Objective To evaluate the safety and efficacy of endoscopic variceal ligation (EVL) as an alternative to sclerotherapy for the treatment of esophageal variceal bleeding and rebleeding.Methods From January 1991 to January 1995, we treated 250 patients with esophageal varices by EVL. The patients were aged 49 years on the average, and 82% of them were male. Portal hypertension was caused by post-hepatitis cirrhosis in 168 patients. Forty-five patients belonged to Child-Pugh class A, 85 class B, and 120 class C. All but 16 patients had one or more previous episodes of variceal bleeding. At the time of treatment, 78 patients had active bleeding. Seventy-nine patients had undergone devascularization or shunt surgery or had experienced postoperative rebleeding. EVL was repeated at two-week intervals until the varices were eradicated or reduced to grade one.Results The varices were eradicated or reduced to grade one in 81% of the 250 patients. Eradication of varices required a mean of 4 sessions of treatment. The active bleeding was controlled in 73 (93.6%) of the 78 patients. No major EVL-related complication was observed. Follow-ups ranged from 4 to 48 months (average: 25 months). Bleeding recurred in 15.6% of the 250 patients. Thirty-two patients died during the study. Of them, 13 died from hepatic failure, 12 from advanced hepatoma, and 7 from uncontrollable massive bleeding. Conclusions EVL is safe, effective and simple in controlling and preventing esophageal variceal bleeding. It has few complications but broad indications. In particular, it is indicated for patients with poor liver function who cannot tolerate a surgical procedure and/or recurrent bleeding after devascularization or shunt surgery.