The initial priorities for the management of an acute variceal hemorrhage include focussing on achieving hemodynamic stability and airway protection. Vasoactive medication such as terlipressin, octreotide, and vasopressin are used to decrease bleeding. Antibiotics improve survival and reduce rebleeding risk. Endoscopy with band ligation is the preferred endoscopic therapy for esophageal varices. For gastric varices, injection of cyanoacrylate to obliterate them are effective. TIPSS is usually used for rescue therapy. Balloon tamponade is generally used in situations when endoscopy is not available, when endoscopy fails to control bleeding, or when bleeding is so profound that there is not sufficient time to wait for endoscopy.