Delayed Bleeding Rate According to the Forrest Classification in Second-Look Endoscopy After Endoscopic Submucosal...

Area of Science:

• Gastroenterology
• Endoscopic Surgery
• Oncology

Background:

• The Forrest classification is used to predict rebleeding risk in peptic ulcers.
• Its utility in predicting delayed bleeding after endoscopic submucosal dissection (ESD) is less understood.
• Second-look endoscopy is sometimes used to assess risk after ESD.

Purpose of the Study:

• To evaluate the delayed bleeding rate in Forrest classification II and III lesions after ESD when not treated during second-look endoscopy.
• To determine if the presence of visible vessels impacts delayed bleeding risk in these lesions.

Main Methods:

• A prospective study of 706 lesions in 656 patients undergoing ESD between July 2011 and February 2012.
• Second-look endoscopy was performed on the second day post-ESD.
• Lesions were classified using the Forrest criteria; late delayed bleeding was tracked up to 1 month post-procedure.

Main Results:

• Overall, late delayed bleeding occurred in 4.1% of lesions post-ESD.
• Forrest I lesions treated during second-look endoscopy had no further bleeding.
• Untreated Forrest II and III lesions (643 cases) showed no significant difference in late delayed bleeding rates (3.2%-4.8%) regardless of visible vessels.

Conclusions:

• The Forrest classification may not be a reliable predictor of delayed bleeding in post-ESD ulcers.
• The presence or absence of visible vessels in Forrest II and III lesions does not significantly alter the risk of late delayed bleeding after ESD.