Abstract Background: Acute variceal bleeding (AVB) is a potentially fatal complication in cirrhotic patients with portal hypertension. Simple endoscopic techniques requiring limited expertise are needed to improve morbidity and mortality. Aim of Study: To test the efficacy of hemostatic powder for control of AVB due to portal hypertension in cirrhotic patients presenting in the emergency department. Patients and Methods: In this single-arm, prospective study, conducted at a center in Egypt, patients admitted to the emergency department with suspected AVB were admitted. Endoscopy was performed within 6 hours of admission and hemostatic powder was applied in the case variceal bleeding was performed. Patients were observed for 24 hours and underwent second endoscopy and definitive therapy the following day. Results: Forty patients were admitted and after the first endoscopy, 32 had confirmed AVB. Child-Pugh class C liver disease was present in 50% of patients. Esophageal varices were observed in 78.1% of patients, gastric varices in 12.5% and duodenal varices in 9.4%. No major adverse events or mortalities were observed during the follow-up. All patients achieved primary endoscopic hemostasis. Conclusion: In cirrhotic patients presenting to the emer-gency department with suspected AVB, hemostatic powder application was safe and effective for achieving endoscopic hemostasis.