Left: 72 year-old woman with hematemesis and melena. Endoscopy revealed a continuous flow of blood arising from a point source in the duodenum. The image on the left shows the site just after lavage, with thin stream of blod flowing in a downward direction. Lavage revealed no underlying ulcer, vessel or neoplasm.

Right: Hemostasis was achieved by the injection of epinephrine into surrounding mucosa. Once bleeding was controlled, a pinpoint defect in the mucosa became visible at the site of previous bleeding, shown here as viewed through the banding apparatus, prior to the application of a band. The defect represents the site of bleeding, and not a mucosal injection site.