This 64-year-old woman, who was admitted to the general internal medicine ward with pneumonia, began having coffee ground emesis one day after her initial presentation. The following ulcer (see video below) was found in the proximal duodenum on upper endoscopy. What is the lesion’s Forrest classification, and what is the risk of rebleeding without endoscopic therapy?

The ulcer in question is flat with a pigmented spot, making it Forrest class IIc. As such, the risk of further rebleeding without endoscopic therapy is approximately 10%.