Secondary Prophylaxis of Gastric Variceal Bleed

Endoscopic Cyanoacrylate Injection vs. Balloon-occluded Retrograde Transvenous Obliteration in the Prevention of Gastric Variceal Rebleeding

The purpose of this study is to study the efficacy of endoscopic cyanoacrylate injection versus balloon-occluded retrograde transvenous obliteration in the prevention of gastric variceal rebleeding and improvement in survival.

Inclusion Criteria:

1. Cirrhosis
2. Patients who had bled from GOV2 or IGV1（≥5 days and ≤ 28days）
3. Presence of gastrorenal shunt

Exclusion Criteria:

1. Previous treatment of gastric varices, including endoscopic therapy, NSBB, TIPS, or surgery
2. Non-cirrhotic portal hypertension
3. Contraindications to cyanoacrylate injection or BRTO
4. Portal cavernoma
5. Hepatorenal syndrome
6. Proven malignancy including hepatocellular carcinoma
7. End-stage renal disease under renal replacement therapy;
8. Cardiorespiratory failure
9. Pregnancy or patients not giving informed consent for endoscopic procedures