The is a globally recognized endoscopic grading system used to evaluate the life cycle and healing stages of peptic (specifically gastric) ulcers. Developed in Japan, it provides clinicians with a standardized framework to assess whether an ulcer is in an active, healing, or scarring phase. This classification directly informs treatment efficacy and determines the duration of acid-suppressive therapy. 🔬 Classification Breakdown
: The ulcer floor is covered with a thick white slough. The surrounding mucosa is edematously swollen with no regenerating epithelium. A2 (Active-2)
The ulcer is very shallow and nearly covered by new tissue. The surrounding inflammation has largely disappeared. PubMed Central (PMC) (.gov) 3. Scarring Stage (S)
[A1: Acute Edema] ➔ [A2: Clear Margin] ➔ [H1: Epithelial Growth] ➔ [H2: Flat Crater] ➔ [S1: Red Scar] ➔ [S2: White Scar] Granular Breakdown of the Six Sakita-Miwa Stages 1. The Active Stage (A-Stage) sakitamiwa classification
It provides a common language for endoscopists to record the exact status of an ulcer, ensuring consistency in patient care and research. Sakita-Miwa vs. Other Classifications
: The ulcer becomes significantly smaller and shallower. The regenerative epithelium covers most of the ulcer base, leaving only a small amount of central white slough. 3. Scarring Stage (S)
This is the final stage where the ulcer has completely closed, leaving only a scar behind. ClinicalTrials.gov S1 (Scarring 1/Red Scar): The is a globally recognized endoscopic grading system
For those interested in delving deeper into the Sakitamiwa classification, we recommend:
The white coating has completely disappeared, leaving only a red scar (red scar stage).
Over time, the redness fades as the capillaries decrease, and the area becomes a pale, "white scar" that eventually blends with the surrounding normal mucosa. Summary Table Key Endoscopic Feature Active (A) A1 Thick slough, significant edema, no regeneration A2 Clearer margins, reduced edema, initial regeneration Healing (H) H1 Thin slough, defect reduced by ~50%, more regeneration H2 Minimal slough, defect mostly covered by new tissue Scarring (S) S1 Red scar; no slough; complete epithelial coverage S2 White scar; pale appearance; fully healed 🔬 Classification Breakdown : The ulcer floor is
While the Sakita-Miwa classification is the most widely accepted endoscopic staging system, it is sometimes helpful to compare it with other schemes that a clinician might encounter.
The red scar fades and becomes white over time (white scar), indicating long-term, mature scarring. Clinical Applications and Importance
The ulcer is almost gone, with a very small, thin white coating, and regenerative tissue is present. 3. Scarring Stage (S)