EUS-guided Combined Therapy Versus Beta Blocker Therapy in Primary Prophylaxis o GOV II and IGV I

Inclusion Criteria: * Above 18 years old * Writeen informed consent provided. * Proven GV (GOV II or IGV I) on esophagogastroduodenoscopy and EUS. * Gastric varices with high-risk of bleeding (large diameter, high MELD score, presence of portal hypertensive gastropathy) * Patient preference for EUS-guided therapy. Exclusion Criteria: * Under 18 years old. * Refuse to sign written informed consent. * Pregnancy or nursing. * Previous treatment of gastric varices. * Non-cirrhotic portal hypertension * Concurrent hepato-renal syndrome and/or multi-organ failure. * Proven malignancy including hepatocellular carcinoma * Platelet count less than 50,000/ml or International Normalized Rate (INR) \>2. * Severe ascites that increases the distance between gastric or duodenal and gallbladder walls. * Esophageal stricture. * Uncontrolled coagulopathy.