A 79-year-old man was brought to the emergency department following a 2-week history of epigastric discomfort and a 4-day history of melaena and presyncope. His medical history was significant for hypertension, haemorrhagic strokes, peptic ulcer disease (PUD), previous Helicobacter pylori infection, chronic kidney disease, peripheral vascular disease and cognitive impairment. On examination, the patient was haemodynamically stable and afebrile, with tenderness elicited in his epigastrium and right upper quadrant. Laboratory results demonstrated a haemoglobin level of 93 g/L, white cell count of 9.9×109/L, urea of 28.4 mmol/L, creatinine of 109 µmol/L and estimated glomerular filtration rate of 55 mL/min/1.73 m2. His liver function tests (LFTs) were deranged with an aspartate transaminase of 374 U/L, alanine transaminase of 422 U/L, gamma-glutamyltransferase of 302 U/L, alkaline phosphatase of 507 U/L and bilirubin of 9 µmol/L.

An oesophagogastroduodenoscopy (OGD) revealed a …