Bleeding from ruptured esophageal and gastric varices is a serious complication in patients with cirrhosis. About 50% of cirrhotic patients develop esophageal varices and 5C33% of cirrhotic patients with portal hypertension have gastric varices. About 5C8% of cirrhotic patients develop new esophageal varices each year, and although only 1-2% of patients are at risk of bleeding, once bleeding occurs, the 6-week mortality rate of patients is as high as 20%. Therefore, it is important to manage patients with esophageal and gastric varices in cirrhosis rationally to reduce the incidence of bleeding and bleeding-related mortality. 1, patients with cirrhosis need to do gastroscopy Once diagnosed, the condition of patients with cirrhosis basically belongs to the decompensated stage (also can be called late stage), the clinical manifestations can be various, but almost every patient has increased portal vein pressure, manifested as esophageal and gastric varices. The degree of varices varies in severity. Mild varices can gradually develop into severe varices, at this time the patient’s esophagus and stomach is like a time bomb, once it explodes, it will manifest as a dangerous and fatal gastrointestinal hemorrhage. Therefore, patients with liver cirrhosis should have gastroscopy after diagnosis to understand the degree of varices and provide a basis for subsequent related treatment. However, in actual clinical work, many patients with cirrhosis have fear and dread of gastroscopy. With the development of gastrointestinal endoscopy technology, the discomfort brought by gastroscopy is becoming less and less. Depending on the patient’s specific situation, gastroscopy can be done under sedation and painlessly. If severe varices or rupture precursors are found, timely endoscopic treatment is required to prevent the first bleeding. According to the relevant information, it is summarized as follows:1 Gastroscopic screening: once the diagnosis of cirrhosis is confirmed that gastroscopic screening of esophagogastric varices;2 monitoring according to the degree of cirrhosis and the presence or absence and size of varices, no varices in the compensated stage of cirrhosis (early stage), gastroscopy every 2-3 years, small varices 1-2 years gastroscopy. In the decompensated stage of cirrhosis (middle and late stage), gastroscopy is performed once a year. There are various ways how to determine the degree of varicose veins by gastroscopy. Two classification methods are recommended. One is two-level classification method i.e. large and small varices, the former refers to veins larger than 5 mm in diameter and the latter is less than 5 mm. the second is three-level classification method; mild varices refer to slight elevation of esophageal mucosal surface and visible blue veins, moderate varices refer to twisted veins occupying less than 1/3 of esophageal lumen and severe varices refer to twisted veins occupying more than 1/3 of esophageal lumen. 2. What are the consequences of gastrointestinal bleeding in patients with cirrhosis? The consequences of gastrointestinal bleeding are mainly manifested in the following aspects: Firstly, hemorrhage directly leads to death or cannot be saved after various treatment measures are ineffective. Secondly, although the bleeding stops after treatment, it is immediately followed by ascites, jaundice, hepatic encephalopathy, and decompensated liver function, which further aggravates the liver condition. It also increases the patient’s pain and economic burden. Third, about 30% of patients will bleed again within one year after bleeding. The incidence of rebleeding is higher within two to three years. Therefore, it is very important to prevent bleeding. 3, cirrhotic patients with gastrointestinal bleeding, prevention is more important than treatment First of all, individuals start with diet, rest, life and living. Avoid smoking, alcohol, spicy stimulating, rough food, fatigue, cold, etc. The medical aspect of prevention focuses on intervention before bleeding. According to the guidelines, non-selective beta-blockers (NSBBs) should be used for primary prevention of small esophageal varices at risk of bleeding. NSBBs are an inexpensive and effective means of prevention that not only prevent bleeding in portal hypertensive gastric disease, but also reduce portal resistance and lower the risk of variceal bleeding, which can significantly benefit patients with long-term use. Of course, for patients who do not want to take NSBBs or have contraindications to taking them, endoscopic laparoscopy is another option for effective bleeding prevention. Guidelines for primary prevention of gastric varices do not provide a definitive protocol. NSBBs should also be used for primary prevention of gastric varices, considering their ability to reduce vessel wall pressure. Although tissue gel injections are superior to NBBSs for primary prevention, they have relatively high complications and are not recommended for primary prevention. For patients who have had severe bleeding, secondary prevention (prevention of a second occurrence) should be started as soon as possible after the bleeding has stopped. The guideline recommendation is NBBSs combined with multiple endoscopic sleeve treatments until the varicose vein disappears. Gastric varices are more often treated with tissue gel injections for secondary prevention, usually repeated every 2-4 weeks after the initial bleeding has stopped until the varicose vein disappears. Endoscopic treatment is the first-line treatment for esophageal and gastric varices because it is time-consuming, less traumatic, less expensive, and the patient recovers quickly.