Background: Upper gastrointestinal (GI) endoscopy, either diagnostic or therapeutic, is frequently performed under conscious sedation in cirrhotic patients. The standard agent, on the other hand, is not yet well established. Objective: Comparison between propofol and midazolam for conscious sedation during upper GI endoscopy in patients with liver cirrhosis in terms of safety and effectiveness. Patients and methods: Sixty cirrhotic (Child-Pugh A or B) patients, at Al-Azhar University Hospitals' Endoscopy Unit, were included in the study and randomly assigned to either propofol group (30 patients) or midazolam group (30 patients). Patients aged 18 to 65 years with known chronic liver disease who presented for upper GI endoscopy for routine variceal screening or banding were eligible. Patients with advanced or decompensated liver disease (Child score >10) were excluded. Sedation was administered by an anesthesiologist. Results: Our results observed clearly that the recovery time, patient satisfaction, and the incidences of hypoxia differ significantly between groups. Conclusions: propofol is safe and effective when compared to midazolam for sedation during upper GI endoscopy in cirrhotic patients.