Forrest Classification

Forrest JAH, Finlayson NDC, Shearman DJC. Endoscopy in gastrointestinal bleeding. Described the endoscopic stigmata of recent haemorrhage in peptic ulcers (active bleeding, visible vessel, adherent clot, pigmented spot, clean base) and their relation to the risk of continued or recurrent bleeding.

International consensus and ACG/ESGE guidance: Forrest Ia–IIa lesions warrant endoscopic haemostasis (injection plus a second modality, or clips / thermal therapy) and high-dose proton-pump inhibitor therapy; IIb clots should be irrigated and, if they persist, considered for removal and treatment of the underlying lesion; IIc and III lesions are low risk and do not require endoscopic therapy. Combine with a validated risk score (Glasgow-Blatchford, Rockall, AIMS65).