The role of esophago-gastro-duodenoscopy is defined by its dual function for the diagnosis of the exact origin of the bleeding and the therapy of the bleeding during the same examination. The aim of treatment of acute bleeding from esophageal varices is not only its controlling but also preventing rebleeding and complications mostly infections. Combined endoscopic and pharmacological treatment with vasoactive drugs can control bleeding in up to 90 % of patients. All patients who survived variceal bleeding should by treated with salvage transjugular intrahepatic portosystemic shunt (TIPS) or, in selected cases, with surgical shunts. Liver transplantation should be considered for patients with severe liver insufficiency in which first-line treatments failed.