Background: Differences in endoscopic practice in major teaching and community hospitals are not known. Methods: A total of 1031 consecutive patients discharged from 13 hospitals (4 major teaching, 9 others) in 1994 with upper gastrointestinal hemorrhage were studied. Data obtained from chart abstraction included endoscopic findings and therapy and selected outcomes. Multivariable analyses adjusted for admission severity of illness and endoscopic findings. Results: Rates of endoscopy were similar between patients admitted to major teaching and other hospitals, although procedures to control hemorrhage were used more often in major teaching hospitals (35% vs. 19%, p < 0.001). Use of endoscopic therapy was higher in major teaching hospitals for lesions in which therapy is recommended, as well as other lesions. Recurrent bleeding was also more common in major teaching hospitals (14.3% vs. 7.8%, p = 0.001), and the difference persisted in multivariable analysis (odds ratio 1.69: 95% CI [1.09 to 2.64], p = 0.02). Unadjusted and adjusted length of stay were somewhat shorter in major teaching hospitals. Conclusions: There was large variation in the use of endoscopic therapy, with higher rates observed in major teaching hospitals for lesions in which therapy is recommended, as well as other stigmata. Further studies are needed to better define the reasons for the practice variation and to assess the impact on other outcomes such as readmission and costs. (Gastrointest Endosc 1998;48:348-53.)