Gastrointestinal bleeding remains one of the most important emergencies in gastroenterology. It has been widely accepted that the first-line treatment for acute upper gastrointestinal bleeding, especially peptic ulcer bleeding, is endoscopic hemostasis. Several techniques are available to achieve hemostasis during endoscopy. However, some 5%–10% of the patients still experience recurrence of bleeding after initial hemostasis with combined endoscopic therapy including injection, thermal coagulation, or mechanical hemostasis. Endotherapy for upper gastrointestinal bleeding can be challenging. A simple and effective method of endoscopic hemostasis would have a significant impact on the treatment of active gastrointestinal bleeding. Hemospray (Cook Medical, Winston-Salem, North Carolina, USA) is a novel hemostatic agent for the treatment of upper gastrointestinal bleeding. Its efficacy has been shown in peptic ulcer bleeding, as well as in cancer-related gastrointestinal bleeding and in patients taking antithrombotic therapy. These initial reports are very promising, but they are limited by the small number of patients. Further studies are needed to confirm the efficacy of Hemospray in the management of upper gastrointestinal bleeding.