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a Sengstaken-Blakemore tube can be used in severe or uncontrollable cases as a temporary control to compress the bleeding Upper GI malignancies will require biopsies to be taken and a definitive surgical and oncological management plan is required Key Points Peptic ulcer disease, oesophageal varices, and malignancy are the most common causes of melena Urgent resuscitation is the mainstay of initial treatment for any cases of melena Definitive investigation in most cases of melena is via gastroscopy, however further investigations may be required if normal