One hundred and forty two patients with bleeding peptic ulcers underwent emergency endoscopy. Seventy six had endoscopic stigmata of haemorrhage and nine subsequently died. There were no deaths amongst sixty six patients without stigmata (p < 0.02). Patients with stigmata were also significantly more likely to experience further bleeding (p < 0.001) and to require emergency operations (p < 0.01). Excess risk attached to those with bleeding at the time of endoscopy and those with visible vessels or clot adherent to the ulcer but not to patients with staining of the ulcer base. Patients without stigmata or with staining alone should be managed conservatively. Clinical trials in bleeding peptic ulcer disease should only include patients in the high risk group.