We read with considerable interest the study of Konstantinidis et al about the use of ethanolamine 5% as injection therapy for bleeding peptic ulcer [1]. Having experienced a severe complication induced by ethanolamine injection, we are concerned with the study’s conclusion that injection treatment with ethanolamine is safe.An 85-year-old man with a history of heart failure stage III, hypertension and recent diclofenac treatment for knee osteoarthritis, presented with hematemesis. Urgent upper gastrointestinal endoscopy revealed a relatively large ulcer with a non-bleeding visible vessel on the posterior wall near to the apex of duodenal bulb. Four mL of epinephrine solution (1:10000) plus 3 mL ethanolamine were injected in the four quadrants around the ulcer (epinephrine) and within the ulcer base (ethanolamine). Six hours later he developed severe upper abdominal pain and non-bloody vomiting. An abdominal x-ray showed free air under the diaphragms. Surgery demonstrated an extensive necrosis of distal antrum, bulb and second part of duodenum due to thrombosis of the gastroduodenal artery. He underwent a Whipple operation with uneventful course.Despite the fact that sclerosants are described as safe and effective in treating bleeding ulcers, they may be associated with serious complications including perforation, necrosis, ulceration, vessel thrombosis and hemorrhage, leading to significant morbidity and one reported fatality [2-6]. Moreover, four studies showed no advantage of using ethanolamine alone or in combination over using epinephrine alone [7-10].Therefore, we believe that there is a limited role for sclerosants in light of other therapies with fewer associated complications.