Sakitamiwa Classification [2021]

The ulcer base becomes a red, thin scar (red scar stage). The ulcer is officially considered healed, even if the tissue is still remodeling.

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

At this point, the ulcer is considered "endoscopically cured" because the mucosal defect has vanished. sakitamiwa classification

: The floor is completely covered by regenerating epithelium, and the white coating has disappeared. It appears as a "red scar" due to visible capillaries. S2 (White Scar)

[ Active Stage ] ----------> [ Healing Stage ] ----------> [ Scarring Stage ] ├── A1: Acute Slough ├── H1: Mucosal Bridging ├── S1: Red Scar └── A2: Defined Margins └── H2: Converging Folds └── S2: White Scar 1. The Active Stage (A-Stage) The ulcer base becomes a red, thin scar (red scar stage)

The system divides the ulcer life cycle into three primary stages: , Healing (H) , and Scarring (S) . Each stage is further divided into two substages (1 and 2) to provide a granular view of the mucosal defect’s status. 1. Active Stage (A)

The is a standard endoscopic staging system used to evaluate the healing process of gastric and duodenal ulcers. It divides ulcer progression into three main stages (Active, Healing, and Scarring), with each further subdivided into two levels. Classification Stages The system uses the following six-stage categorical scale: Stage Description A1 Acute phase; thick white coating (slough) and sharp edges. A2 This marks the final stage of healing

Provide a universal language for endoscopists to describe ulcer activity.

This stage represents the acute phase of the ulcer where the mucosal defect is most prominent.

: The open mucosal break has completely disappeared, replaced entirely by a fresh layer of regenerated epithelium. Because this new tissue is highly vascularized and packed with newly formed capillaries, the area appears as a bright red patch contrasting against the normal surrounding mucosa.