Variceal bleeding (VB) is one of the main causes of morbidity and mortality associated with portal hypertension (PHT) complications in patients with liver cirrhosis. There is scarce information from South America on the frequency, primary prophylaxis and treatment of this complication. This study aimed to know the frequency of VB as the first cause of decompensation in patients with liver cirrhosis, and to describe the primary prophylaxis and management of VB. We conducted a retrospective cohort study that included 1061 patients from 8 centers in five South American countries. Data from medical records collected in a template form in REDCAP were evaluated. Patients with a confirmed diagnosis of liver cirrhosis by clinical, laboratory, imaging and/or pathology data were included. VB was defined according to endoscopic and clinical criteria of each center. Endoscopic findings were classified according to Baveno and Sarin criteria. 206 (19%) patients presented VB during evolution and it was the first cause of decompensation in 177 (17%) patients. 53 (26%) patients with history VB had received primary prophylaxis with endoscopic ligation due to intolerance to beta-blockers. In 186 (90%) patients bleeding was attributed to esophageal varices and in 20 (10%) patients to gastric varices. During the VB episode, 96 (47%) patients received treatment with splanchnic vasoactive agents (terlipressin n=50, octreotide n=45 and somatostatin n=1). Three patients (1.5%) required TIPS placement as part of the management of bleeding. 48 (23%) patients died withing 1-year follow-up from bleeding. VB was the first decompensation in 1/5 of patients with liver cirrhosis. A significant proportion of those patients received primary prophylaxis with endoscopic ligation. During BV, less than half of the patients received splanchnic vasoactive and TIPS placement was infrequent. More data are needed to evaluate the management of complications of liver cirrhosis in our region.