Objective To investigate the incidence and risk factors of early rebleeding after endoscopic ligation (EVL) in cirrhotic patients with moderate-to-severe esophagogastric varices (EGV), and establish a prediction model to evaluate the efficacy of early rebleeding after EVL. Methods Clinical data of patients who underwent EVL in the Digestive Endoscopy Center of the First Affiliated Hospital of Anhui University of Science and Technology (Huainan First People's Hospital) from May 2019 to December 2023 were selected, and the patients eligible for this study were screened and included in the follow-up analysis, and followed up for 6 weeks. The patients were divided into bleeding group (n=18) and non-bleeding group (n=159) according to whether rebleeding occurred within 6 weeks after ligation. Univariate analysis was performed on the clinical data of the two groups, and meaningful indicators were included in multivariate Logistic regression analysis to filter the independent influencing factors of early rebleeding after cirrhosis with moderate-to-severe esophageal varices ligation. Then R software was used to construct a nomogram prediction model, and the predictive ability of nomogram prediction model was evaluated by receiver operating characteristic (ROC) curve. Bootstrap method was used for internal verification of the model, C-index was calculated to evaluate the model differentiation, and calibration curve was drawn to evaluate the calibration degree of the model. Results A total of 177 patients were included, of which 18 patients had rebleeding within 6 weeks after EVL surgery (10.2%), the number of varicose vein ligation points (OR=1.405, 95%CI: 1.087～1.817, P=0.009), ALB (OR=0.818, 95%CI: 0.700～0.957, P=0.012), and APTT (OR=1.188, 95%CI: 1.041～ 1.356, P=0.01), Child-Pugh classification (OR=8.119, 95%CI: 1.205～54.689, P=0.031) were independent factors affecting early rebleeding after EVL in patients with moderate-to-severe EGV. The area under ROC curve was 0.932 (95%CI: 0.882～0.981)) for early rebleeding after EVL in cirrhotic patients with moderate-to-severe EGV. After internal verification, the C-index of the model was 0.925. The calibration curve showed that the predicted results of the model were in good agreement with the actual results. Conclusion The number of varicose veins ligation, ALB, APTT and Child-Pugh grades are independent factors that cause early rebleeding after EVL. The number of varicose veins ligation, APTT and Child-Pugh grades are risk factors, and ALB is protective factor, which should be paid full attention in clinical practice. Moreover, the nomogram model constructed based on this study can individually predict the incidence of early rebleeding after EVL in cirrhotic patients with moderate-to-severe EGV