Forrest classification

In 1974, John A. H. Forrest et al. prepared a paper on which the Forrest classification named after him is based. It was originally used to describe bleeding from peptic ulcers. Later studies from 2008 by Elmunzer et al. and 2014 by de Groot et al. recognized the prognostic significance of the classification, particularly for the correlation of bleeding in stages Fl a and Fl b and the probability of recurrent bleeding (Götz 2017).

In a modified form, the Forrest classification can also be applied to non-variceal (ulcer) bleeding (Götz 2017).

Forrest classification is the endoscopic classification of upper gastrointestinal (GI) bleeding in terms of bleeding activity and risk of percent recurrent bleeding (Herold 2022).

• Forrest l: Here, there is active bleeding.
  • l a: Injectable arterial hemorrhage. The risk of recurrent bleeding is 90%.
  • l b: oozing hemorrhage. The risk of recurrent bleeding is 20% (Herold 2022).

• Forrest ll: Inactive hemorrhage is found.
  • ll a: Lesion with vascular stump evident. The risk of recurrent hemorrhage is 50%.
  • lll b: Lesion covered with coagulum. The risk of recurrent hemorrhage is 25%.
  • lll c: Lesion covered with hematin. The risk of recurrent hemorrhage is < 10% (Herold 2022).

• Forrest lll: Lesions are present that do not show signs of bleeding. The risk of recurrent hemorrhage is < 5% (Herold 2022).

However, both recognition and correct classification of hemorrhage are experience- and examiner-dependent. This is especially true for the stages Fl a / Fl b (Götz 2017).

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3. Elmunzer B J, Young S D, Inadomi J M, Schoenfeld P, Laine L (2008) Systematic review of the predictors of recurrent hemorrhage after endoscopic hemostatic therapy for bleeding peptic ulcers. Am J Gastroenterol. 103 (10) 2625 - 2632
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