The patient with bleeding esophageal varices represents always a challenge to the medical team carrying a high mortality in spite of advances in pharmacologic and endoscopic treatments, notwithstanding that bleeding is just one added complication in the setting of the ailments of portal hypertension. Sclerotherapy, once the treatment of choice, has been displaced in recent year by variceal ligature, with less morbidity and equal success rate, both of them being technically simple. In the same way, variceal ligature has displaced sclerotherapy as treatment for secondary prophylaxis, with less complications and less sessions needed for variceal erradication and bleeding prevention. On the other hand, sclerotherapy is not indicated for patients with large varices, while ligature competes with pharmacologic treatment, some people suggesting the superiority of ligature because of better patient compliance, although probably the best option would be a combination of both. Thus, endoscopic treatment has an important role in this clinical situation, both for diagnosis as for management of active bleeding and primary prophylaxis.