OBJECTIVE: To describe the management and outcome after endoscopic treatment of hematemesis by Mallory-Weiss Syndrome (MWS) occurred after CPRE (suspected choledocolithiasis). BACKGROUND DATA: Although cough and retching is common during EGD or CPRE, MWS resulting from endoscopy seems to be uncommon (0.0001-0.04%) and always self-limiting. CASE REPORT: The patient was submitted to CPRE with the suspicion of choledocholithiasis. Eight hours after CPRE the patient presented with hematemesis and hypotension. With emergency EGD, the AA identified a small bleeding mucosal tear (visible vessel with spurting) just proximal to the esophagogastric junction. The patient was safely treated with endoscopic hemoclipping after the failure of sclerotherapy. CONCLUSIONS: The usefulness of hemoclipping in MWS is emphasized: although always self-limiting, endoscopic hemostasis is mandatory in high risk patients. The hemoclips are effective and safe in hemostasis in the case of bleeding visible vessel (spurting or oozing), even with or after sclerotherapy. The hemoclips not obstacles the healing.