Management of nonvariceal UGI bleeding that is refractory to initial endoscopic management

What is the management of nonvariceal UGI bleeding that is refractory to initial endoscopic management? 

Initial endoscopic therapy is successful in obtaining permanent control of bleeding in 80% to 90% of patients with nonvariceal UGI bleeding. In patients with recurrent bleeding after endoscopic therapy, approximately 70% will be controlled after a second attempt at endoscopic therapy. Angiography or surgery is recommended in patients who continue to bleed despite two attempts at endoscopic hemostasis. Surgical or radiographic consultation should be obtained in patients who present with massive bleeding.

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