A 78-year-old male was admitted with symptoms of hematemesis and epigastric pain on the same day he visited the hospital. He had repeatedly experienced heartburn and intermittent dysphagia beginning 2 years prior. Esophagogastroduodenoscopy (EGD) showed a large epiphrenic esophageal diverticulum with a 5 cm diameter, accompanied by a bleeding ulcer and erosions in the diverticular mucosa located at 4 cm superior to the gastroesophageal junction (Fig. 1). Esophagography showed a 6 × 5 cm diverticulum that was connected to the esophagus at the approximately 2 cm-wide mouth of the diverticulum and the contrast agent traveled to the stomach after a half of its level was collected in the diverticulum (Fig. 2). Given the location of the ulcer in the epiphrenic esophageal diverticulum, we performed conservative management, such as fasting for 48 hours and administration with proton-pump inhibitor for 8 weeks instead of endoscopic therapy. For the management of symptom recurrence, the patient was provided with dietary education, including chewing foods slowly, drinking a sufficient amount of water, and not laying down immediately after a meal. The 3-month follow-up EGD showed improvement of the lesions in the diverticulum (Fig. 3). Until now, six months later, he is on outpatient follow-up without rebleeding.