During emergency upper GI endoscopy for hematemesis, a duodenal ulcer with a non-bleeding visible vessel is identified. According to the Forrest classification, what is the risk of rebleeding without endoscopic intervention, and what is the appropriate next step?

• A Forrest Ib; risk 10%; observe with high-dose PPI
• B Forrest III; risk less than 5%; no endoscopic therapy needed
• C Forrest IIb; risk 30%; requires endoscopic hemostasis
• D Forrest IIa; risk approximately 50%; requires endoscopic hemostasis ✓

Explanation

A non-bleeding visible vessel is classified as Forrest IIa and carries a rebleeding risk of approximately 50% without endoscopic intervention, requiring definitive hemostasis (adrenaline injection plus heater probe or clips). Forrest Ib is an oozing bleed. Forrest IIb is an adherent clot. Forrest III is a clean-base ulcer with low rebleeding risk.

Reference: Bailey and Love's Short Practice of Surgery, 28th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

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