Endoscopic treatment with combined modalities is considered standard of care f or patients with high-risk peptic ulcer bleeding. This study compared epinephri ne injection plus bipolar probe coagulation with bipolar probe coagulation alone in patients with high-risk peptic ulcer bleeding. Patients with endoscopically confirmed peptic ulcer bleeding (active or visible vessel) seen from January 20 00 through December 2002 were prospectively randomized to two groups. The study group (n = 58) had epinephrine injection followed by bipolar coagulation; the co ntrol group (n = 56) was treated by bipolar coagulation alone. The primary outco mes assessed were the rate of initial hemostasis and the rate of recurrent bleed ing. Secondary outcomes were the following:need for surgical intervention to con trol bleeding,transfusion requirements, length of hospital stay (in days)-, and 30-day mortality. The rate of initial hemostasis was significantly higher in t he combination therapy group (p = 0.02; absolute risk reduction 31.6%: 95%CI [ 5.4, 57.7]).There was no significant difference between the two treatment groups with respect to all other outcomes measures,except that significantly fewer uni ts of blood were transfused in the combination therapy group (p = 0.006). In pat ients with active peptic ulcer bleeding, epinephrine injection plus bipolar coag ulation achieved significantly higher rate of initial hemostasis. All other outc ome measures were similar with either treatment in patients with non-bleeding s tigmata. Endoscopic treatment with combined modalities is considered standard of care f or patients with high-risk peptic ulcer bleeding. This study compared epicphri ne injection plus bipolar probe coagulation alone in patients with high-risk peptic ulcer bleeding. The study group (n = 58) had epinephrine injection followed by bipolar coagulation; the co ntrol group (n = 56) was treated by bipolar coagulation alone. The primary outco mes rated were the rate of initial hemostasis and the rate of recurrent bleed ing. ) -, and 30-day mortality. The rate of initial hemostasis was significantly higher in he he therapy group (p = 0.02 ; absolute risk reduction 31.6%: 95% CI [5.4, 57.7]). There was no significant difference between the two treatment groups with respect to all other measures measures, except that significant fewer uni ts of blood were transfused in the combination therapy group (p = 0.006). In patients with active peptic ulcer bleeding, epinephrine injection plus bipolar coagulation significantly higher rate of initial hemostasis. All other outc ome measures were similar with either treatment in patients with non-bleeding s tigmata.