Gastrointestinal bleeding is a common and potentially life-threatening emergency requiring rapid diagnosis and intervention. Presentations range from occult bleeding to massive hemorrhage with hemodynamic instability. Emergency endoscopy plays a central role in identifying bleeding sources, providing definitive therapy, and guiding further management. Advances in endoscopic hemostatic techniques—including injection therapy, thermal devices, mechanical clips, and topical agents—have significantly reduced rebleeding and mortality rates. Risk stratification tools and early intervention protocols improve patient outcomes and optimize resource utilization. Multidisciplinary coordination involving gastroenterologists, intensivists, radiologists, and surgeons is often required in complex cases. This topic focuses on modern approaches to managing acute GI bleeding, innovations in emergency endoscopy, and strategies to improve survival and reduce complications.