Introduction: Bleeding from gastric varices (GV) is less frequent than from esophageal varices (EV) but is usually more severe with higher transfusion requirements and higher mortality. Several treatments including cyanoacrylate glue injection, banding, transjugular intrahepatic portosystemic shunt (TIPS), balloon-occluded retrograde transvenous obliteration (BRTO), beta blockers (BB) and ethanolamine oleate (EO) injections have been used with variable success. We conducted a systematic review and meta-analysis to compare the efficacy and safety of cyanoacrylate glue injection and other modalities in the management of GV. Methods: We searched Medline, Embase, Scopus and Cochrane database from inception to June 1, 2016 to identify studies comparing cyanoacrylate glue injections with other modalities for treatment of GV. Risk ratios (RR) were calculated for mortality, re-bleeding, initial hemostasis and adverse events (AE) comparing cyanoacrylate with other modalities. We used a random effects model and conducted subgroup analyses based on the treatment modality being compared. We assessed publication bias with funnel plots and Egger's test. Results: We included 14 studies (8 RCTs and 6 observational studies) with 1156 patients. Pooled RR with 95% confidence interval for initial hemostasis was 0.43 (0.25, 0.74), (I2=0%) with no publication bias (P=0.10). Pooled RR for mortality was 0.74 (0.57, 0.96) with low heterogeneity (I2=18%) and no publication bias (P=0.73). RRs for mortality in subgroup analyses were: EO injection 0.39 (0.13, 1.16); banding 0.77 (0.59, 0.99) (I2=0%); alcohol injection 0.34 (0.08, 1.53); TIPS 0.82 (0.54, 1.26) (I2=0%); BRTO 2.17 (0.71, 6.66), BB 0.26 (0.07, 0.88) (I2=0%). Pooled RR for re-bleeding was 0.77 (0.52, 1.16), (I2=62%) without publication bias (P=0.39). RR for re-bleeding in subgroup analyses were: EO injection 0.34 (0.13, 0.89); banding 0.51 (0.36, 0.73) (I2=0%); alcohol injection 0.85 (0.30, 2.45); TIPS 1.32 (0.76, 2.30) (I2=49%); BRTO 4.64 (1.24, 17.33), BB 0.21 (0.07, 0.65). Pooled RR for AEs was 0.89 (0.56, 1.41), (I2=70%). Conclusion: Cyanoacrylate glue injection should be considered the treatment of choice for acutely bleeding GVs. It has excellent efficacy in achieving initial hemostasis and is associated with decreased mortality. However, rates of re-bleeding and AEs were not significantly different from other modalities.Figure 1Figure 2Figure 3