Role of Doppler Ultrasound in Severe Peptic Ulcer Hemorrhage

Inclusion Criteria: * Clean base ulcer with severe upper GIB (defined as melaena, hematochezia, hematemesis, and/or gross blood in NG lavage), and any one of the following: 1. SBP ≤ 90mmHg; P of ≥110 bpm; or orthostatic changes with SBP drops 20mmHg or P increases 20 bpm; or, 2. Transfusion of 2 or more units of packed red blood cells within 12 hrs of admission; or, 3. A documented HCT drop of at lest 6% from baseline. * Endoscopically confirmed bleeding from GU, DU, pyloric ulcer, or anastomotic ulcer * Pt can either have primary or secondary acute UGI haemorrhage Exclusion Criteria: * Bleeding site from lesion other than GU, DU, pyloric or anastomotic ulcer * there is more than one type of significant bleeding lesion * Documented hx of cirrhosis / portal HT * ESRF requiring any form of dialysis * Expected or persistent (\>24hrs) coagulopathy with INR\> 1.5 * Platelet count is under 50000/mm3 * Aspirin User / Plavix \[Clopidogrel\] User * If the ulcer is neoplastic * Cannot obtained consent * Age \< 18 or is pregnant * Severe comorbid of which life expectancy \<30 days