Background and study aim: The bleeding from gastric varices are more severe, requiring more blood transfusions, and has a higher mortality rate than esophageal variceal bleeding, there is little data on primary prophylaxis of GV bleeding, we compared the efficacy of cyanoacrylate injection and beta-blockers in primary prophylaxis of gastric variceal bleeding.Methods: Cirrhotics with gastroesophageal varices type 2 with eradicated esophageal varices or large isolated gastric varix type 1, who had never bled from gastric varix, were randomized to cyanoacrylate injection (Group I, n = 30), beta-blockers (Group II, n = 30) or no treatment (Group III, n = 30). Primary endpoints were bleeding from gastric varix or death.Results: bleeding from gastric varices over 6 months follow up was 6.67% in Group I, 20% in Group II, 36.67% in Group III (p = 0.017). GV obliterated or decreased in size 42.86% and 57.14% of group I respectively. No patients neither in group II nor in group III had an obliteration or decrease in GV size. (p < 0.001). Conclusion:Primary prophylaxis in patients with gastric varices is recommended to reduce the risk of first bleeding. Cyanoacrylate injection is more effective than beta-blocker therapy in preventing first gastric variceal bleeding.