Acute bleeding from esophagus varices in portal hypertension is still a considerable therapeutic problem, and quite different approached to treatment are being followed. We use the following approach general procedures like treatment of shock, treatment of coagulation disorders etc.; emergency endoscopy; submucosal sclerosing if varices can be identified endoscopically as the source of bleeding. If bleeding cannot be stopped in this way a Sengstaken probe is applied for 4-6 hours, and after that sclerosing of the bleeding area is tried again. If bleeding does not stop at that time yet, the vena coronaria ventriculi or the venae gastricae breves are sclerosed by the transhepatic route. In almost all cases bleeding can be stopped successfully if this sequence of procedures is followed. After bleeding has been stopped, surgery establishing a portacaval shunt may be taken into account.