Cirrhotic patients undergoing an upper gastrointestinal endoscopy have additional inherent risks and a higher rate of complications related to their liver disease and portal hypertension. Understanding the unique characteristics associated with advanced liver disease is necessary to administer drugs and blood products properly and to use monitoring devices for a safe endoscopic procedure in a cirrhotic patient. In addition, there are many complications of cirrhosis that require endoscopy for identification and treatment. Endoscopy is considered part of first line of therapy in the treatment of upper gastrointestinal bleeding because it can identify the cause of bleeding and provide direct therapeutic intervention. It also has a significant role in the screening of varices and the further prevention of recurrent variceal bleeding. Understanding the necessary precautions and management issues when performing an elective and therapeutic endoscopic procedure in a cirrhotic patient minimizes risks and maximizes benefits of the procedure.