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The Old Endoscopy Quiz (and Answer) of the Month
February 2002

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Question:

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Videoclip: The finding in the gastric body in this patient

This middle aged man came to the hospital after having stomach pain for a few days and he was found to have black stools and a severe anemia. This is the finding in upper endoscopy, a quite big but benign gastric ulcer in the lower part of the gastric body on the lesser curvature. A black spot is seen in the ulcerated surface. What is the risk of rebleeding with a finding like this (e.g. according to the Forrest classification)?

Answer

These images shows a flat spot covered with hematin in the ulcer surface. According to the Forrest classification this is a Forrest II C-lesion, with a risk of rebleeding between 0 and 13%.

A gastric ulcer with a Forrest IIc lesion
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:
IA
IB
IIA
IIB
IIC
III
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:
100%
55% (17 - 100%)
43% (8-81%)
22% (14 - 36%
10% (0 - 13%)
5% (0 - 10%)

Correct answers and comments were emailed by

Pigeon Rocks, Beirut, Lebanon

Elie Choueiry, Beirut, Lebanon
dongjun fan, taiyuan, China
Rafel Campo, Sabadell, Spain
LUISGUILLERMOGUERRERO, BOGOTA, COLOMBIA
Massimo Picasso, Sanremo, Italy

Sofia Alemán Villanueva, Madrid, España
Sérgio Peixoto, Campos Brazil / RJ
Gregar Ivan MD, Olomouc, Czech Repub.

Comments:

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