Endoscopy image of a duodenal ulcer in the posterior part of the duodenal bulb without stigmata of recent hemorrhage. This would be a Forrest III lesion
Acute hemorrhage
Forrest I a (Spurting hemorrhage)
Forrest I b (Oozing hemorrhage)
Signs of recent hemorrhage
Forrest II a (Non bleeding Visible vessel)
Forrest II b (Adherent clot)
Forrest II c (Flat pigmented haematin (coffee ground base) on ulcer base)
Lesions without active bleeding
Forrest III (Lesions without signs of recent hemorrhage or fibrin-covered clean ulcer base)[2]
Application
Forrest's classification is instrumental when stratifying patients with upper gastrointestinal hemorrhage into high and low risk categories for mortality. It is also a significant method of prediction of the risk of rebleeding and very often is used for evaluation of the
endoscopic intervention modalities.[3] A prospective controlled study revealed that "Forrest criteria are essential for proper planning of endoscopic therapy and urgent surgery in bleeding peptic ulcers".[4]
History
The classification was first published by J.A. Forrest, et al. in the Lancet in 1974.[5]
