Gastroesophageal varices are dilated veins of the esophagus or stomach that result when patients develop portal hypertension which is often seen in conjuction with hepatic cirrhosis. Overtime, they may progressively enlarge until they rupture with catastrophic results. Esophagogastroduodenoscopy allows direct visualization and intervention with elastic banding, sclerotherapy, or tissue adhesive, and is the preferred screening modality.

Therapies that reduce portal hypertension are effective measures to reduce the risk of variceal bleeding or to help stop bleeding acutely. Propranolol or nadolol are used to reduce portal hypertension and the risk of variceal bleeding as either primary (before a first variceal bleed) or secondary prophylaxis. The beta-blocking agent may be combined with a long acting nitroglycerin agent or endoscopic therapy for secondary prophylaxis in high-risk patients. During an acute bleeding episode intravenous octreotide can be used to lower portal pressures and help stop the acute event.  Octreotide can be used initially during a hemorrhagic event, and if bleeding continues, endoscopic intervention may be necessary.  When medical or endoscopic therapy fails to prevent variceal progression, transjugular intrahepatic portosystemic shunting is a potential alternative.