Endoscopy — Esophageal Varices Grade III

A 56-year-old man with Child-Pugh B cirrhosis (alcohol-related, now abstinent; SVR post-DAA for HCV) undergoes screening upper endoscopy. Esophageal findings from 25–40 cm show the structure marked **A**: large tortuous varices occupying >1/3 of the esophageal lumen, non-flattening with full insufflation, with multiple red wale marks and cherry-red spots. Platelets 78,000, INR 1.5, HVPG estimated >12 mm Hg. No prior variceal bleeding. Which of the following is the most appropriate PRIMARY PROPHYLAXIS strategy for this patient?