The presence of varices or bleeding from them suggests the existence of portal hypertension (PH) as well as the presence of portosystemic collaterals confirmed by imaging methods. The most common cause is cirrhosis. Therefore, clinical and imaging examinations, as well as LSM (liver stiffness measurement), must be performed to search for the presence of cirrhosis. Varices and the presence of collaterals indicate the presence of clinically significant portal hypertension (CSHP), and if varices are absent, CSHP is confirmed by hepatic venous pressure gradient (HVPG). Pharmacological reduction of portal hypertension plays a significant role in the treatment and prevention of many complications of cirrhosis, especially variceal bleeding. Non-selective beta-blockers (NSBB) and endoscopic band ligation (EBL) are used for primary prophylaxis of bleeding. Acute variceal bleeding requires prompt volume replacement to ensure and maintain hemodynamic stabilization of the patient. Protection of the airway with endotracheal intubation and implementation of restrictive transfusion therapy are recommended. Antibiotic prophylaxis is recommended in cirrhotic patients due to several benefits. Vasoactive drugs should be initiated immediately when variceal bleeding is suspected, and after hemodynamic stabilization of the patient, endoscopy is performed. If it is an esophageal variceal (EV) bleeding, ligation is performed immediately. The combination of vasoactive drugs and EBL represents the first-line treatment for acute bleeding. Early transjugular intrahepatic portosystemic shunt (TIPS) may be suggested for high-risk patients. Although the initial management is similar, endoscopic management of gastric varices does not rely solely on EBL as the main method because suction is challenging, and post-procedural ulcers can cause severe bleeding. Endoscopic methods for managing bleeding from gastric varices (GOV2 and IGV1) include obliteration with cyanoacrylate glue or EUS-guided coiling and cyanoacrylate application. Radiological methods include TIPS and balloon-occluded retrograde transvenous obliteration (BRTO), with TIPS having a higher success rate in achieving initial hemostasis. Combinations of these two methods can also be used. Once varices have bled, secondary prophylaxis is performed using a combination of NSBB and EBL.