In a prospective study of death in 817 patients with haematemesis and melaena admitted on 894 occasions, the protocol included admission of all patients to a defined unit, early endoscopy and resuscitation, and planned management. Over the three consecutive two-year periods of the study mortality significantly decreased from 9% to 2⋅4%. Although the operative rate remained the same, the operative mortality fell from 16% to 1⋅6%. The fall in mortality was greatest in patients with bleeding gastric ulcers. These results suggest that prospective studies with a defined policy can influence the mortality in patiemts with upper gastrointestinal bleeding. © 1979, British Medical Journal Publishing Group. All rights reserved.