Bleeding from ruptured varices of the esophagus and fundus of the stomach is the most common cause of death in portal hypertension, which can be caused by various etiologies such as cirrhosis, hepatocellular carcinoma, Budd-Chiari syndrome, pancreatic origin diseases, and constrictive pericarditis. The mortality rate of first bleeding is 30%-50%. It is a common emergency in gastroenterology. Before the introduction of endoscopic technology, the main rescue measures were blood transfusion, intravenous drip of pituitary posterior lobe hormone and balloon compression for hemostasis, which was often unsatisfactory. Surgical procedures mainly include interruption of flow, shunt surgery, etc., and the hemostatic effect is more satisfactory. However, the surgical mortality rate and postoperative complications during bleeding are high. With the development of endoscopic treatment and other technologies, there have been more new advances in the treatment of esophageal and gastric fundus variceal hemorrhage, and the treatment of this disease should take into account the following different clinical scenarios: prevention of the first bleeding from the variceal vein (primary prevention); prevention of the variceal vein from re-bleeding (secondary prevention); and the treatment of acute variceal hemorrhage. Prevention of first variceal bleeding (primary prevention): 1. Patients with at least moderate esophageal varices and/or red flags; 2. Cardiac nonselective β-blockers (propranolol or nadolol) should be started in small doses and, if necessary, the dose should be increased gradually until the resting heart rate is reduced to 25% of the basal value, but not lower than 55 beats per minute; 3. In the primary prevention of bleeding, the beneficial effects of varicose vein sclerotherapy (EVS) are offset by the adverse effects caused by EVL, while esophageal variceal ligation (EVL) is well tolerated by patients and is effective. Therefore, EVL can be used in patients who cannot tolerate β-blockers or in whom the application of β-blockers is contraindicated; prevention of rebleeding from varices (secondary prevention) After the initial bleeding, endoscopic treatment can be very effective in reducing the incidence of rebleeding, and the annual incidence of bleeding can be reduced from about 80% to 20%-30%. I. Endoscopic treatment: For varices of the esophagus, EVL has better outcome-adverse effects than EVS and is an optional endoscopic treatment for removal of esophageal varices. It should be emphasized that EVL requires several therapeutic manipulations (ligation every 14-28 days until clearance, usually about 3-4 times), and the varices may recur (the likelihood of variceal recurrence is higher after EVL compared to EVS); therefore, endoscopic surveillance every 3-6 months (long-term monitoring), and EVL after detection of a variceal vein, is necessary to prevent rebleeding. Currently, it has been suggested that sequential EVL- EVS treatment in combination with non-selective beta-blocker therapy can achieve better preventive results. For the varices in the fundus of the stomach, intravascular tissue glue injection is usually used; cardiac non-selective β-blocker therapy; prophylactic surgery: recent data have shown that there is a tendency not to perform prophylactic surgery, and the focus of this group of patients should be on medical liver care. However, if there is severe esophagogastric fundal varices, especially the “red sign” on the surface of the varices under the microscope, prophylactic surgery can be considered as appropriate, which is mainly to perform a flow-control operation. In patients with severe splenomegaly, combined with obvious hypersplenism, simple splenectomy is effective. Liver transplantation has become an effective surgical treatment for end-stage liver disease, and the survival rate has exceeded 70%. Liver transplantation is the ideal treatment for patients with end-stage liver disease complicated by portal hypertension and esophagogastric fundal variceal hemorrhage, both replacing the diseased liver and restoring the hemodynamics of the portal venous system to normal. However, the shortage of donor livers, the risk of lifelong immunosuppression, the risk of surgery, and the high cost limit the clinical promotion of liver transplantation. Treatment of acute variceal hemorrhage: 1. General treatment and medication Establish effective venous access, expand blood volume, and take measures to monitor the patient’s vital signs. Growth inhibitor, terlipressin, PPI and other days of drug treatment. The early rebleeding rate of drug treatment is high, and further measures must be taken to prevent rebleeding; 2, endoscopic treatment During acute bleeding, there are still different opinions on the timing of endoscopic treatment, but it is currently recognized that EVL, EVS is the preferred method of controlling acute hemorrhage, and the success rate of up to 80% -100%. Sclerotherapy and ligation are ineffective for fundal variceal rupture bleeding, and fundal bleeding needs to be treated with tissue adhesive.EVS and EVL need to be performed several times.The necrotic deafferentation time after EVL is about 7-15 days, and there is a risk of hemorrhage, so it is feasible to perform EVL or EVS again, and the time of 15-30 days after the operation is suitable; 3. Triple lumen tube compression for hemostasis The compression of triple lumen can control bleeding in 80% of esophagogastric fundal varices, but about half of them can be controlled. Bleeding is controlled, but about half of the patients bleed again immediately after emptying the balloon. The complication rate is 10-20%, and the complications include aspiration pneumonia, esophageal rupture and asphyxiation; 4. transjugular intrahepatic portosystemic shunt (TIPS): Establishing a channel between the hepatic vein and the main branch of the portal vein through the jugular route, and placing a stent to realize the portal shunt, TIPS. The diameter of the internal support tube of TIPS is 8-12 mm. TIPS can significantly reduce the pressure of the portal vein, generally to half of the original pressure, and can treat acute bleeding and prevent recurrent bleeding. The main problems are progressive stenosis of the supporting ducts and complications of hepatic failure (5%-10%) and hepatic encephalopathy (20%-40%). At present, the main indications for TIPS are ineffective drug and endoscopic treatment, poor liver function in patients with varicose vein rupture and bleeding and for patients waiting for liver transplantation; 5. Emergency surgical treatment: 3. Indications for emergency surgical treatment: (1) patients with a history of hemorrhage, or the bleeding is aggressive, bleeding, or after a short period of active hemostatic treatment, there are still recurrent bleeding, should be considered for emergency surgery (2) If the bleeding cannot be controlled within 48 hours after strict medical treatment, or if the bleeding recurs after short-term hemostatic treatment, emergency surgery should be actively performed to stop bleeding. Surgery can not only prevent rebleeding, but also is an effective measure to prevent hepatic coma. Emergency surgery should be avoided because of the high mortality rate due to the severe condition and shock.Emergency surgery is not recommended for Child C patients.