Management of Massive Peptic Ulcer Bleeding

Managing massive bleeding from a peptic ulcer remains a challenge, and it should involve a multidisciplinary team. Endoscopy is the first-line treatment. Even with larger ulcers, endoscopic hemostasis can be achieved in the majority of cases. Surgery is clearly indicated in patients in whom arterial bleeding cannot be controlled at endoscopy. Angiographic embolization is an alternate option, particularly in those unfit for surgery. In selected patients judged to belong to the high-risk group, a more aggressive post-endoscopy management is warranted. The role of early elective surgery or angiographic embolization in selected high-risk patients to forestall recurrent bleeding remains controversial.