Furthermore, isosorbide mononitrate or band ligation have a place where there is intolerance or contraindications to propranolol for the prevention of the first episode of bleeding and . It is now recommended that all patients with established cirrhosis should be screened by upper gastrointestinal endoscopy for the presence of varices at the time of diagnosis. Patients with large varices should be treated with non-selective β-blockers to reduce the incidence of first variceal bleeding. Furthermore, patients without varices or with small varices should be re-endoscoped every 1–3 years and