This is a real-world medical entrance exam question, please give the true answer based on the question and selection. Topic name: Stomach & Duodenum, Subject name: Surgery
A 35-year-old man presents with a bleeding duodenal ulcer documented by endoscopy. The patient is somewhat unstable, and bleeding does not stop despite transfusing 8 U of blood. What is the most appropriate surgical therapy? 
Select and explain. 
A. Further blood transfusion alone, B. Oversewing the ulcer alone, C. Oversewing the ulcer and performing a gastrojejunostomy, D. Oversewing the ulcer and performing a vagotomy and pyloroplasty
D: Oversewing the ulcer and performing a vagotomy and pyloroplasty
Answer: D: Oversewing the ulcer and performing a vagotomy and pyloroplasty 
Explanation: For the patient who is unstable and has a pyloric or duodenal ulcer, oversewing the ulcer and closing the pyloric incision as a pyloroplasty and performing a vagotomy is the procedure of choice because of its low operative mortality. However, this procedure carries a higher-recurrence rate. Major resections, such as antrectomy and subtotal gastrectomy are contraindicated in the unstable patient. At endoscopy biopsies for H. pylori should be taken and, if positive, treatment designed to eradicate H. pylori should be started. Eradication of H. pylori reduces the recurrence rate of bleeding.