In order to explore the optimal time of endoscopy in patients with acute upper gastrointestinal hemorrhage (UGIB). 736 patients with acute UGIB who received digestive endoscopy examination in the Emergency Department of Beijing Friendship Hospital from June 2020 to June 2022 were retrospective analysised. According to the endoscopic examination time after visit the Department of Emergency, the patients were divided into emergency endoscopy group (within 12 hours after visit the Department of Emergency) and selective endoscopy group (after 12 hours). The general clinical data, endoscopic related data, interventional embolization rate, surgical procedure rate, blood transfusion volume, 30 day rebleeding rate, mortality rate, and average hospital stay of the two groups were compared. A total of 428 patients were enrolled in this study, 326 of whom underwent emergency endoscopic examination (76.2%). Compared with the elective endoscopy group, the emergency endoscopy group showed a significant increase in heart rate ( =0.043) and a decrease in systolic blood pressure ( =0.061). 14 patients (3.3%) were referred to the vascular intervention department for transarterial embolization after endoscopic treatment failed, while 6 patients (1.4%) were transferred to general surgery for surgical treatment. The two groups of patients ( =0.115， =0.561) showed no significant difference. There was no significant difference in average blood transfusion volume and hospital stay between the two groups of patients ( =0.138， =0.799). The rate of rebleeding within 30 days was 10.0% (43/428), 11.7% (38/326) in the emergency endoscopy group, and 4.9% (5/102) in the elective endoscopy group ( =0.048). The total 30-day mortality rate was 6.8% (29/428), and there was no difference between the emergency endoscopy group and the elective endoscopy group (7.7% and 3.9%, =0.189). Compared with emergency endoscopy, elective endoscopy for UGIB patients has a lower probability of rebleeding after 30 days, and there is no significant difference in intervention embolization rate, surgical surgery rate, blood transfusion volume, 30-day mortality rate, and average hospital stay. After hemodynamic stability, UGIB patients should use selective endoscopy.