The most appropriate management is endoscopic therapy. Upper endoscopy should be performed at the time of an upper gastrointestinal bleed after appropriate volume resuscitation to diagnose the cause of bleeding, provide a prognosis, and provide endoscopic therapy if required. An ulcer with a visible vessel has an approximately 50% risk of rebleeding if not treated endoscopically. These ulcers can be effectively treated with injection of sclerosants, thermal coagulation via endoscopic probes, or mechanical modalities such as hemostatic clips. Clean-based ulcers rebleed in less than 5% of cases and do not require endoscopic therapy.

Prospective trials have shown a 5% to 10% rebleeding rate following endoscopic hemostasis. In these patients, endoscopic therapy may be repeated if the patient remains hemodynamically stable and if the endoscopist thinks that the bleeding lesion is amenable to endoscopic therapy. If repeat endoscopy is unsuccessful or the bleeding vessel is inaccessible or too large, surgical consultation should be obtained. However, in this patient, endoscopic intervention is the first management choice for an accessible and small visible vessel.

Octreotide may have a marginal benefit by decreasing the rate of nonvariceal bleeding, but it is inferior to intravenous proton pump inhibitors. Octreotide is most useful in patients with variceal bleeding.

Observation is not appropriate for this patient with a high-risk lesion seen on endoscopy. Without endoscopic therapy, patients with this type of lesion have a 30% to 50% chance of rebleeding.