The hemostatic efficacy of endoscopic therapeutic modalities has been reported in many studies and frequently has been found to exceed 90%. Four groups of modalities are used in the endoscopic management of bleeding peptic ulcers: thermal probe methods, injection sclerotherapy, local spray methods, and mechanical hemostatic therapy. Use of a metallic hemoclip as a mechanical hemostatic method also has been suggested. This method has several advantages, including fewer associated com- plications and the fact that less expertise is needed to achieve permanent hemostasis. 1-3 Review of rele- vant published reports indicates that no compar- isons of the hemostatic efficacy of the hemoclip pro- cedure with that of other methods have been pub- lished to date. We evaluated and compared the relative efficacy and usefulness of the hemoclip method, hypertonic saline–epinephrine (HSE) injection therapy, and combined therapy by determining initial hemostatic rates, rates of recurrent bleeding, transfusion requirements, permanent hemostasis rates, need for surgical intervention, and mortality rates. We also compared the efficacy of each method according to ulcer location and degree of bleeding among patients at high risk for recurrent bleeding in rela- tion to endoscopic features such as the presence of visible vessels with or without spurting and oozing. Comparison of the hemostatic efficacy of the endoscopic hemoclip method with hypertonic saline–epinephrine injection and a combination of the two for the management of bleeding peptic ulcers Il-Kwun Chung, MD, Jung-Sik Ham, MD, Hong-Soo Kim, MD, Sang-Heum Park, MD, Moon-Ho Lee, MD, and Sun-Joo Kim, MD Chonan, Korea Background: The endoscopic hemoclip method is a safe and effective hemostatic method for managing bleeding peptic ulcers. We compared the hemostatic efficacy of the endoscopic hemoclip method with that of hyper- tonic saline–epinephrine (HSE) injection and a combined method in the management of bleeding peptic ulcers. Methods: From July 1994 to July 1997, we conducted a randomized clinical trial of endoscopic hemostasis involving 124 patients with actively bleeding or visible vessels at endoscopic inspection. Results: Patients were randomly assigned to hemoclip (41 patients), HSE (41 patients), and combined treatment groups (42 patients). Initial hemosta- sis was achieved in 97.6%, 95.1%, and 97.6% of cases, respectively. Recurrent bleeding developed in 2.4%, 14.6%, and 9.5% of cases. Emergency operations were performed in 4.9%, 14.6%, and 2.3% of cases. The hemosta- sis rate was 71.4%, 50%, and 66.7% for spurting hemorrhage in each group. Permanent hemostasis was achieved in 95.1%, 85.4%, and 95.2% of cases. Three patients had complications, all in the HSE group. Conclusions: The hemoclip method is an effective hemostatic procedure and is safer than HSE injection.The combined method does not provide sub- stantial advantage over use of the hemoclip method alone in the hemostatic management of bleeding peptic ulcers. (Gastrointest Endosc 1999;49:13-8.) Received September 17, 1997. For revision January 23, 1998. Accepted July 5, 1998. From the Division of Gastroenterology, Department of Internal Medicine, Soonchunhyang University Hospital, Soonchunhyang University College of Medicine, Choongnam, Republic of Korea. Presented in part at the annual meeting of the American Society for Gastrointestinal Endoscopy/Digestive Diseases Week 1997, Washington DC, May 11-14, 1997. Reprint requests: Il-Kwun Chung, MD, Division of Gastroenterology, Department of Internal Medicine, Soonchunhyang University Hospital, 23-20 Bongmyung-dong, Chonan City, Choongnam, Republic of Korea 330-100. Copyright © 1999 by the American Society for Gastrointestinal Endoscopy 0016-5107/99/$8.00 + 0 37/1/92896 VOLUME 49, NO. 1, 1999 GASTROINTESTINAL ENDOSCOPY 13