Forrest classification explained

Forrest classification is a classification of upper gastrointestinal hemorrhage used for purposes of comparison and in selecting patients for endoscopic treatment.^[1]

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)^[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 theendoscopic 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]

See also

• Rockall score
• Glasgow-Blatchford

External links

• Illustrated Forrest classification
• Forrest Classification System with Respective Prognosis

Notes and References

1. Book: Block, Berthold. Endoscopy of the Upper GI Tract: A Training Manual. Schachschal. Guido. Schmidt. Hartmut H.. 2004-01-01. Thieme. 9783131367310. en.
2. Web site: Stomach: Forrest classification in Atlas of Gastroenterological Endoscopy by A. Freytag, T. Deist. T. Deist. A. Freytag. www.endoskopischer-atlas.de. 2016-04-11.
3. Web site: SIGNIFICANCE OF FORREST CLASSIFICATION, ROCKALL’S AND BLATCHFORD’S RISK SCORING SYSTEM IN PREDICTION OF REBLEEDING IN PEPTIC ULCER DISEASE . Hadzibulic . Edvin . Svjetlana Govedarica . 2008-08-11 . dead . https://web.archive.org/web/20130603031133/http://publisher.medfak.ni.ac.rs/2007-html/4-broj/SIGNIFICANCE%20OF%20FORREST...pdf . June 3, 2013 .
4. 10.1055/s-2007-1010729. Heldwein W. Schreiner J . Pedrazzoli J . Lehnert P . Nov 21, 1989. Is the Forrest classification a useful tool for planning endoscopic therapy of bleeding peptic ulcers?. Endoscopy. 21. 258–62. 6. 2693077.
5. Forrest . JA. . Finlayson . ND. . Shearman . DJ. . Endoscopy in gastrointestinal bleeding. . Lancet . 2 . 7877 . 394–7 . Aug 1974 . 10.1016/s0140-6736(74)91770-x. 4136718 .