Introduction: Duodenal varices (DV) are a rare but potentially serious complication of portal hypertension due to high risk of massive gastrointestinal bleeding. Case Report: A 52-year-old male with a past medical history of idiopathic non-cirrhotic portal hypertension since childhood was transferred to our hospital for management hematemesis and melena. His medical history was significant for recurrent gastric and esophageal variceal bleeds, which were treated with sclerotherapy. He underwent splenorenal shunt surgery and splenectomy approximately 23 years ago with good response. Abdominal contrast tomography demonstrated evidence of thrombosis of main portal vein and right hepatic vein, precluding the management with trans-jugular intrahepatic porto systemic shunt (TIPS). The patient’s hemoglobin was 7.4 at admission, despite receiving 5 units of packed red blood cells (RBCs) at another hospital. He underwent esophagogastroduodenoscopy (EGD) with visualization of spurting DV in the second part of duodenum (Figure 1). Endoscopic band ligation (EBL) of DV with 1 band was performed and hemostasis achieved. Post-EBL patient was hemodynamically stable, and his melena resolved. Follow-up EGD 2 weeks later showed of obliteration of the banded DV. Surveillance EGD 5 months later showed complete regression of banded DV with scarring at the site and non-bleeding varices on the opposite duodenal wall.Figure 1: Bleeding DV in second part of duodenum.Discussion: EBL is widely accepted as a primary therapy for esophageal variceal bleeding; however, there is no widely accepted treatment modality for duodenal varices. Blood flow in duodenal varices is frequently high, and results in profuse bleeding. Prognosis is poor, with mortality rates as high as 40%. With this case, we share our experience of successful EBL as a treatment for DV hemorrhage in a patient where other modalities, such as TIPS, are impossible or contraindicated. However, one must monitor for the formation of additional varices in other intestinal sites after EBL with surveillance endoscopy or capsule endoscopy.