Objective To analyze the efficacy of endoscopic histoacryl injection in the treatment of gastric variceal bleeding caused by regional portal hypertension. Methods The endoscopic features and efficacy of endoscopic histoacryl injection were examined and compared in two groups of patients admitted to our hospital from June 2012 to December 2012. One of the groups included 6 patients with gastric variceal bleeding caused by regional portal hypertension and the other group included 6 patients with gastric variceal bleeding caused by hepatitis B cirrhosis- related portal hypertension. Between- group comparison of categorical data was made by Fisher' s test. Results In patients with regional portal hypertension,five of them had severe isolated gastric varices( IGV) and one had severe IGV with mild esophageal varices. All six patients with hepatitis B cirrhosis- related portal hypertension had severe IGV and the endoscopic features were similar to those of patients with regional portal hypertension. Significant differences were observed between the group with regional portal hypertension and the group with hepatitis B cirrhosis related portal hypertension in short- term response rate( 1 /6 vs 6 /6,P = 0. 015) and long- term response rate( 0 /6 vs 5 /6,P = 0. 015). Conclusion The gastric varices caused by regional portal hypertension has a fast progression rate and a high bleeding risk. The efficacy of endoscopic histoacryl injection in patients with this type of gastric varices is poor.