Lutsevich E.V., Prazdnikov E.N., Semenov M.V., Ipatkin R.V., Petrov R.V., Kuzin A.V., Tolstykh M.P., Makhinya V.A., Gallyamov E.A., Ovcharov S.E. Moscow Gastroduodenal bleeding, including that of ulcerative etiology, remains a far from resolved and pressing problem in modern surgical gastroenterology. This is due to the high incidence of bleeding, unsatisfactory treatment results associated with a high level of postoperative complications and mortality with traditional surgical intervention. The aim of this study was to improve the treatment outcomes of patients with bleeding gastroduodenal ulcers by developing and implementing biendoscopic surgical interventions. At the clinic of Moscow State University of Medicine and Dentistry, biendoscopic surgical interventions have been performed on 28 patients from 1999 to the present. To achieve the goal of treating gastroduodenal bleeding using biendoscopic technologies, the following tasks must be addressed stepwise: localizing the bleeding source during surgery, temporarily stopping ongoing bleeding, and achieving definitive hemostasis and curing patients. The clinic has developed several techniques for localizing the bleeding source during biendoscopic procedures, including marking the bleeding source with perifocal transmucosal intraparietal dye injection, transillumination of the gastric or duodenal wall in the area of ??the bleeding source, instrumental palpation of the ulcer defect, and intracorporeal sonography using color Doppler mapping. These techniques allow for precise localization of the bleeding source without opening the lumen of the hollow organ, which positively impacts the postoperative course. To achieve temporary hemostasis, the following biendoscopic techniques have been developed: laparoscopic transserous sclerotherapy of the bleeding vessel, transserous coagulation, clipping, and suturing of the bleeding vessel. When indicated and technically feasible, excision of the bleeding ulcer with or without vagotomy and gastric resection were used as radical surgical treatment to achieve definitive hemostasis. Hemostasis is monitored during the procedure using intraoperative endoluminal endoscopy, which the operating surgeons observe on an additional video monitor. All measures to stop bleeding are carried out until complete hemostasis is achieved. The use of biendoscopic surgical interventions in the treatment of patients with gastroduodenal bleeding has optimized patient management and achieved adequate hemostasis, which in turn has led to a significant reduction in the incidence of postoperative complications and mortality in this category of patients. There were no specific complications associated with the use of biendoscopic technologies.