Background <p>Gastric varices (GV) pose the potential risk of massive bleeding. Endoscopic ultrasound (EUS) guided real-time delivery of adhesives and devices has emerged as a promising therapeutic modality for GV but was limited in its generalizability due to the unavailability and lack of expertise of linear echoendoscopy. Therefore, we utilized the more readily available EUS mini-probe (EMP) in assisting cyanoacrylate (CYA) injection in the management of GV.</p> Methods <p>This is a retrospective cohort study from a single tertiary medical center. One hundred and thirty-three eligible patients were divided into three groups based on the treatment modalities including EMP-guided CYA injection via a dual-channel gastroscope (EMP-D group), EMP-guided injection via a single-channel gastroscope (EMP-S group) and direct endoscopic injection (DEI group). The clinical characteristics, procedural parameters, outcomes, adverse events and follow-up data were analyzed.</p> Results <p>An overall statistical significance was achieved in the number of puncture site (<i>p</i> &lt; 0.001), the number of instant blood return upon puncture (<i>p</i> = 0.001), cyanoacrylate dose (<i>p</i> = 0.004), late rebleeding rate (<i>p</i> = 0.018), post-injection ulcer (<i>p</i> = 0.005), and non-rebleeding interval (<i>p</i> = 0.026) among the three groups. Patients in EMP-D group exhibited a lower rate of post-injection ulcer than those in DEI group (<i>p</i> = 0.009). Procedural time of EMP-D was shorter than that of EMP-S (<i>p</i> &lt; 0.001). Less amount of cyanoacrylate was needed per reinjection session in EMP-D than in DEI (<i>p</i> = 0.002).</p> Conclusions <p>EMP-guided cyanoacrylate injection exhibited superior effectiveness and safety to DEI, while use of the dual-channel gastroscope further enhanced the precision and efficiency.</p> Graphical abstract <p></p>