Objective To compare the therapeutic effects of carvedilol alone and carvedilol combined with endoscopic variceal ligation （EVL） in the prevention of re-bleeding from gastroesophageal varices，and to provide strategies for clinical treatment. Methods We retrospectively included 178 patients who had received carvedilol alone or carvedilol plus EVL to prevent gastroesophageal variceal re-hemorrhage from October 2010 to June 2023. They were divided into carvedilol alone group （47 cases） and carvedilol+EVL group （131 cases）. Between-group comparisons were conducted using the paired t test for normally distributed continuous data，the Mann-Whitney U test for non-normally distributed continuous data，and the chi-square test for categorical data. A Cox proportional hazards model was employed for univariable and multi-variable analyses. The cumulative incidence rates of re-bleeding and mortality were estimated using the Kaplan-Meier method. The baseline characteristics of the two groups were matched through propensity score matching （PSM） to reduce selection bias and enhance the credibility of causal inference. Results The re-bleeding rate of the carvedilol+EVL group was significantly lower than that of the carvedilol alone group （10-year cumulative incidence：29.8% vs 36.2%，hazard ratio ［HR］=0.505，95% confidence interval ［CI］：0.292‍ ‍—‍ ‍0.847，P=0.015）. There was no significant difference in liver-related mortality （10-year cumulative incidence：21.3% vs 21.4%，HR=0.799，95%CI：0.406‍ ‍—‍ ‍1.578，P=0.518）. The results were stable with PSM analysis. The Cox regression analysis revealed that creatinine was an independent risk factor affecting re-bleeding （HR=1.004，95%CI：1.001‍ ‍—‍ ‍1.008，P=0.011） and liver-related mortality （HR=1.004，95%CI：1.001‍ ‍—‍ ‍1.007，P=0.019）. Conclusion Carvedilol combined with EVL is better than carvedilol alone in the prevention of gastroesophageal variceal re-bleeding.