Forrest classification

Forrest classification

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)

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. A prospective controlled study revealed that "Forrest criteria are essential for proper planning of endoscopic therapy and urgent surgery in bleeding peptic ulcers".

History

The classification was first published by J.A. Forrest, et al. in the Lancet in 1974.

References

References

1. Block, Berthold. (2004-01-01). "Endoscopy of the Upper GI Tract: A Training Manual". Thieme.
2. T. Deist, A. Freytag. "Stomach: Forrest classification in Atlas of Gastroenterological Endoscopy by A. Freytag, T. Deist".
3. Hadzibulic, Edvin. "SIGNIFICANCE OF FORREST CLASSIFICATION, ROCKALL’S AND BLATCHFORD’S RISK SCORING SYSTEM IN PREDICTION OF REBLEEDING IN PEPTIC ULCER DISEASE".
4. Heldwein W. (Nov 21, 1989). "Is the Forrest classification a useful tool for planning endoscopic therapy of bleeding peptic ulcers?". Endoscopy.
5. (Aug 1974). "Endoscopy in gastrointestinal bleeding.". Lancet.