The ulcer floor is covered heavily by a thick, deep-seated layer of white or yellowish-gray exudate (necrotic slough). The surrounding mucosal margins are prominently edematous, hyperemic, and lack any signs of epithelial regeneration. Thrombi or exposed, pulsating blood vessels may be visibly projecting through the exudative base.
It is commonly used to measure the healing rate of artificial ulcers produced after Endoscopic Submucosal Dissection (ESD).
Since its introduction in 1970, the Sakita-Miwa classification has become a cornerstone of gastrointestinal endoscopy, providing a practical and objective method for tracking ulcer healing. Its strength lies in its simplicity: by observing a few key characteristics—the presence of edema, the appearance of regenerating epithelium, the extent of white coating, and the nature of scar tissue—an endoscopist can accurately determine the ulcer's stage. This reliable framework is essential for clinical decision-making, from selecting appropriate therapies to designing rigorous clinical trials. Ultimately, the Sakita-Miwa classification ensures that clinicians worldwide can speak a common language when managing one of the most common gastrointestinal conditions, leading to more effective and consistent patient care. sakitamiwa classification
The ulcer begins to shrink. The white coating becomes thinner, and regenerating epithelium (new skin) starts to extend into the base. Mucosal folds may begin to converge toward the ulcer margin. H2 (Healing-2):
If you need a more detailed breakdown of the clinical trials mentioned, or a comparison between the Sakita-Miwa classification and other endoscopic staging methods (like the Forrest classification for bleeding), I can provide that information.ncbi.nlm.nih.gov/articles/PMC6460617/">Forrest classification for bleeding risks. the healing rates found in specific studies. Explain how different PPIs affect each stage. The ulcer floor is covered heavily by a
[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)
It is important not to confuse the Sakita-Miwa classification with another common endoscopic scoring system for ulcers: the . It is commonly used to measure the healing
Over weeks or months, the redness fades into a white or pale scar as the tissue matures. This marks the final stage of healing. Clinical Utility and Scoring
: The white coating becomes thin, and new epithelium significantly extends into the ulcer base. The ulcer crater is still visible, but its diameter is reduced to about one-half or two-thirds of the A1 size.