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Short article: Gastrointestinal bleeding in multiorgan failure. BACKGROUND AND AIMS: Gastrointestinal bleeding (GIB) may present as complication of multiorgan failure (MOF). The study aims to analyze the reasons for the limited success of hemostasis of GIB in MOF. METHODS: Using a Markov process, GIB is modeled as one of several complications associated with multiorgan breakdown to study how the reversal of GIB affects clinical outcome. RESULTS: Although endoscopic hemostasis can delay mortality in patients with severe systemic disease, its overall influence on survival is relatively small. In patients with a time-limited transition through an acute phase of increased mortality risk secondary to MOF, endoscopic hemostasis may substantially prolong survival in absolute terms. However, its relative contribution to overall survival still remains relatively small even in the scenario of transient risk only. The benefit of endoscopy is largest, if GIB is a major contributor to morbidity and mortality in comparison with all other disease complications. CONCLUSION: Because disease outcome in MOF is ultimately determined by other complications than GIB alone, the influence of endoscopic hemostasis on patient survival often remains disappointingly small.