• Yong-Kang Lai, Chun-Yan Peng, Gui-Hai Guo, and Xu Shu.
• Department of Gastroenterology, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China.
• Medicine (Baltimore). 2020 Oct 9; 99 (41): e22646.

RationaleNon-variceal gastrointestinal bleeding is a common critical disease worldwide, and according to relevant guidelines, surgery and interventional treatment are the final therapies. However, few studies have reported on therapeutic strategies to employ when the ultimate treatment fails. This report offers a reasonable option for hemostasis after surgery and interventional treatment both fail.Patient ConcernsA 47-year-old man with recurrent bleeding had undergone endoscopy, surgery, and interventional therapy; however, effective hemostasis was not achieved.DiagnosisThis patient's clinical manifestations and typical gastroscopic findings confirmed duodenal bulb ulcer with hemorrhage INTERVENTIONS:: A Billroth II + Bancroft operation, interventional treatment, and endoscopic hemostasis with an over-the-scope clip (OTSC) system were administered.OutcomesThe bleeding was successfully controlled, and the patient remained well during long-term follow-up.LessonsThe OTSC system can represent a reasonable option for ulcer hemostasis after surgery when other interventional therapies have failed.

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