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Background In patients with acute gastrointestinal bleeding, massive intragastric clotting (MIC) remains a significant technical challenge during emergency endoscopy for subsequent hemostasis. Traditional methods, including biopsy channel suction, endoscopic baskets and suction tube, are often time-consuming and may lead to secondary mucosal injury. To address this, we evaluated a novel, highly accessible approach utilizing an automated gastric lavage machine under direct endoscopic visualization for MIC in patients with non-variceal upper gastrointestinal bleeding (NVUGIB).Methods This retrospective study included 12 consecutive patients from the ICU and Emergency Department treated between June 2025 and January 2026. All patients experienced initial endoscopic failure to identify the bleeding site due to MIC. A 30-Fr gastric lavage tube was inserted orally parallel to the gastroscope. Under continuous direct endoscopic visualization, the tube was dynamically maneuvered to target consolidated blood clots. An endoscopic snare was deployed through the working channel to grasp and precisely direct the lavage tube’s distal tip into dense clot accumulations. Automated cycles of saline dilution and negative-pressure aspiration were performed using the gastric lavage machine until the gastric mucosa was sufficiently cleared and the underlying lesion was exposed. Evaluated clinical indicators included initial hemostasis success, the rate of complete clot evacuation, procedure time for clot clearance, 7-day rebleeding rate, 7-day all-cause mortality, length of hospital stay, and procedure-related adverse events such as aspiration pneumonia and secondary mucosal trauma.Results The technique was successfully implemented in all 12 patients. Following evacuation, all bleeding sites were positively identified and effectively treated with targeted endoscopic hemostasis. The initial hemostasis success and clot evacuation rate was 100%, and the 7-day rebleeding rate was 0%. The mean procedure time for clot clearance was 12.75±1.06 minutes. All patients maintained stable post-procedure hemoglobin levels and were discharged after a mean hospital stay of 11.75 ± 4.05 days. No instances of mortality, aspiration pneumonia, or secondary mucosal trauma were observed. Conclusions Endoscopic-guided gastric lavage is a feasible and highly efficient technique for clearing MIC in patients with NVUGIB. By leveraging widely available hospital equipment, this method provides a rapid alternative to traditional suction techniques, facilitating timely and safe endoscopic intervention.