Portal hypertension is one of the most significant complications of both acute and chronic liver diseases. It generally develops as a result of an increase in vascular resistance at the pre-hepatic, intra-hepatic, or post-hepatic level. An increase in portal blood flow may also contribute. The dominant cause of portal hypertension relates to liver cirrhosis which increases resistance through the hepatic sinusoids. Gastro-esophageal varices are the most important clinical manifestation of this syndrome and are associated with a high risk of upper gastrointestinal hemorrhage and its attendant high mortality.In the last two decades recommended therapy for primary prophylaxisincludes the administration of nonselective beta-blockers (mainly Propranolol and Nadolol) or endoscopic variceal ligation (EVL) with elastic bands . Nonselective B blockers are the gold standard in the prevention of first variceal hemorrhage in patients with medium/large varices. Endoscopic variceal ligation has been established as an alternative to nonselective B blockers for the prevention of initial variceal hemorrhage.