Patients with cirrhosis are at risk for developing portal hypertension that can lead to the formation, dilation, and rupture of esophageal varices. The annual incidence of esophageal varices is approximately 5% and one third of those will bleed.

Beta blockers should be the first line of prevention against variceal bleeding in patients with cirrhosis and portal hypertension. While banding is similarly effective in reducing the incidence of such bleeding, it can have fatal complications and is more expensive.

Variceal bleeding (abnormal bleeding from ruptured blood vessels) is a severe and frequent complication of cirrhosis, a condition in which scarring and damage to the liver reduces its function.

Endoscopic variceal ligation is cost-effective relative to beta-blockers for the prevention of variceal bleeding in cirrhotic patients if quality of life-years are considered. If only life-years are considered, then endoscopic variceal ligation is not cost-effective.