Esophageal variceal bleeding is a frequent complication in patients with chronic liver disease. There is no published study that evaluates the management of this complication in Puerto Rico. Our study describes the management of patients with esophageal varices admitted to the emergency room of the Puerto Rico Medical Center from January 2002 to December 2004. Seventy-four patients were included, 50% of which presented stigmata of recent bleeding from esophageal varices. In patients who presented stigmata of recent esophageal variceal bleeding, larger varices were identified (65% vs. 27% p = 0.002). Significant bleeding and banding of esophageal varices was most common in patients with stigmata of recent bleed. Octreotide infusion and prophylactic antibiotics were received by the vast majority. The management of esophageal variceal bleeding in our institution is compliant with the American Association for the Study of Liver Diseases guidelines.