American Board of Internal Medicine (ABIM) Certification Practice Exam

For patients experiencing rebleeding after initial endoscopy, what is the recommended approach?

1. Routine second-look endoscopy

2. A second attempt at endoscopic therapy

3. Full surgical intervention

4. Discharge and outpatient management

The correct answer is: A second attempt at endoscopic therapy

In cases where patients experience rebleeding after an initial endoscopy, a second attempt at endoscopic therapy is often considered the most effective management strategy. This approach allows for a direct intervention at the site of bleeding using endoscopic techniques, which can include thermal coagulation, band ligation, or clipping to achieve hemostasis. Endoscopy is usually favored because it is less invasive compared to surgical interventions and can often effectively control the source of bleeding without the need for more aggressive operations. Moreover, rebleeding indicates a persistent problem that can usually be addressed during an endoscopic procedure. The rebleeding might provide clearer visibility of the bleeding source, allowing the endoscopist to apply more targeted interventions compared to the initial procedure. In contrast, surgical intervention is typically reserved for cases where endoscopic techniques have failed or when there are complications such as anatomical abnormalities or extensive lesions that cannot be managed endoscopically. Discharging the patient for outpatient management would not be appropriate in an acute setting where rebleeding has occurred, as this would expose the patient to significant risk. Routine second-look endoscopy may not be beneficial without specific indications because it does not intervene on the source of active bleeding directly. Thus, opting for a second attempt at