Objective To explore and compare the efficacy of CO₂ and Nd:YAG laser in the treatment of active epistaxis with endoscopy. Methods Eighty-three cases with active epistaxis were randomly divided into two groups: CO₂ laser-treated group (38 cases) and Nd:YAG treated group (45 cases). A comparison of the therapeutic effect of the two laser remedies was made between the two groups. Results The total effective rate was 44.7% in the CO₂ laser-treated group and 91.1% in the Nd:YAG group. There was no significant difference between the two groups of epistaxis in diverse area with different kind of laser. Conclusions The therapeutic efficacy of Nd:YAG laser is obviously better than that of CO₂ laser for the treatment of active epistaxis with endoscopy.