Established methods of diagnosis and treatment of bleeding esophageal varices continue to be studied with further clarification of acute and chronic management strategies. New endoscopic and radiologic techniques have been introduced that provide additional or alternative approaches. The question of prophylactic variceal therapy remains in the noninvasive arena and elective invasive methods continue to carry a significant morbidity, but there are attempts to define the patient most at risk of bleeding and rebleeding. The next few years should see a rationalization of treatment algorithms as experience is gained with newer modalities used alone or in combination.