Further bleeding is defined by failure to control bleeding during first endoscopy or recurrent bleeding after initial control. Recurrent bleeding is defined by fresh hematemesis, fresh melena or hematochezia with hemodynamic instability (systolic blood pressure lower than 90mmHg, heart rate greater than 110 per minute) and/or drop in hemoglobin > 2g/dl in 24 hours after transfusion to around 8 g/dl. An episode of recurrent bleeding has to be confirmed by repeat endoscopy showing fresh blood in stomach or active bleeding from the previously treated lesion.