blocker use, warranting further investigation. Surgical adhesiolysis remains effective for fit patients, while high‑risk cirrhotic patients may benefit from conservative management.