BACKGROUND Variceal hemorrhage remains a major contributor to morbidity and mortality among patients with liver cirrhosis. Although primary prophylaxis is strongly recommended, uncertainty persists regarding the relative efficacy of carvedilol and other nonselective beta-blockers (NSBBs) vs endoscopic variceal ligation (EVL). AIM To compare the efficacy of carvedilol and other NSBBs with EVL for the primary prophylaxis of variceal bleeding in patients with cirrhosis. METHODS A systematic search