Uphill or downhill bleeding?

An 87-year-old woman presented with a 2-day history of melaena and symptomatic anaemia. Medical history included idiopathic hyperthyroidism, a gastric ulcer and diverticular disease. On arrival, vital signs were stable apart from a tachycardia (107 bpm). Her initial haemoglobin was 48 g/L and urea 32.7 mmol/L. A large anterior neck mass was observed on examination. At endoscopy, this abnormality was identified in the upper oesophagus (figure...