 Gastric variceal hemorrhage GVH has a poorer prognosis than esophageal variceal hemorrhage. However, data on its optimal treatment are limited. We designed a prospective study to compare the efficacy of endoscopic band ligation GVL and endoscopic N-butyl-2-cyanoacrylate injection GVO. Liver cirrhotic patients with or without concomitant hepatocelluar carcinoma HCC and patients presenting with acute GVH were randomized into two treatment groups. Forty-eight patients received GVL, and another 49 patients received GVO. Both treatments were equally successful in controlling active bleeding 1415 vs. 1415, P 1.000. More of the patients who underwent GVL had GV rebleeding GVL vs. GVO, 2148 vs. 1149; P .044. The 2-year and 3-year cumulative rate of GV rebleeding were 63.1 95 confidence interval CI, 44.5-81.7, 72.3 95 CI, 51.3-93.3 for GVL and 26.8 95 CI, 12.5-41.1, 26.8 95 CI, 12.5-41.1 for GVO; P .0143, log-rank test. The rebleeding risk of GVL sustained throughout the entire follow-up period. Multivariate Cox regression indicated that concomitance with HCC relative hazard: 2.453, 95 CI: 1.036-5.806, P .041 and the treatment method GVL vs. GVO, relative hazard: 2.660, 95 CI: 1.167-6.061, P .020 were independent factors predictive of GV rebleeding. There was no difference in survival between the two groups. Severe complications due to these two treatments were rare. In conclusion, the efficacy of GVL to control active GVH appears to have no difference with GVO, but GVO is associated with a lower GV rebleeding rate. 