Esophageal variceal hemorrhage is an important complication of portal hypertension and represents a significant challenge to both the gastroenterologist and gastroenterology nurse and associate (GNA). No single modality has emerged as superior for all patients, and new medications and techniques have continued to be introduced. This article reviews the currently available modalities for treating esophageal variceal hemorrhage and discusses patient management issues and endoscopic techniques that GNAs are likely to be involved with.