title: An upper gastrointestinal ulcer still bleeding after endoscopy: what comes next?
abstract: BACKGROUND
  Recurrent bleeding from an upper gastrointestinal ulcer when endoscopy fails is a reason for radiological or surgical treatment, both of which have their advantages and disadvantages.
  
  
  METHODS
  Based on a patient with recurrent gastrointestinal bleeding, we reviewed the available evidence regarding the efficacy and safety of surgical treatment and embolisation, respectively.
  
  
  CONCLUSIONS
  Transarterial embolisation (TAE) and surgical treatment are both options for recurrent gastrointestinal bleeding when endoscopy fails. Both therapies have serious complications and a risk of rebleeding. Choosing the therapy depends on the capability of the patient to tolerate haemodynamic instability, resuscitation and hypotension.
  
  
  CONCLUSIONS
  Choosing between TAE and surgery depends a great deal on the case presented, haemodynamic stability and the skills and tools available at that moment.
authors.forename: E M E
authors.initials: EM
authors.lastname: Craenen
authors.forename: H S
authors.initials: HS
authors.lastname: Hofker
authors.forename: F T M
authors.initials: FT
authors.lastname: Peters
authors.forename: G M
authors.initials: GM
authors.lastname: Kater
authors.forename: K R
authors.initials: KR
authors.lastname: Glatman
authors.forename: J G
authors.initials: JG
authors.lastname: Zijlstra
mesh_terms: D004381:Duodenal Ulcer / Q000150:complications*; D004621:Embolization, Therapeutic; D016558:Hemostasis, Endoscopic; D006801:Humans; D008297:Male; D008875:Middle Aged; D010438:Peptic Ulcer Hemorrhage / Q000209:etiology* / Q000601:surgery / Q000628:therapy*; D012008:Recurrence