AbstractBleeding esophageal varices remain a major problem which has not been solved despite the number of ingenious and imaginative efforts to control and prevent hemorrhage through a variety of surgical, radiologic, pharmacologic, and endoscopic techniques.A surgically constructed portal systemic shunt still remains the most effective method of permanent control, but the high morbidity and mortality rates have led to efforts to explore other types of therapy. Variations of shunt surgery, such as the selective procedure described by Warren, are promising as are types of portal azygous disconnections and transections.There has been a revival of endoscopic sclerosis of varices stimulated by the development of more sophisticated equipment. Radiologic obliteration of the coronary vein and other portal systemic collaterals is under evaluation.In the face of the catastrophic emergency of exsanguinating hemorrhage, balloon tamponade is the most effective means of temporary control prior to definitive therapy in those patients who have not responded to other conservative approaches such as vasopressin or pituitrin. Success is primarily determined by the degree of hepatocellular function, and biochemical evaluations such as amino‐acid tolerance appear to be more predictive than the simpler and widely used Child's classification which has been the yardstick for 3 decades.In short, the multiplicity of recommended methods of therapy indicates the lack of unanimity and thus the absence of a single universally accepted algorithm for management of this difficult and multifactorial clinical problem.