The purpose of this study was to assess the efficacy of EVL for treatment of active variceal hemorrhage. Twenty-three consecutive patients with actively bleeding esophageal varices had EVL with a flexible gastroscope. Treatment was measured by initial control of bleeding, incidence of early and late rebleeding, survival, complications, and size of varices at subsequent endoscopy. Repeat EVL was performed as needed for bleeding and at two week intervals until varices were grade I or eradicated. Follow up of survivors ranged from 90 to 400 days (mean 280). Bleeding varices were initially controlled in 22 (95.6%) patients. Nine (39.1%) died, five from hepatic failure with no recurrent bleeding, four from continued (1) or early recurrent (3) hemorrhage. All deaths occurred within 3 to 24 days (mean = 9.4) of initial treatment for active bleeding. Twelve of 14 surviving patients have achieved variceal eradication or reduction in size to grade I or less with a mean of 5.5 repeat EVL sessions (range, 0-10). One refused further treatment; one is lost to follow up. Excluding rebleeding, there were no treatment-related complications in 80 EVL sessions. Active variceal bleeding requiring endoscopic control is associated with substantial mortality, especially in higher risk patients. EVL is effective for initial and long term control of bleeding. EVL appears to be associated with a low incidence of non-bleeding complications.