Endoscope system, endoscope system operation method, and program

Abstract

Provided are: an endoscope system capable of quantitatively evaluating the peristaltic movement of the esophagus; a method for operating the endoscope system; and a program. This endoscope system comprises an endoscope and a processing device. The endoscope has an insertion part in which a first microphone and a second microphone are disposed at different positions in the longitudinal axis direction thereof. The processing device has a processor. The processor processes sound data sequentially outputted from each of the first and second microphones as time-series data, and generates diagnosis assistance information on the basis of the time-series data.

Description

Endoscope system, operation method and program for endoscope system

[0001] The present disclosure relates to an endoscope system, an operation method for an endoscope system, and a program.

[0002] Gastroesophageal reflux disease (GERD) is a pathological condition caused by the reflux of stomach contents, including a large amount of stomach acid, into the esophagus. Conventionally, an endoscope system using an endoscope has been proposed as a system for diagnosing gastroesophageal reflux disease (see, for example, Patent Document 1). In this technology, an insertion portion of the endoscope is inserted into the stomach, the endoscope is set to be able to image the gastric cardia, and air is blown into the stomach. The endoscope system then evaluates the function of the lower esophageal sphincter based on the pressure change inside the stomach detected during gas blowing into the stomach and the state of the gastric cardia observed from the image captured using the endoscope.

[0003] US Patent Application Publication No. 2020 / 0375485

[0004] In cases where GERD symptoms are confirmed, a physician must observe the condition in Phase 3 of the above-mentioned Patent Document 1 in order to identify the cause and determine a treatment method. In this case, the physician must observe the peristaltic movement of the esophagus in the clinically characteristic changes in organ activity, such as lower esophageal sphincter (LES) relaxation, scope holding sign (SHS) opening, peristalsis, belching, peristalsis, and LES contraction, while observing endoscopic images captured by an endoscope. However, it may be difficult to quantitatively evaluate esophageal peristalsis using visual confirmation of endoscopic images, leaving room for improvement.

[0005] The present disclosure has been made in consideration of the above, and aims to provide an endoscope system, an operation method for an endoscope system, and a program that can quantitatively evaluate peristaltic movement of the esophagus.

[0006] In order to solve the above-mentioned problems and achieve the objectives, the endoscopic system of the present disclosure is an endoscopic system including an endoscope and a processing device, wherein the endoscope has an insertion section in which a first microphone and a second microphone are arranged at different positions in the longitudinal axis direction, and the processing device has a processor, which processes sound data sequentially output from each of the first microphone and the second microphone as time-series data and generates diagnostic assistance information based on the time-series data.

[0007] In addition, an operating method of an endoscopic system according to the present disclosure is a method of operating an endoscopic system comprising an endoscope and a processing device, the endoscope having an insertion section in which a first microphone and a second microphone are arranged at different positions in a longitudinal axis direction, and the processing device having a processor, wherein the processor processes sound data sequentially output from each of the first microphone and the second microphone as time series data and generates diagnostic assistance information based on the time series data.

[0008] In addition, the program according to the present disclosure is a program executed by an endoscopic system including an endoscope and a processing device, the endoscope having an insertion section in which a first microphone and a second microphone are arranged at different positions in the longitudinal axis direction, and the processing device having a processor, the program causing the processor to process sound data sequentially output from each of the first microphone and the second microphone as time series data, and to generate diagnostic assistance information based on the time series data.

[0009] According to the present disclosure, it is possible to quantitatively evaluate the peristaltic movement of the esophagus.

[0010] FIG. 1 is a diagram illustrating a configuration of an endoscopic system according to a first embodiment of the present disclosure. FIG. 2 is a diagram illustrating a configuration of an endoscopic system according to the first embodiment of the present disclosure. FIG. 3 is a diagram illustrating the configuration and arrangement of a pressure sensor. FIG. 4 is a diagram illustrating a method for diagnosing gastroesophageal reflux disease according to the first embodiment of the present disclosure. FIG. 5 is a diagram illustrating a method for diagnosing gastroesophageal reflux disease according to the first embodiment of the present disclosure. FIG. 6 is a diagram illustrating a method for diagnosing gastroesophageal reflux disease according to the first embodiment of the present disclosure. FIG. 7 is a diagram illustrating a method for diagnosing gastroesophageal reflux disease according to the first embodiment of the present disclosure. FIG. 8 is a diagram illustrating a method for diagnosing gastroesophageal reflux disease according to the first embodiment of the present disclosure. FIG. 9 is a diagram illustrating the principle of sound derived from peristalsis. FIG. 10 is a diagram illustrating a state in which an endoscope is inserted into a subject. FIG. 11 is a diagram illustrating an example of time-series data in sound data sequentially output from each of the first microphone and the second microphone. Fig. 12 is a diagram showing an example of time-series data in sound data sequentially output from each of the first microphone and the second microphone when an abnormality occurs in the esophagus or stomach of a subject. Fig. 13 is a diagram illustrating an evaluation method for evaluating peristaltic movement in the esophagus. Fig. 14 is a flowchart illustrating an outline of processing executed by a processing device according to a first embodiment of the present disclosure. Fig. 15 is a flowchart illustrating an outline of processing executed by a processing device according to a second embodiment of the present disclosure. Fig. 16 is a diagram illustrating a functional configuration of an endoscope system according to a third embodiment of the present disclosure. Fig. 17 is a diagram illustrating a configuration of an overtube and an arrangement of audio microphones according to a fourth embodiment of the present disclosure.

[0011] Hereinafter, a mode for carrying out the present invention (hereinafter referred to as an embodiment) will be described with reference to the drawings. Note that the present invention is not limited to the embodiment described below. Furthermore, in the description of the drawings, the same parts are given the same reference numerals.

[0012] (First Embodiment) [Configuration of Endoscopic System] Fig. 1 is a diagram illustrating the configuration of an endoscopic system according to a first embodiment of the present disclosure. Fig. 2 is a diagram illustrating the functional configuration of the endoscopic system according to the first embodiment of the present disclosure. The endoscopic system 1 shown in Figs. 1 and 2 is used in the medical field and is a system for diagnosing gastroesophageal reflux disease in a subject using an endoscope 2. As shown in Figs. 1 and 2 , the endoscopic system 1 includes an endoscope 2, a light source device 3, a processing device 4, a display device 5, an air supply device 6, and an intragastric pressure measuring device 7.

[0013] In this embodiment, the endoscope 2 is a so-called flexible endoscope. A portion of the endoscope 2 is inserted into a living body, captures images of the living body, and outputs image signals generated by the image capture. As shown in FIG. 1 , the endoscope 2 includes an insertion section 21, an operation section 22, and a universal cord 23.

[0014] The insertion section 21 is a section that has at least a portion that is flexible and is inserted into a living body. As shown in Figures 1 and 2, the insertion section 21 includes a tip section 24, a freely bendable bending section 25 (Figure 1) composed of a plurality of bending pieces, a long, flexible flexible tube section 26 (Figure 1) that is connected to the base end side of the bending section 25, a first microphone 81, and a second microphone 82. An image sensor 244 (Figure 2) is built into the tip section 24. The insertion section 21 is inserted into a body cavity of a subject, and captures an image of a subject, such as biological tissue, that is located in a position that is not accessible by external light, using the image sensor 244.

[0015] Here, a pressure sensor 9 that detects pressure applied to the outer peripheral surface is provided on the outer peripheral surface of the insertion portion 21. The detailed configuration and arrangement of the pressure sensor 9 will be described later in the section "Configuration and arrangement of pressure sensor."

[0016] The detailed configuration and arrangement of the first microphone 81 and the second microphone 82 will be described later in the section "Configuration and arrangement of the first microphone 81 and the second microphone 82."

[0017] The operation unit 22 is connected to the base end portion of the insertion section 21. The operation unit 22 receives various operations for the endoscope 2. As shown in Fig. 1 , the operation unit 22 includes a bending knob 221 for bending the bending section 25 in the up-down and left-right directions, a treatment tool insertion section 222 that extends from the operation unit 22 to the tip of the insertion section 21 and inserts treatment tools such as biopsy forceps, an electric scalpel, and an examination probe into the body cavity of the subject, an air supply conduit 223 (Fig. 2) that extends from the operation unit 22 to the tip of the insertion section 21 and supplies air into the body cavity of the subject, and a plurality of switches 224 for operating peripheral devices such as the air supply device 6 and a water supply device (not shown).

[0018] The universal cord 23 incorporates at least a light guide 241 ( FIG. 2 ) and a cable assembly 245 ( FIG. 2 ) that bundles one or more signal lines. The light guide 241 is made of glass fiber or the like and serves as a light guide path for light emitted by the light source device 3. As shown in FIG. 1 , the universal cord 23 branches at the end opposite the end connected to the operation unit 22. The branched ends of the universal cord 23 are provided with a connector 231 that is detachable from the light source device 3 and a connector 232 that is detachable from the processing device 4. A portion of the light guide 241 extends from the end of the connector 231. The universal cord 23 transmits illumination light emitted from the light source device 3 to the distal end 24 via the connector 231 (light guide 241), the operation unit 22, and the flexible tube portion 26. The universal cord 23 also transmits image signals captured by an image sensor 244 provided in the distal end 24 to the processing device 4 via the connector 232. The cable assembly 245 includes a signal line for transmitting an image signal, a signal line for transmitting a drive signal for driving the image sensor 244, and a signal line for transmitting and receiving information including unique information related to the endoscope 2 (image sensor 244). Note that, in this embodiment, the signal lines are described as transmitting electrical signals, but they may also be used to transmit optical signals, or may be used to transmit signals between the endoscope 2 and the processing device 4 by wireless communication.

[0019] The output end side of the light guide 241 is inserted into the tip portion 24. As shown in Fig. 2, the tip portion 24 includes an illumination lens 242, an optical system 243 for collecting light, and an image sensor 244 that is provided at the imaging position of the optical system 243 and receives the light collected by the optical system 243, photoelectrically converts the light into an electrical signal, and performs predetermined signal processing.

[0020] The optical system 243 is configured using one or more lenses, and forms an observation image on the light receiving surface of the image sensor 244. The optical system 243 may have an optical zoom function that changes the angle of view and a focus function that changes the focus.

[0021] The image sensor 244 photoelectrically converts light from the optical system 243 to generate an electrical signal (image signal). The image sensor 244 is configured with a plurality of pixels arranged in a matrix, each of which has a photodiode that accumulates an electric charge according to the amount of light and a capacitor that converts the electric charge transferred from the photodiode into a voltage level. The image sensor 244 photoelectrically converts light incident on each pixel via the optical system 243 to generate an electric signal, sequentially reads out the electric signals generated by pixels arbitrarily designated as readout targets among the plurality of pixels, and outputs the electric signals as an image signal. The image sensor 244 is realized, for example, using a CCD (Charge Coupled Device) image sensor or a CMOS (Complementary Metal Oxide Semiconductor) image sensor.

[0022] For ease of explanation, the image signal generated by the image sensor 244 capturing an image will be referred to as a captured image below.

[0023] Here, the endoscope 2 has a memory (not shown) that stores execution programs and control programs for the image sensor 244 to perform various operations, as well as data including identification information of the endoscope 2. The identification information includes the endoscope 2's unique information (ID), model year, specification information, transmission method, etc. The memory may also temporarily store captured images generated by the image sensor 244.

[0024] As shown in FIG. 2 , the light source device 3 includes a light source unit 31 , an illumination control unit 32 , and a light source driver 33 .

[0025] The light source unit 31 emits light under the control of the illumination control unit 32. The light source unit 31 emits light having a wavelength band of visible light (white light (illumination light)). The light source unit 31 is realized using any light source such as an LED (Light Emitting Diode) light source, a laser light source, a xenon lamp, or a halogen lamp. The light source unit 31 may also include one or more lenses. The light generated by the light source unit 31 passes through the light guide 241 and the illumination lens 242 and is emitted from the tip of the tip unit 24 toward the subject.

[0026] The light emitted from the light source unit 31 is not limited to white light, but may be narrowband light having light in a specific wavelength band, or excitation light that excites substances contained in the object of observation.

[0027] The light source driver 33 supplies current to the light source unit 31 under the control of the illumination control unit 32, thereby causing the light source unit 31 to emit light.

[0028] The processing device 4 includes an image processing unit 41 , a synchronization signal generating unit 42 , an input unit 43 , a control unit 44 , and a storage unit 45 .

[0029] Under the control of the control unit 44, the image processing unit 41 performs predetermined image processing on the captured image received from the endoscope 2 to generate an endoscopic image.

[0030] Examples of image processing performed by the image processing unit 41 include optical black subtraction processing (clamping processing), white balance adjustment processing, demosaic processing, color correction matrix processing, gamma correction processing, YC processing that converts RGB signals into luminance color difference signals (Y, Cb / Cr signals), digital gain adjustment that multiplies by digital gain, noise removal, and filter processing that emphasizes structure.

[0031] The image processing unit 41 described above is configured using dedicated processors such as memory and dedicated processors having hardware such as a GPU (Graphics Processing Unit), a DSP (Digital Signal Processing) or an FPGA (Field Programmable Gate Array), or various arithmetic circuits that execute specific functions, such as an ASIC (Application Specific Integrated Circuit).

[0032] The synchronization signal generation unit 42 generates a clock signal (synchronization signal) that serves as a reference for the operation of the processing device 4, and outputs the generated synchronization signal to the light source device 3, the image processing unit 41, the control unit 44, and the endoscope 2. Here, the synchronization signal generated by the synchronization signal generation unit 42 includes a horizontal synchronization signal and a vertical synchronization signal. Therefore, the light source device 3, the image processing unit 41, the control unit 44, and the endoscope 2 operate in synchronization with each other using the generated synchronization signal.

[0033] The input unit 43 is realized using a keyboard, a mouse, a switch, and a touch panel, and accepts various operations for instructing the operation of the endoscope system 1. The input unit 43 may include a switch provided on the operation unit 22 or a portable terminal such as an external tablet computer.

[0034] The control unit 44 is configured using a general-purpose processor such as a CPU or a dedicated processor such as various arithmetic circuits that execute specific functions such as an ASIC. In the first embodiment, the control unit 44 functions as the processor of the present disclosure.

[0035] The control unit 44 also processes the sound data sequentially output from the first microphone 81 and the second microphone 82 as time-series data, and generates diagnostic assistance information based on this time-series data. Details of the processing by the control unit 44 will be described later.

[0036] The storage unit 45 stores various programs executed by the control unit 44 and data including various parameters necessary for the processing of the control unit 44. Specifically, the storage unit 45 has a program storage unit 451 that stores various programs. The various programs can be recorded on computer-readable recording media such as a hard disk, flash memory, CD-ROM, DVD-ROM, or flexible disk and widely distributed. The various programs can also be obtained by downloading them via a communication network. The communication network referred to here is realized, for example, by an existing public line network, a LAN (Local Area Network), a WAN (Wide Area Network), or the like, and can be wired or wireless.

[0037] The storage unit 45 having the above configuration is realized using a ROM (Read Only Memory) in which various programs etc. are pre-installed, and a RAM, hard disk, SSD (Solid State Drive) etc. that store calculation parameters and data etc. for each process.

[0038] In this embodiment, the light source device 3 and the processing device 4 are provided in separate housings, but this is not limiting, and they may be provided integrally in the same housing.

[0039] The display device 5 displays the display image received from the processing device 4 (image processing unit 41) via the video cable. The display device 5 is configured using a monitor such as a liquid crystal or organic EL (Electro Luminescence) monitor.

[0040] The gas supply device 6 adjusts the pressure of gas supplied from a gas supply source (not shown, for example, a carbon dioxide gas cylinder) to a predetermined pressure and discharges the gas from the tip of the insertion section 21 into the space where the tip is located through the gas supply conduit 223. As shown in Fig. 1, the gas supply device 6 includes a gas supply unit 61, a flow rate measurement unit 62, and a control unit 63.

[0041] Although not specifically shown, the gas supply unit 61 includes a primary pressure reducer, a secondary pressure reducer, and a flow control valve. These primary pressure reducer, secondary pressure reducer, and flow control valve are connected in this order by an air supply conduit made of silicone, fluororesin, or the like. Gas supplied from a gas supply source (not shown) passes through the primary pressure reducer, secondary pressure reducer, and flow control valve in this order via the air supply conduit. After being adjusted to a predetermined pressure and flow rate, the gas is discharged from the air supply tube TU ( FIG. 1 ) via the flow rate measuring unit 62. The control unit 63 controls the flow control valve provided in the gas supply unit 61 to adjust the flow rate of gas supplied to the endoscope 2 to a predetermined value. The flow control valve is, for example, a type of electromagnetically driven valve, and is configured as a regulating valve using an electromagnetic coil in the drive unit. The opening degree of the valve unit is controlled by controlling the position of the plunger depending on the magnitude of the current flowing through the electromagnetic coil, thereby adjusting the flow rate of gas flowing through the air supply conduit to a predetermined value.

[0042] The gastric pressure measuring device 7 corresponds to an internal pressure sensor according to the present invention. This gastric pressure measuring device 7 detects the pressure inside the space where the tip is located via a pressure measurement probe 71 inserted to the tip of the insertion section 21 through the treatment tool insertion section 222. A signal (hereinafter referred to as gastric pressure information) related to the pressure (hereinafter referred to as gastric pressure) detected by the gastric pressure measuring device 7 is output to the processing device 4.

[0043] [Configuration and Arrangement of Pressure Sensor] Next, the configuration and arrangement of the pressure sensor 9 will be described. FIG.

[0044] The pressure sensor 9 shown in Fig. 3 is configured by, for example, a resistance-type pressure sensor or a capacitance-type pressure sensor that detects pressure using a known method. As shown in Fig. 3, the pressure sensor 9 according to the first embodiment is a circular pressure sensor that is provided around the entire circumference in the rotational direction around a central axis along the axial direction of the insertion portion 21. Note that the pressure sensor 9 is not limited to a circular pressure sensor, and a point-type pressure sensor that is provided only around a portion of the entire circumference in the rotational direction may also be used.

[0045] 3, a total of 36 pressure sensors 9 are arranged at 1 cm intervals along the axial direction of the insertion section 21 on the outer peripheral surface of the insertion section 21. As a result, when the insertion section 21 is inserted into the stomach, the pressure sensors 9 are arranged at positions that detect contraction pressure and relaxation pressure at various locations inside the esophagus from the upper esophageal sphincter to the lower esophageal sphincter.

[0046] The number of pressure sensors 9 is not limited to 36, but may be, for example, 6 or more, 12 or more, or even more.

[0047] Here, the pressure sensors 9 may be positioned a predetermined distance from one or more of the nearest other pressure sensors 9. Optionally, the spacing between each pressure sensor 9 may be substantially the same. The spacing may be 3 centimeters or less, for example 2 centimeters or less, for example 1 centimeter, or even less than 1 centimeter.

[0048] The signal relating to the pressure detected by the pressure sensor 9 described above (hereinafter referred to as esophageal pressure information) is output to the processing device 4.

[0049] [Configuration and Arrangement of First and Second Microphones] Next, a description will be given of the configuration and arrangement of the first microphone 81 and the second microphone 82. The first microphone 81 and the second microphone 82 shown in Fig. 3 generate analog audio signals (electrical signals) by collecting external sounds or vibrating due to interference of sound waves, and then perform ADC conversion on these analog audio signals and output them to the control unit 44 as digital audio data.

[0050] The first microphone 81 and the second microphone 82 are configured using, for example, a piezoelectric microphone that combines a diaphragm and a piezoelectric element or a sound sensor such as a MEMS (Micro-Electro-Mechanical Systems) microphone, an amplifier that amplifies the audio signal, an ADC conversion circuit, etc. The first microphone 81 and the second microphone 82 are arranged closer to the operation unit 22 (see FIG. 1) than the bending portion 25 (see FIG. 1) of the insertion section 21 of the endoscope 2. The first microphone 81 and the second microphone 82 are arranged on the outer periphery in the rotation direction around a central axis along the axial direction of the insertion section 21.

[0051] 3, the first microphone 81 and the second microphone 82 are spaced a predetermined distance apart and arranged at different positions in the longitudinal direction of the insertion section 21. Specifically, the second microphone 82 is arranged at a position 20 cm or more away from the first microphone 81. The distance between the first microphone 81 and the second microphone 82 can be changed as appropriate.

[0052] The first microphone 81 is arranged in the insertion section 21 so as to be located in the lower esophagus when the tip portion 24 of the insertion section 21 of the endoscope 2 is inserted inside the stomach. The second microphone 82 is arranged in the insertion section 21 so as to be located in the upper esophagus when the tip portion 24 of the insertion section 21 of the endoscope 2 is inserted inside the stomach.

[0053] Each of the first microphone 81 and second microphone 82 described above outputs temporally synchronized sound data to the processing device 4 in accordance with the synchronization signal input from the synchronization signal generation unit 42. The processing device 4 processes the sound data sequentially output from each of the first microphone 81 and second microphone 82 as time-series data in accordance with the synchronization signal input from the synchronization signal generation unit 42. Here, time-series data is data that associates time with the volume of the sound data.

[0054] [Method for Diagnosing Gastroesophageal Reflux Disease] Next, a method for diagnosing gastroesophageal reflux disease will be described. FIGS. 4 to 8 are diagrams illustrating a method for diagnosing gastroesophageal reflux disease according to embodiment 1. Specifically, FIG. 4 is a flowchart illustrating the method for diagnosing gastroesophageal reflux disease. FIG. 5 is a cross-sectional view showing the vicinity of the gastric cardia, illustrating steps S1 to S3. For ease of explanation, FIG. 5 omits the pressure sensor 9 provided on the outer peripheral surface of the insertion section 21. FIGS. 6 and 7 are diagrams illustrating the structures of the stomach and esophagus. FIG. 6 is a cross-sectional view showing the structures of the stomach and esophagus. FIG. 7 is a view of the stomach and esophagus as viewed from the outside. FIG. 8 is a diagram illustrating images captured in Phases 1 to 3, which correspond to dynamic changes that occur when air is supplied to the stomach (during pneumoperitoneum).

[0055] First, a user such as a doctor inserts the insertion portion 21 into the subject through a natural opening such as the mouth or nose, and introduces the insertion portion 21 into the stomach through the esophagus, as shown in FIG. 5 (step S1).

[0056] After step S1, a user such as a doctor operates (bends) the bending knob 221 to set the field of view to include the gastric cardia (step S2). In step S2, in response to the operation of the bending knob 221, the insertion section 21 is set into a J-shape with the tip pointing toward the gastric cardia, as shown in Fig. 5. In this state, the pressure sensor 9 is disposed at a position to detect the contraction pressure and relaxation pressure at various locations inside the esophagus from the upper esophageal sphincter to the lower esophageal sphincter.

[0057] After step S2, a user such as a doctor operates switch 224 to start supplying air from the air supply device 6 to the stomach through the air supply conduit 223 (step S3). In Fig. 5, the state in which intragastric pressure increases due to air supply is represented by a hollow arrow.

[0058] When gas is supplied to the stomach (pneumoperitoneum), if the subject is healthy, the dynamic changes shown below occur in Phases 1 to 3. Before explaining Phases 1 to 3, the structure of the stomach and esophagus will be described with reference to Figures 6 and 7.

[0059] The intramural anti-reflux barrier complex (IM-ARB complex), which is part of the anti-reflux mechanism at the gastroesophageal junction, is composed of three main components: the collar sling muscle fibers (Figure 7), the clasp muscle fibers (Figure 7), and the lower esophageal sphincter (Figures 6 and 7).

[0060] The Collar Sling Muscle Fibers are obliquely arranged muscles along the greater curvature of the stomach (Figure 6) and are arranged in a sling-like fashion to surround the upper part of the stomach (Figure 7). These Collar Sling Muscle Fibers tighten the gastric cardia to prevent reflux of gastric contents into the esophagus. From inside the stomach, the Collar Sling Muscle Fibers can be seen as a gastroesophageal flap valve (Figure 6). The gastroesophageal flap valve (GEFV) is a protrusion within the gastroesophageal junction formed by the acute angle between the esophagus and the gastric cardia and is a type of mucosal flap valve (MFV). The MFV located at the gastroesophageal junction is called the gastroesophageal flap valve. The MFV is a flap-shaped portion of the mucosa. The gastroesophageal flap valve changes shape with the expansion and contraction of muscles such as the Collar Sling Muscle Fibers and Clasp Muscle Fibers.

[0061] Clasp muscle fibers are located on the lesser curvature side of the stomach (Figure 6) and consist of a circular muscle layer. These clasp muscle fibers tighten the gastric cardia to prevent the reflux of stomach contents into the esophagus.

[0062] The lower esophageal sphincter (LES) is a ring of muscle located at the junction of the esophagus and stomach that normally contracts to close the esophagus and prevent stomach contents from refluxing.

[0063] Phase 1 begins with the amount of gas sent into the stomach being 0. During Phase 1, the gastroesophageal flap valve and the longitudinal folds of the lesser curvature are observed, as shown in Figures 8(a) and 8(b). The longitudinal folds of the lesser curvature are mucosal folds that extend vertically along the inner wall of the stomach. Their shape changes with the expansion and contraction and relaxation of muscles such as clasp muscle fibers, and they gradually stretch and flatten as intragastric pressure increases. Note that the esophageal mucosa is not observed during Phase 1. During Phase 1, as the amount of gas sent into the stomach increases, the longitudinal folds of the lesser curvature are stretched, the gastroesophageal flap valve gradually flattens, and the crura open, as shown in Figure 8(b). However, the esophageal mucosa is not observed.

[0064] In other words, in Phase 1, it is possible to evaluate the valve function (anti-reflux mechanism) of the stomach structure formed by the gastroesophageal flap valve and the longitudinal folds of the lesser curvature.

[0065] Phase 2 occurs after Phase 1. In Phase 2, as shown in Figure 8(c), the esophageal mucosa is observed beyond the squamocolumnar junction (SCJ) in Figure 6). The SCJ is the intersection of the esophageal squamous epithelium at the gastroesophageal junction (GEJ) and the gastric columnar epithelium, marking the boundary between different epithelial cells in the digestive tract. The GEJ is located near the border between the esophagus and the stomach and is composed of various anatomical components that form a barrier to prevent reflux of gastric contents. The GEJ also includes collar sling muscle fibers, clasp muscle fibers, the lower esophageal sphincter, the gastroesophageal flap valve, and the SCJ. If the subject is healthy, the scope holding sign (SHS) is observed. The SHS refers to the phenomenon in which the insertion tube 21 is held in place by contraction of the lower esophageal sphincter when intragastric pressure increases. The state shown in FIG. 8(c) is the SHS.

[0066] That is, in Phase 2, it becomes possible to evaluate the valve function (anti-reflux mechanism) of the lower esophageal sphincter.

[0067] Phase 3 occurs after Phase 2. In Phase 3, intragastric pressure exceeds the contractile force of the lower esophageal sphincter, causing the lower esophageal sphincter to relax. In Figure 8(d), the arrow indicates that gas leaks into the esophagus (producing a belching sound) due to the relaxation of the lower esophageal sphincter. If the subject is healthy, peristaltic waves will subsequently descend from the upper esophagus, and SHS will be observed again.

[0068] That is, in Phase 3, it becomes possible to evaluate the acid clearance function due to esophageal peristalsis.

[0069] After step S3, a user such as a doctor determines whether the state corresponds to the above-mentioned Phase 1 based on the diagnostic support information displayed on the display device 5, and evaluates the valve function (state of the gastric cardia) based on the structure of the stomach side (step S4).

[0070] After step S4, a user such as a doctor determines whether or not the state corresponds to the above-mentioned Phase 2 based on the diagnostic support information displayed on the display device 5, and evaluates the valve function of the lower esophageal sphincter (the state of the lower esophageal sphincter) (step S5).

[0071] After step S5, a user such as a doctor determines whether or not the patient is in a state corresponding to the above-mentioned Phase 3 based on the diagnostic support information displayed on the display device 5, and evaluates the acid clearance function due to esophageal peristalsis (the state of peristaltic movement in the esophagus) (step S6).

[0072] After step S6, a user such as a doctor diagnoses gastroesophageal reflux disease based on the evaluation results of steps S4 to S6 (step S7).

[0073] [Principles of Sounds Induced by Peristaltic Movement] Next, the principles of sounds derived from peristaltic movement will be described. FIG. 9 is a diagram illustrating the principles of sounds derived from peristaltic movement. FIG. 10 is a diagram illustrating a state in which the endoscope 2 is inserted into a subject. FIG. 11 is a diagram illustrating an example of time-series data of sound data sequentially output from each of the first microphone 81 and the second microphone 82. FIG. 12 is a diagram illustrating an example of time-series data of sound data sequentially output from each of the first microphone 81 and the second microphone 82 when an abnormality occurs in the subject's esophagus or stomach. In FIGS. 11 and 12, curve L1 represents the time-series data of sound data output from the second microphone 82, curve L2 represents the time-series data of sound data output from the first microphone 81, curve L3 represents the time-series data of sound data output from the second microphone 82 when an abnormality occurs in the subject's esophagus or stomach, and curve L4 represents the time-series data of sound data output from the first microphone 81 when an abnormality occurs in the subject's esophagus or stomach. 11 and 12, the horizontal axis represents time and the vertical axis represents volume. The sound data sequentially output from the first microphone 81 and the second microphone 82 is processed by the control unit 44 as time-series data.

[0074] As shown in FIG. 9 , sounds resulting from peristalsis are generated sequentially as esophageal contraction (LES contraction) and relaxation (LES relaxation) alternate when an object W1, such as saliva or other liquid, passes through the esophagus. In subjects diagnosed with GERD symptoms, a physician must observe the condition in Phase 3 described above to identify the cause and determine a treatment method. In this case, as shown in FIG. 10 , the physician inserts the insertion section 21 of the endoscope 2 into the subject and observes endoscopic images captured by the endoscope 2 to observe the subject's esophageal peristalsis, which is a clinically characteristic change in organ activity, including LES relaxation, SHS opening, peristalsis, belching (burping), peristalsis, and LES contraction. However, it may be difficult for a physician to quantitatively evaluate esophageal peristalsis through visual confirmation of endoscopic images.

[0075] Therefore, as shown in Figures 11 and 12, the state of peristalsis is quantitatively evaluated by continuously collecting sounds from the entire esophagus, which is the observation target section, based on sound data sequentially output from each of the first microphone 81 and the second microphone 82. Specifically, the first microphone 81 and the second microphone 82 collect (detect) sounds from a sound source generated by peristaltic movement. This sound source is generated when the esophageal mucosa, whose shape has changed due to peristaltic movement, comes into contact with the side surface of the insertion section 21 of the endoscope 2. Therefore, as shown by curves L1 and L2 in Figure 11, in the case of normal peristaltic movement, the center of the sound source becomes the peak P1 (maximum value) of the volume, and the waveform becomes mountain-shaped from this peak P1. In contrast, as shown by curves L3 and L4 in Figure 12, in the case of abnormal peristaltic movement, the center of the sound source becomes the peak P1 of the volume, but the sound is absorbed at the abnormal part P2 of the esophagus, resulting in a waveform with a valley.

[0076] As described above, the control unit 44 processes the sound data sequentially output from each of the first microphone 81 and the second microphone 82 as time-series data, generates diagnostic assistance information based on this time-series data, and outputs it to the display device 5. Specifically, the control unit 44 identifies the sound source position by calculating the arrival time difference between the sound waves included in the sound data sequentially output from each of the first microphone 81 and the second microphone 82. For example, the control unit 44 calculates the arrival time difference between the peak P1 (maximum value) of the volume in the sound data sequentially output from each of the first microphone 81 and the second microphone 82, and identifies the sound source position and direction from this calculated arrival time difference. In this case, the control unit 44 identifies the sound source position from the positional relationship between the sound source, the first microphone 81, and the second microphone 82 using well-known triangulation techniques.

[0077] The control unit 44 then identifies changes in the sound source position based on the time-series data of the sound data sequentially output from each of the first microphone 81 and the second microphone 82, tracks the changes in the sound source position, and estimates the movement of the sound source. In this case, the control unit 44 determines whether the sound source is moving at an approximately constant speed based on the estimated movement of the sound source. Here, "approximately constant speed" means that the sound source moves at regular intervals, for example, every 1 to 2 seconds, due to peristaltic movement. That is, the control unit 44 identifies the sound source position corresponding to the peristaltic movement based on the time-series data of the sound data sequentially output from each of the first microphone 81 and the second microphone 82, and identifies changes in this sound source position. Specifically, the control unit 44 identifies the sound source position of the sound generated by the peristaltic movement of the esophagus, and then tracks the sound source position that changes due to the peristaltic movement of the esophagus, to estimate the movement of the peristaltic movement. In this case, the control unit 44 determines from the peristaltic movement whether the peristaltic movement is moving at a substantially constant speed, i.e., whether the peristaltic movement is moving smoothly from the upper esophagus to the lower esophagus. If the peristaltic movement is not moving smoothly from the upper esophagus to the lower esophagus, the control unit 44 determines that the peristaltic movement is abnormal. However, if the peristaltic movement is moving smoothly from the upper esophagus to the lower esophagus, the control unit 44 determines that the peristaltic movement is normal. The control unit 44 then generates diagnostic support information including information on whether the peristaltic movement is normal or abnormal and outputs the information to the display device 5. Furthermore, the diagnostic support information includes information on changes in the sound source position corresponding to the peristaltic movement. This allows a physician to quantitatively evaluate esophageal peristalsis, which is difficult to determine by observing an endoscopic image, by observing the diagnostic support information displayed on the display device 5.

[0078] [Method for Evaluating Esophageal Peristalsis] Next, a method for evaluating esophageal peristalsis will be described. Fig. 13 is a diagram illustrating the method for evaluating esophageal peristalsis. The method for evaluating esophageal peristalsis is performed by a doctor in parallel with Phase 3 or independently when the above-described method for diagnosing gastroesophageal reflux disease is performed.

[0079] 13, first, the doctor inserts the insertion portion 21 into the subject through a natural opening such as the mouth or nose (step S21). In this case, as shown in FIG. 5, the insertion portion 21 is introduced into the stomach through the esophagus.

[0080] Next, the physician bends the bending knob 221 of the operation unit 22 to set the field of view to include the gastric cardia, and observes the gastric cardia (step S22), and then moves the insertion section 21 of the endoscope 2 forward or backward in the insertion direction (step S23). In this case, in response to the physician's operation of the bending knob 221, the insertion section 21 is set into a J-shape with the tip pointing toward the gastric cardia, as shown in Fig. 5 above. In this state, the pressure sensor 9 is disposed at a position that detects the contraction pressure and relaxation pressure at various locations inside the esophagus from the upper esophageal sphincter to the lower esophageal sphincter.

[0081] Thereafter, the doctor operates the switch 224 to start supplying air from the air supply device 6 through the air supply conduit 223 into the stomach (step S24), thereby increasing the pressure inside the stomach (step S25).

[0082] Next, the doctor operates the switch 224 of the endoscope 2 to cause the control unit 44 to process the sound data sequentially output from the first microphone 81 and the second microphone 82 as time-series data (step S26). In this case, the control unit 44 determines whether the peristaltic movement is moving smoothly from the upper esophagus to the lower esophagus based on the time-series data, and determines that the peristaltic movement is abnormal if the peristaltic movement is not moving smoothly from the upper esophagus to the lower esophagus, while determining that the peristaltic movement is normal if the peristaltic movement is moving smoothly from the upper esophagus to the lower esophagus. The control unit 44 then generates diagnostic assistance information including information on whether the peristaltic movement is normal or abnormal and outputs the information to the display device 5.

[0083] Thereafter, the doctor evaluates the peristaltic movement based on the endoscopic image and the diagnostic support information displayed on the display device 5 (step S27). This allows the doctor to quantitatively evaluate the peristaltic movement of the esophagus, which is difficult to judge by observing the endoscopic image, by observing the diagnostic support information displayed on the display device 5.

[0084] [Processing by Processing Device] Next, processing executed by the processing device 4 will be described. Fig. 14 is a flowchart showing an outline of processing executed by the processing device 4. Note that Fig. 14 describes processing that is performed after a doctor performs bending operation using the bending knob 221 of the operation unit 22 of the endoscope 2 to set the gastric cardia portion in the observation field, observes the gastric cardia portion, and moves the insertion section 21 of the endoscope 2 forward and backward in the insertion direction.

[0085] 14 , first, the control unit 44 determines whether or not the physician has operated the switch 224 to start gas supply from the gas supply device 6 to the stomach through the gas supply conduit 223 (step S100). If the control unit 44 determines that gas supply from the gas supply device 6 to the stomach through the gas supply conduit 223 has started (step S100: Yes), the processing device 4 proceeds to step S101. On the other hand, if the control unit 44 determines that gas supply from the gas supply device 6 to the stomach through the gas supply conduit 223 has not started (step S100: No), the control unit 44 continues this determination.

[0086] Next, the control unit 44 acquires sound data sequentially output from the first microphone 81 and the second microphone 82 (step S101) and processes the sound data as time-series data (step S102). Specifically, the control unit 44 generates time-series data that associates the volume of sound waves included in the sound data with time. In this case, the control unit 44 generates the time-series data by referring to the distance between the first microphone 81 and the second microphone 82.

[0087] Next, the control unit 44 identifies the sound source position based on the time-series data (step S103) and identifies changes in the sound source position (step S104). Specifically, the control unit 44 identifies the sound source position and identifies changes in the sound source position over time by calculating the arrival time difference between sound waves included in the sound data sequentially output from each of the first microphone 81 and the second microphone 82. For example, the control unit 44 identifies the sound source position by calculating the arrival time difference (see FIGS. 11 and 12 ) between the maximum volume (intensity) of sound waves included in the sound data sequentially output from each of the first microphone 81 and the second microphone 82.

[0088] Thereafter, the control unit 44 tracks changes in the sound source position over time to estimate the movement of the sound source (step S105) and determines the movement of the sound source (step S106). Specifically, the control unit 44 determines whether the peristaltic movement is moving smoothly from the upper esophagus to the lower esophagus. If the peristaltic movement is not moving smoothly from the upper esophagus to the lower esophagus, the control unit 44 determines that the peristaltic movement is abnormal, whereas if the peristaltic movement is moving smoothly from the upper esophagus to the lower esophagus, the control unit 44 determines that the peristaltic movement is normal.

[0089] Next, if the control unit 44 determines that the peristaltic movement is normal (step S107: Yes), it generates diagnostic assistance information including at least one of information that the peristaltic movement is normal and information regarding changes over time in the sound source position corresponding to the peristaltic movement, and displays this information on the display device 5 (step S108). After step S108, the processing device 4 ends this process. On the other hand, if it determines that the peristaltic movement is abnormal (step S107: No), it generates diagnostic assistance information including at least one of information that the peristaltic movement is abnormal and information regarding changes over time in the sound source position corresponding to the peristaltic movement, and displays this information on the display device 5 (step S109). After step S109, the processing device 4 ends this process.

[0090] According to the first embodiment described above, the control unit 44 calculates the difference in arrival times of sound waves contained in the sound data sequentially output from each of the first microphone 81 and the second microphone 82, thereby identifying the position of the sound source, and after identifying a change in the sound source position, tracks the change in the sound source position to estimate the movement of the sound source, and by determining the movement of the sound source, it is possible to determine whether peristaltic movement is moving smoothly from the upper part of the esophagus to the lower part of the esophagus.Therefore, by referring to the diagnostic assistance information while observing the endoscopic image, the doctor can quantitatively evaluate the peristaltic movement of the esophagus.

[0091] In the first embodiment, the control unit 44 identifies the sound source position and identifies changes in the sound source position by calculating the arrival time difference between the sound waves contained in the sound data sequentially output from each of the first microphone 81 and the second microphone 82, but the sound source position and changes in the sound source position may also be identified by calculating the phase difference between the sound waves contained in the sound data sequentially output from each of the first microphone 81 and the second microphone 82.

[0092] In the first embodiment, the control unit 44 may determine whether peristaltic movement is abnormal or normal using a trained model such as a convolutional neural network (CNN). In this case, the trained model learns training data (learning data) that combines time-series data obtained by processing sound data, sounds generated by peristaltic movement, and whether the peristaltic movement is normal or abnormal, and outputs normal or abnormal peristaltic movement as an output parameter. The control unit 44 inputs time-series data obtained by processing sound data sequentially output from the first microphone 81 and the second microphone 82 into the trained model, generates diagnostic assistance information using the output parameter indicating whether the output peristaltic movement is normal or abnormal, and displays the diagnostic assistance information on the display device 5. This allows a physician to quantitatively evaluate esophageal peristaltic movement by referring to the diagnostic assistance information while observing the endoscopic image.

[0093] (Embodiment 2) Next, embodiment 2 will be described. The endoscope system according to embodiment 2 has the same configuration as the endoscope system 1 according to embodiment 1 described above, but the processing performed by the treatment device is different. Specifically, in embodiment 1 described above, the sound source position is identified and a change in the sound source position is estimated using the arrival time difference of sound waves, but in embodiment 2, the sound source position is identified and a change in the sound source position is estimated using the volume. The processing performed by the treatment device according to embodiment 2 will be described below. Note that the same reference numerals as those in the endoscope system 1 according to embodiment 1 described above are assigned the same reference numerals, and detailed description thereof will be omitted.

[0094] [Processing by Processing Device] Fig. 15 is a flowchart showing an outline of the processing executed by the processing device 4 according to embodiment 2. Note that Fig. 15 describes the processing that is performed after a doctor performs a bending operation using the bending knob 221 of the operation unit 22 of the endoscope 2 to set the gastric cardia in the observation field, observes the gastric cardia, and then moves the insertion unit 21 of the endoscope 2 forward and backward in the insertion direction. Also, in Fig. 15, steps S200 to S202 correspond to the processing of steps S100 to S102 in Fig. 14 described above, respectively, and therefore detailed description thereof will be omitted.

[0095] In step S203, the control unit 44 identifies the position of the sound source based on the time-series data. Specifically, the control unit 44 calculates the volume of the sound waves included in the sound data of the first microphone 81 and the second microphone 82 based on the time-series data of each of the first microphone 81 and the second microphone 82, and calculates the volume difference between the first microphone 81 and the second microphone 82. Then, the control unit 44 identifies the position of the sound source, for example, the direction and distance from the first microphone 81, based on the volume difference between the first microphone 81 and the second microphone 82 and the distance (e.g., 20 cm) between the first microphone 81 and the second microphone 82.

[0096] Next, the control unit 44 estimates the volume of the sound source position corresponding to the peristaltic movement based on the time-series data (step S204), tracks the change in the sound source position, and determines the change in volume over time (step S205). Specifically, the control unit 44 determines whether there is a change in the volume of the sound source position corresponding to the peristaltic movement, and if the change in the volume of the sound source position corresponding to the peristaltic movement is greater than a threshold, determines that the peristaltic movement is abnormal. More specifically, the control unit 44 determines that the peristaltic movement is abnormal if there is a position where the volume of the sound source position corresponding to the peristaltic movement has disappeared. That is, the control unit 44 determines that the peristaltic movement is abnormal because the sound source position does not move smoothly from the upper esophagus to the lower esophagus, resulting in a position where the volume of the sound source position corresponding to the peristaltic movement has disappeared. Here, the disappearance of the volume means that the volume is below a predetermined value. In contrast, the control unit 44 determines that the peristaltic movement is normal when the change in volume at the sound source position corresponding to the peristaltic movement is equal to or less than the threshold value. That is, the control unit 44 determines that the peristaltic movement is normal because the sound source position moves smoothly from the upper esophagus to the lower esophagus and the change in volume at the sound source position corresponding to the peristaltic movement is equal to or less than the threshold value.

[0097] Next, if the control unit 44 determines that the peristaltic movement is normal (step S206: Yes), it generates diagnostic assistance information including at least one of information that the peristaltic movement is normal and information regarding changes over time in the volume of the sound source position corresponding to the peristaltic movement, and displays this information on the display device 5 (step S207). After step S207, the processing device 4 terminates this process. On the other hand, if it determines that the peristaltic movement is abnormal (step S206: No), it generates diagnostic assistance information including at least one of information that the peristaltic movement is abnormal and information regarding changes over time in the volume of the sound source position corresponding to the peristaltic movement, and displays this information on the display device 5 (step S208). After step S208, the processing device 4 terminates this process.

[0098] According to the second embodiment described above, the control unit 44 calculates the volume of the sound waves contained in the sound data output sequentially from each of the first microphone 81 and the second microphone 82, thereby identifying the position of the sound source, and after identifying changes in the sound source position over time, tracks the changes in the sound source position to estimate the movement of the sound source, and by determining the movement of the sound source, it is possible to determine whether peristaltic movement is moving smoothly from the upper part of the esophagus to the lower part of the esophagus.Therefore, by referring to the diagnostic assistance information while observing the endoscopic image, the doctor can quantitatively evaluate the peristaltic movement of the esophagus.

[0099] (Embodiment 3) Next, embodiment 3 will be described. Embodiment 3 has a different configuration from the endoscope 2 of the endoscope system 1 according to the above-described embodiments 1 and 2. The configuration of the endoscope system according to embodiment 3 will be described below. Note that the same components as those in the endoscope system 1 according to the above-described embodiments 1 and 2 will be assigned the same reference numerals, and detailed description thereof will be omitted.

[0100] [Configuration of Endoscope System] Fig. 16 is a diagram showing the functional configuration of an endoscope system according to embodiment 3. The endoscope system 1A shown in Fig. 16 includes an endoscope 2A instead of the endoscope 2 according to the above-described embodiment 1. The endoscope 2A further includes a third microphone 83 disposed in the insertion section 21.

[0101] The third microphone 83 is disposed between the first microphone 81 and the second microphone 82. The third microphone 83 is disposed in the insertion section 21 so as to be located in the mid-esophagus when the tip portion 24 of the insertion section 21 is inserted inside the stomach of the subject. Like the first microphone 81 and the second microphone 82, the third microphone 83 collects external sounds to generate analog audio signals, performs ADC conversion on the analog audio signals, and outputs them to the control unit 44 as sound data, which is a digital audio signal. The control unit 44 processes the sound data sequentially output from each of the first microphone 81, the second microphone 82, and the third microphone 83 as time-series data, and calculates the arrival time difference of the sound waves based on the time-series data to identify the sound source position and generate the above-mentioned diagnostic assistance information.

[0102] According to the third embodiment described above, the sound source position can be identified with high accuracy, and therefore the peristaltic movement of the esophagus can be quantitatively evaluated.

[0103] (Fourth Embodiment) Next, a fourth embodiment will be described. In the first to third embodiments described above, the audio microphone is disposed in the insertion portion of the endoscope, but in the fourth embodiment, it is disposed on an overtube. The configuration of the overtube according to the fourth embodiment will be described below. Note that the same components as those in the endoscope system 1 according to the first and second embodiments described above are assigned the same reference numerals, and detailed description thereof will be omitted.

[0104] 17 is a diagram illustrating the configuration of an overtube and the arrangement of an audio microphone according to embodiment 4. As shown in Fig. 17 , in addition to the configuration of the endoscope system 1 according to embodiment 1 described above, the endoscope system 1B further includes an overtube 200 having a diameter that allows the insertion section 21 of the endoscope 2 to be inserted therethrough.

[0105] The overtube 200 has a first microphone 81 and a second microphone 82 arranged on the outer periphery in the rotation direction around a central axis along the axial direction of the insertion section 21. The first microphone 81 and the second microphone 82 are electrically connected to the processing device 4 via cables (not shown).

[0106] According to the fourth embodiment described above, the same effect as that of the first embodiment can be obtained, and the peristaltic movement of the esophagus can be quantitatively evaluated.

[0107] (Other Embodiments) Various inventions can be formed by appropriately combining multiple components disclosed in the endoscope systems according to the above-described first to fourth embodiments of the present disclosure. For example, some components may be omitted from all of the components described in the medical support systems according to the above-described embodiments of the present disclosure. Furthermore, the components described in the medical support systems according to the above-described embodiments of the present disclosure may be appropriately combined.

[0108] In the above-described first to fourth embodiments of the present disclosure, in order to diagnose gastroesophageal reflux disease, at least two pieces of information, namely, an endoscopic image and esophageal pressure information, are required, and it is not necessary to use all of the information, namely, the endoscopic image, the esophageal pressure information, the intragastric pressure information, and the eructation information.

[0109] Although the above-described first to fourth embodiments of the present disclosure have been described as technologies capable of diagnosing gastroesophageal reflux disease, this is not intended to be limiting. For example, the present invention can be useful for diagnosing esophageal achalasia, since it can also evaluate the relaxation dysfunction of the lower esophageal sphincter. It can also evaluate the function of the major sphincters present in the human digestive tract. Specifically, it can evaluate the external anal sphincter, i.e., physiological anorectal function associated with aging.

[0110] Furthermore, in the endoscope systems according to the first to fourth embodiments of the present disclosure, the above-described "unit" can be read as "means," "circuit," etc. For example, a control unit can be read as control means or a control circuit.

[0111] In addition, the programs to be executed by the endoscopic systems according to the first to fourth embodiments of the present disclosure are provided as file data in an installable or executable format recorded on a computer-readable recording medium such as a CD-ROM, a flexible disk (FD), a CD-R, a DVD (Digital Versatile Disk), a USB medium, or a flash memory.

[0112] In addition, the programs executed by the medical support systems according to the first and second embodiments of the present disclosure may be configured to be stored on a computer connected to a network such as the Internet and provided by being downloaded via the network.

[0113] In the description of the flowcharts in this specification, expressions such as "first," "then," and "continue" are used to clearly indicate the order of processing between steps, but the order of processing required to implement the present invention is not uniquely determined by these expressions. In other words, the order of processing in the flowcharts described in this specification can be changed within a consistent range. Furthermore, programs are not limited to those consisting of simple branching processing, and branching can be achieved by comprehensively determining more judgment items.

[0114] Although some of the embodiments of the present application have been described in detail above with reference to the drawings, these are merely examples, and the present invention can be implemented in other forms that have undergone various modifications and improvements based on the knowledge of those skilled in the art, including the aspects described in the disclosure of the present invention.

[0115] The present disclosure can also be configured as follows: (Note) An evaluation method for evaluating peristaltic movement in the esophagus, comprising: inserting an endoscope into a subject through a natural opening such as the mouth or nose, introducing a tip of the endoscope into the stomach, manipulating the insertion section of the endoscope to move forward or backward so that a first microphone and a second microphone disposed in the insertion section are positioned at predetermined positions in the esophagus, commencing the supply of gas into the stomach via an air outlet provided in the endoscope, continuously supplying gas into the stomach to increase intragastric pressure, processing sound data sequentially output from the first microphone and the second microphone as time-series data, and evaluating peristaltic movement based on the time-series data.

[0116] REFERENCE SIGNS LIST 1 endoscopic system 2 endoscope 3 light source device 4 processing device 5 display device 6 air supply device 7 gastric pressure measuring device 9 pressure sensor 21 insertion section 22 operation section 23 universal cord 24 tip section 25 bending section 26 flexible tube section 31 light source section 32 lighting control section 33 light source driver 41 image processing section 42 synchronization signal generation section 43 input section 44 control section 45 memory section 61 air supply section 62 flow rate measurement section 63 control section 71 pressure measurement probe 81 first microphone 82 second microphone 83 third microphone 221 bending knob 222 treatment tool insertion section 223 air supply conduit 224 switch 231, 232 connector 241 light guide 242 illumination lens 243 optical system 244 image sensor 245 Collective cable TU Air supply tube

Claims

1. An endoscopic system comprising: an endoscope; and a processing device, wherein the endoscope has an insertion section in which a first microphone and a second microphone are arranged at different positions in a longitudinal axis direction; and the processing device has a processor, which processes sound data sequentially output from each of the first microphone and the second microphone as time-series data, and generates diagnostic support information based on the time-series data.

2. An endoscope system according to claim 1, wherein the first microphone and the second microphone are arranged closer to the operation section than the bending section of the insertion section.

3. An endoscope system according to claim 1, wherein the first microphone and the second microphone are positioned at a distance of 20 cm or more from each other.

4. An endoscope system according to claim 1, wherein the insertion section further comprises a third microphone disposed between the first microphone and the second microphone.

5. An endoscope system according to claim 1, wherein the first microphone is arranged in the insertion section so as to be located in the lower part of the esophagus when the tip of the insertion section is inserted inside the stomach.

6. An endoscope system according to claim 5, wherein the second microphone is arranged in the insertion section so as to be located in the upper part of the esophagus when the tip of the insertion section is inserted inside the stomach.

7. An endoscope system according to claim 5, wherein the insertion section further includes a third microphone disposed between the first microphone and the second microphone, and the third microphone is disposed in the insertion section so as to be positioned in the middle of the esophagus when the tip of the insertion section is inserted inside the stomach.

8. An endoscope system according to claim 1, wherein the processor calculates the arrival time difference between the sound waves detected by the first microphone and the second microphone based on the time series data.

9. An endoscope system according to claim 1, wherein the processor calculates a phase difference between the sound waves detected by the first microphone and the second microphone based on the time series data.

10. An endoscope system according to claim 1, wherein the processor calculates the volume of the sound waves detected by each of the first microphone and the second microphone based on the time series data.

11. An endoscope system according to claim 1, wherein the processor identifies a sound source position based on the time-series data.

12. An endoscope system according to claim 1, wherein the processor identifies a change in the position of a sound source based on the time-series data.

13. An endoscope system according to claim 12, wherein the processor tracks changes in the sound source position to estimate the movement of the sound source.

14. An endoscope system according to claim 13, wherein the processor determines from the movement of the sound source whether the sound source is moving at a substantially constant speed.

15. An endoscope system according to claim 1, wherein the processor identifies a sound source position corresponding to peristaltic movement based on the time series data.

16. An endoscope system according to claim 15, wherein the processor identifies a change in the sound source position corresponding to peristaltic movement based on the time series data.

17. An endoscope system according to claim 16, wherein the processor estimates peristaltic movement by tracking a sound source position corresponding to the peristaltic movement based on the time series data.

18. An endoscope system according to claim 17, wherein the processor determines from the peristaltic movement whether the peristaltic movement is moving at a substantially constant speed.

19. An endoscopy system according to claim 18, wherein the processor determines whether peristaltic movement is moving smoothly from the upper esophagus to the lower esophagus.

20. An endoscope system according to claim 19, wherein the processor determines that there is an abnormality when peristaltic movement does not move smoothly from the upper esophagus to the lower esophagus.

21. An endoscope system according to claim 1, wherein the processor estimates the volume at a sound source position corresponding to peristaltic movement based on the time series data.

22. An endoscope system according to claim 21, wherein the processor determines whether there is a change in volume at a sound source location corresponding to peristaltic movement.

23. An endoscope system according to claim 22, wherein the processor determines that a large change in volume at the position of a sound source corresponding to peristaltic movement is abnormal.

24. An endoscope system according to claim 22, wherein the processor determines that there is an abnormality when there is a position where the volume of a sound source corresponding to peristaltic movement has disappeared.

25. An endoscope system according to claim 20 or 22, wherein the processor detects abnormalities in peristaltic movement based on the time-series data.

26. An endoscope system according to claim 1, wherein the diagnostic support information includes information on whether peristalsis is normal or abnormal.

27. An endoscope system according to claim 16, wherein the diagnosis support information includes information relating to changes over time in the position of a sound source corresponding to peristaltic movement.

28. An endoscope system according to claim 21, wherein the diagnosis support information includes information relating to changes over time in volume at a sound source position corresponding to peristaltic movement.

29. An endoscope system according to claim 16, wherein the sound source is generated by contact between the esophageal mucosa, whose shape has changed due to peristaltic movement, and the side surface of the insertion portion of the endoscope.

30. An endoscopic system as described in claim 1, further comprising an air supply device that supplies gas via an air supply pipe provided in the insertion section of the endoscope, and the processor processes sound data sequentially output from the first microphone and the second microphone as the time series data after air supply has started by at least the air supply device.

31. An endoscope system according to claim 1, wherein the sound data sequentially output from the first microphone and the second microphone are synchronized in time.

32. An endoscope system according to claim 1, wherein the processor refers to the distance between the first microphone and the second microphone when processing sound data output sequentially from each of the first microphone and the second microphone.

33. An endoscope system according to claim 1, wherein the first microphone and the second microphone are arranged on an overtube having a diameter that allows the endoscope to be inserted therethrough.

34. A method for operating an endoscopic system comprising an endoscope and a processing device, wherein the endoscope has an insertion section in which a first microphone and a second microphone are arranged at different positions in the longitudinal axis direction, and the processing device has a processor, wherein the processor processes sound data sequentially output from each of the first microphone and the second microphone as time-series data, and generates diagnostic support information based on the time-series data.

35. An endoscope system comprising an endoscope and a processing device, wherein the endoscope has an insertion section in which a first microphone and a second microphone are arranged at different positions in the longitudinal axis direction, and the processing device has a processor. A program executed by the processor causes the processor to process sound data sequentially output from each of the first microphone and the second microphone as time-series data, and generate diagnostic support information based on the time-series data.

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