In patients with portal hypertension small anastomoses develop between the veins of the portal system and the veins of the systemic circulation. These portosystemic anastomoses are usually of little consequence; however, at the gastroesophageal junction, they lie in a submucosal and mucosal position and are subject to trauma. Torrential hemorrhage may occur from even minor trauma, and death may ensue following blood loss. These varices require urgent treatment, which includes injecting sclerosant substances, banding, and even surgical ligation.