What is your preferred management for large esophageal varices with red wale marks found on screening EGD in a patient with decompensated cirrhosis, no prior GI bleeding, and good adherence to medical care?

You're describing high-risk varices, which need to be treated somehow. Guidelines do suggest NSBB and banding as an alternative if patients can't tolerate NSBB, so if you feel this patient may not be able to undergo subsequent EGDs every 2-4 weeks until eradicated, then suggest NSBB.