An 80 year old woman was admitted in February 1999 with a history of coffee ground vomiting over a 24 hour period. Her past medical history included renal impairment (1993), pancreatitis secondary to “sludge” in the gall bladder and endoscopic retrograde cholangiopancreatography (December 1994), open cholecystectomy (December 1995), and recently diagnosed bladder tumour (January 1999). On examination, she was pale, although well, and cardiovascularly stable. Pulse was 66 beats/min regular, blood pressure was 120/70 mm Hg, …