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Gastric Ulcers with Forrest II Lesions

    High resolution image: Ulcer with eroded vessel, indication a 40% risk of rebleeding.

    Eroded vessel in a gastric ulcer

    A finding like this indicate, that this ulcer has been bleeding, and that there is a high risk of rebleeding. In the middle of the ulcer an eroded blood vessel is seen.

    Eroded vessel in a gastric ulcer

    In this ulcer, the eroded vessel is in the margin of the ulcer

    Gastric ulcer, that just has been bleeding

    The black bottom of this gastric ulcer is caused of coagulated blood, indicating that this finding gives an excellent explanation to the patients gastrointestinal bleeding.

    Small ulcer with an eroded vessel

    A finding like this is associated with a significant risk of rebleeding

    Ulcer with an eroded vessel

    An ulcer like this with a visible artery in the middle of the ulcer could be treated with injection therapy, electrocoagulation or laser to diminish the risk of rebleeding.

    Another example of ulcers with eroded vessels

    Forrest classification of bleeding ulcers:

    Click on an image to get a magnification!

    Forrest Classification Peptic ulcer disease is the most common cause of upper gastrointestinal bleeding. The endoscopic finding can give valuable information about the risk of rebleeding after hospital admission. Endoscopic signs indicating risk of rebleeding were classified in 1974 by Forrest et al (Forrest JA, Finlayson ND, Shearman DJ. Endoscopy in gastrointestinal bleeding. Lancet 1974;17:394-397). The classification is as follow:

    Forrest class:
    Type of lesion:
    Arterial spurting bleeding
    Arterial oozing bleeding
    Visible vessel
    Sentinel clot
    Hematin covered flat spot
    No stigmata of hemorrhage
    Risk of rebleeding if untreated:
    55% (17 - 100%)
    43% (8-81%)
    22% (14 - 36%
    10% (0 - 13%)
    5% (0 - 10%)

    You might also be interested in:

    Prepyloric Ulcer (Forrest II)
    Ulcerated Gastric GIST (Gastrointestinal Stromal Tumour)
    Gastric Corpus: Hyperplastic Polyps (Slides)
    Gastric Body: Intestinal Metaplasia
    Prepyloric Benign Ulcus