Acute variceal hemorrhage is a medical emergency. Approximately 40% of patients with cirrhosis are found to have esophageal varices on endoscopic evaluation (Bosch et al.2003), and approximately one third of patients will experience variceal hemorrhage (Kleber et al. 1991; The North Italian Endoscopic Club for the Study and Treatment of Esophageal Varices 1988). The mortality of an initial variceal hemorrhage has been found to be as high as 30% (The North Italian Endoscopic Club for the Study and Treatment of Esophageal Varices 1988). The risk of variceal hemorrhage is increased in large varices and in those that demonstrate red wale markings, as well as in patients with high Child’s scores, those with previous episodes of variceal hemorrhage, and in patients who continue to ingest alcohol (The North Italian Endoscopic Club for the Study and Treatment of Esophageal Varices 1988). The size of the varix is the single most important predictor of bleeding risk.