Diagnosis and management of ectopic varices in portal hypertension.

Ectopic variceal bleeding is a rare cause of gastrointestinal bleeding that can occur in settings of cirrhotic and non-cirrhotic portal hypertension and is characterised by its development at locations remote from the oesophagus and stomach. Ectopic varices can be difficult to identify and access, and, although a relatively uncommon cause of portal hypertensive bleeding, can represent a difficult diagnostic and therapeutic challenge associated with considerable mortality. Low incidence and variance in variceal anatomy preclude large randomised controlled trials, and clinical practice is based on experience from case reports, case series, and specialist centre expertise. Optimisation of survival outcomes relies on understanding a patient's portal venous anatomy and functional hepatic reserve to guide timely and targeted endoscopic and endovascular interventions to facilitate the rapid control of ectopic variceal bleeding.

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Declaration of interests THT is supported by a Medical Research Council Clinical Research Training Fellowship (MR/V006757/1). DJ has done consultancy for Cook Medical, Boston Scientific, Albireo, Advanz Medical, and Taewoong Medical. DLS has done consultancy for Norgine Pharmaceuticals, EnteroBiotix, Mallinckrodt Pharmaceuticals, and ONO Pharma UK, and has delivered paid lectures for Norgine Pharmaceuticals, Falk Pharma, and Aska Pharmaceutical. DP has delivered paid lectures for Boehringer Ingelheim, Cook, and WL Gore and Associates. DT has done consultancy and received speaker fees for WL Gore and Associates. All other authors declare no competing interests.