A patient presents with haematemesis. OGD shows a gastric ulcer with a visible vessel in the ulcer base. After successful endoscopic haemostasis (adrenaline injection + heater probe), the patient re-bleeds 6 hours later. The next appropriate step is:

• A Immediate surgery (Billroth gastrectomy)
• B Angiographic embolisation of the gastroduodenal artery
• C Tranexamic acid infusion and transfusion only
• D Repeat endoscopy for second attempt at haemostasis ✓

Explanation

NICE and BSG guidelines recommend a second endoscopic attempt (repeat endoscopy) as the next step after first re-bleeding following successful initial endoscopic haemostasis, as a second endoscopy is successful in 70–80% of cases and avoids operative morbidity. Interventional radiology (embolisation) is the next step if second endoscopy fails or is not feasible. Emergency surgery is reserved for patients failing two endoscopic attempts or haemodynamic instability not responding to resuscitation.

Reference: Bailey & Love's Short Practice of Surgery, 27th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.