A self-assembling peptide-first approach significantly enhances hemostasis for immediate post-sphincterotomy bleeding during ERCP.

• Successful initial hemostasis was achieved in 92.3% of the peptide group versus 76.9% in the balloon group (15.4% risk difference, p=0.027).
• The mean procedure time was shorter for the peptide strategy, and rescue devices were needed less often (7.7% vs 23.1%, p=0.033).

Consider using the peptide strategy as a first-line option, pending further validation.