Endoscope system and endoscope system control method

Abstract

An endoscope system according to the present invention comprises an endoscope including: an insertion part that has a tip end part at which an imaging element is disposed and a bending part which is bendable and is connected to the proximal side of the tip end part; and an operation part that receives an operation for bending the bending part, wherein a first marker that indicates a positioning position and that is located closer to the proximal side than the bending part is formed on the outer circumferential surface of the insertion part.

Description

Endoscope system and control method for endoscope system

[0001] The present invention relates to an endoscope system and a control method for an endoscope system.

[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 endoscopic system using an endoscope has been proposed as a system for diagnosing gastroesophageal reflux disease (see, for example, Patent Document 1). In the endoscopic system described in Patent Document 1, an insertion section of an 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 endoscopic system then evaluates the function of the lower esophageal sphincter based on pressure changes within 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] International Publication No. 2021 / 166127

[0004] However, in diagnosing gastroesophageal reflux disease, it is necessary to evaluate not only the function of the lower esophageal sphincter but also the motility function of the esophagus. Therefore, in addition to the examination using the endoscopic system described in Patent Document 1, it is necessary to additionally evaluate the motility function of the esophagus using, for example, a high-resolution manometry (HRM) examination. This high-resolution manometry examination cannot be performed with the endoscopic system described in Patent Document 1. Therefore, in addition to the examination using the endoscopic system described in Patent Document 1, it is necessary to perform the high-resolution manometry examination using a separate examination device, which places a burden on the subject.

[0005] Therefore, there is a demand for a technique that can diagnose gastroesophageal reflux disease while reducing the burden on the subject.

[0006] In addition, to diagnose gastroesophageal reflux disease, it is necessary to bend the bending section of the endoscope so that the subject's gastric cardia is included in the observation field of the endoscope. Furthermore, to evaluate the valve function of the stomach and esophageal muscles located around the gastric cardia and the peristaltic function of the esophageal body, it is necessary to adjust the insertion section of the endoscope to an appropriate position so that an observation field suitable for evaluation can be obtained.

[0007] The present invention has been made in consideration of the above, and aims to provide an endoscope system that can easily adjust the insertion portion of an endoscope to an appropriate position, and a control method for an endoscope system.

[0008] In order to solve the above-mentioned problems and achieve the object, the endoscopic system of the present invention is an endoscope comprising an insertion section having a tip section where an imaging element is located and a freely bendable bending section connected to the base end side of the tip section, and an operation section that accepts operations to bend the bending section, and a first marker that indicates a positioning position located on the base end side of the bending section is formed on the outer peripheral surface of the insertion section.

[0009] A control method for an endoscopic system according to the present invention comprises an endoscope including an insertion section having a tip section where an imaging element is located and a freely bendable bending section connected to the base end side of the tip section, and an operation section that accepts operations to bend the bending section, and a processor, wherein a first marker indicating a positioning position located on the base end side of the bending section is formed on the outer surface of the insertion section, and the processor generates an endoscopic image based on the imaging signal output by the imaging element, and determines based on the endoscopic image whether the gastric cardia of the subject shown in the endoscopic image approximately coincides with the first marker, and outputs the determination result.

[0010] According to the present invention, it is possible to realize an endoscope system that can easily adjust the insertion section of an endoscope to an appropriate position, and a control method for an endoscope system.

[0011] FIG. 1 is a diagram illustrating a configuration of an endoscopic system according to an embodiment. FIG. 2 is a diagram illustrating a configuration of an endoscopic system according to an embodiment. 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 an embodiment. FIG. 5 is a diagram illustrating a method for diagnosing gastroesophageal reflux disease according to an embodiment. FIG. 6 is a diagram illustrating a method for diagnosing gastroesophageal reflux disease according to an embodiment. FIG. 7 is a diagram illustrating a method for diagnosing gastroesophageal reflux disease according to an embodiment. FIG. 8 is a diagram illustrating a method for diagnosing gastroesophageal reflux disease according to an embodiment. FIG. 9 is a diagram illustrating an example of display of diagnostic support information. FIG. 10 is a diagram illustrating an example of display of diagnostic support information. FIG. 11 is a diagram illustrating an example of display of diagnostic support information. FIG. 12 is a partially enlarged view of the insertion section of the endoscope shown in FIG. 1. FIG. 13 is a diagram illustrating a state in which the insertion section has been introduced into the stomach of a subject. FIG. 14 is a diagram illustrating the lower esophageal sphincter as seen in an endoscopic image. FIG. 15 is a diagram illustrating the lower esophageal sphincter as seen in an endoscopic image. Fig. 16 is a partial enlarged view of an insertion portion of an endoscope according to Modification 1. Fig. 17 is a partial enlarged view of an insertion portion of an endoscope according to Modification 2.

[0012] 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.

[0013] 1 and 2 are diagrams showing the configuration of an endoscopic system 1 according to an embodiment. The endoscopic system 1 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, a gastric pressure measuring device 7, and a microphone 8.

[0014] 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.

[0015] 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) that is configured by a plurality of bending pieces connected to the base end side of the tip section 24, and a long, flexible flexible tube section 26 (Figure 1) that is connected to the base end side of the bending section 25. An imaging element 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 imaging element 244.

[0016] 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."

[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 to 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 execute 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 may be 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 corresponds to a processor according to the present invention. As shown in FIG. 2 , 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] Furthermore, under the control of the control unit 44, the image processing unit 41 generates first support information based on a signal relating to pressure (gastric pressure information) detected by the gastric pressure measuring device 7.

[0032] Furthermore, under the control of the control unit 44, the image processing unit 41 generates second support information based on a signal relating to pressure detected by the pressure sensor 9 (esophageal support information).

[0033] Furthermore, under the control of the control unit 44, the image processing unit 41 generates third support information based on a signal relating to a belching sound (belching sound information) collected by the microphone 8.

[0034] The image processing unit 41 then generates diagnostic support information for diagnosing gastroesophageal reflux disease based on the endoscopic image and the first to third support information. The diagnostic support information is output to the display device 5 and displayed on the display device 5.

[0035] Details of the first to third support information and the diagnostic support information will be explained in the section "Display Examples of Diagnostic Support Information" below.

[0036] The image processing unit 41 described above is configured using a general-purpose processor such as a CPU (Central Processing Unit) or a dedicated processor such as various arithmetic circuits that execute specific functions, such as an ASIC (Application Specific Integrated Circuit).

[0037] 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.

[0038] 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.

[0039] The control unit 44 is configured using a general-purpose processor such as a CPU or a dedicated processor such as an ASIC or various arithmetic circuits that execute specific functions.

[0040] 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. 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 communications network. The communications network referred to here is realized by, for example, an existing public line network, a LAN (Local Area Network), a WAN (Wide Area Network), or the like, and can be wired or wireless.

[0041] The storage unit 45 having the above configuration is realized using a ROM (Read Only Memory) in which various programs and the like are pre-installed, and a RAM, hard disk, and the like for storing calculation parameters and data for each process.

[0042] 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.

[0043] 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.

[0044] 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.

[0045] 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 air supply conduit, in this order, through the primary pressure reducer, secondary pressure reducer, and flow control valve. 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 an adjustment 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.

[0046] 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.

[0047] The microphone 8 is placed on the throat of the subject and collects belching sounds (burping sounds) emitted from the esophagus of the subject. The signal related to the belching sounds collected by the microphone 8 (hereinafter referred to as belching sound information) is output to the processing device 4.

[0048] [Configuration and Arrangement of Pressure Sensor] Figure 3 is a diagram illustrating the configuration and arrangement of the pressure sensor 9. The pressure sensor 9 detects pressure using a known method, and is configured as, for example, a resistance-type pressure sensor or a capacitance-type pressure sensor. As shown in Figure 3, the pressure sensor 9 according to this embodiment is a circular pressure sensor provided around the entire circumference in the rotational direction around a central axis along the axial direction of the insertion section 21. Note that the pressure sensor 9 is not limited to a circular pressure sensor, and a point-type pressure sensor provided only around a portion of the entire circumference in the rotational direction may also be used.

[0049] 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.

[0050] 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.

[0051] 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.

[0052] 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.

[0053] [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 an embodiment. 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).

[0054] 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).

[0055] 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 to a J-shape with the tip pointing toward the gastric cardia, as shown in FIG. 5. Also in step S2, the position of the insertion section 21 of the endoscope 2 in the forward / backward direction is adjusted so that the fiducial marker is positioned at the gastric cardia. In this state, the pressure sensor 9 is positioned to detect contraction pressure and relaxation pressure at various locations inside the esophagus from the upper esophageal sphincter to the lower esophageal sphincter. Details of the fiducial marker will be described later in the section "Positioning the Insertion Section of the Endoscope."

[0056] 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.

[0057] 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.

[0058] 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).

[0059] 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 the 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.

[0060] 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.

[0061] 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.

[0062] 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.

[0063] 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.

[0064] Phase 2 occurs after Phase 1. In Phase 2, as shown in FIG. 8(c), the esophageal mucosa is observed beyond the squamocolumnar junction (SCJ) in FIG. 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.

[0065] That is, in Phase 2, it becomes possible to evaluate the valve function (anti-reflux mechanism) of the lower esophageal sphincter.

[0066] 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.

[0067] That is, in Phase 3, it becomes possible to evaluate the acid clearance function due to esophageal peristalsis.

[0068] 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).

[0069] 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).

[0070] 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).

[0071] Details of the diagnostic assistance information will be explained later in the section "Display Examples of Diagnostic Assistance Information."

[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] [Display Examples of Diagnostic Support Information] Next, the diagnostic support information will be described. FIGS. 9 to 11 are diagrams illustrating display examples of the diagnostic support information I0. Specifically, FIG. 9 is a diagram illustrating an example of the diagnostic support information I0 displayed on the display device 5 when the subject is a healthy individual. FIG. 10 is a diagram illustrating an example of the diagnostic support information I0 displayed on the display device 5 when the subject is suspected of having gastroesophageal reflux disease. FIGS. 11(a) to 11(c) are diagrams illustrating examples of the first to third support information I2 to I4 constituting the diagnostic support information I0 when the subject is a healthy individual. FIGS. 11(d) to 11(f) are diagrams illustrating examples of the first to third support information I2 to I4 constituting the diagnostic support information I0 when the subject is suspected of having gastroesophageal reflux disease.

[0074] 9 to 11 , the processing device 4 generates an endoscopic image I1 by performing predetermined image processing on the captured image received from the endoscope 2 during gastric insufflation by the gastric pressure measuring device 6. The processing device 4 also generates first support information I2 based on intragastric pressure information detected by the gastric pressure measuring device 7 during gastric insufflation. The processing device 4 also generates second support information I3 based on esophageal pressure information detected by the pressure sensor 9 during gastric insufflation. The processing device 4 also generates third support information I4 based on belching sound information collected by the microphone 8 during gastric insufflation. The processing device 4 then generates diagnostic support information I0 for diagnosing gastroesophageal reflux disease (GERD) based on the endoscopic image I1, the first to third support information I2 to I4, and time information I5 related to the time during which gas was insufflated into the stomach by the gas insufflation device 6 (hereinafter referred to as pneumoperitoneum time).

[0075] Here, the processing device 4 processes the captured image, intragastric pressure information, esophageal pressure information, and eructation information in a time-synchronized manner based on the synchronization signal generated by the synchronization signal generating unit 42. The processing device 4 also processes the esophageal pressure information detected by the pressure sensor 9 in a time-synchronized manner based on the synchronization signal.

[0076] 9 to 11 , the first support information I2 includes a pressure waveform I21 that indicates a change in pressure (intragastric pressure) due to an increase in intragastric pressure caused by air being supplied to the stomach by the air supply device 6. Furthermore, as shown in Figures 9 and 10 , the first support information I2 also includes a current intragastric pressure (Current IGP) I22, a maximum intragastric pressure (Maximum IGP) I23 during the increase in intragastric pressure, and a basal intragastric pressure (Basal IGP) I24 before the increase in intragastric pressure. The first support information I2 is not limited to the pressure waveform I21, the current intragastric pressure I22, the maximum intragastric pressure I23, and the basal intragastric pressure I24, but may also include the pressure difference between the maximum intragastric pressure I23 and the basal intragastric pressure I24, or a pressure gradient obtained by dividing the pressure difference by the pneumoperitoneum time.

[0077] The current gastric pressure I22, the maximum gastric pressure I23 when the gastric pressure increases, and the basal gastric pressure I24 before the gastric pressure increase may be represented in any suitable manner, such as a bar graph, a line graph, a contour graph, or other representation, or an appropriate combination of these.

[0078] As shown in Figures 9 to 11, the second support information I3 includes a pressure waveform I31 that indicates changes in pressure detected by each pressure sensor 9. In this embodiment, the pressure waveform I31 is configured as a pressure topography, as shown in Figures 11(c) and 11(f). Specifically, the pressure topography (pressure waveform I31) is a diagram in which the horizontal axis represents time and the changes in pressure detected by the pressure sensors 9, each arranged from the upper esophageal sphincter side to the lower esophageal sphincter side, are expressed as a color pattern from above to below the vertical axis.

[0079] The color patterns shown in Figures 11(c) and 11(f) may, for example, use blue to represent low pressure ranges and red to represent high pressure ranges. The time representation shown on the horizontal axis may move horizontally along the time dimension to indicate the passage of time during the time interval during which the displayed pressure values ​​were measured. For example, the rightmost end of the time representation may correspond to the most recent time during the time interval displayed in the time representation, while the leftmost end may represent the earliest time. To indicate the passage of time during the time interval, the time representation may continuously move left on the screen, thereby allowing the user to observe the representation of the pressure measured in the esophagus over time. This continuous leftward movement allows the user to see the change in pressure (if any) at the displayed location over time and the occurrence of an event that caused the change in pressure (e.g., relaxation of the lower esophageal sphincter or peristalsis in the esophagus).

[0080] Furthermore, information indicating the position within the esophageal tract where the pressure sensor 9 is located may be added to the pressure topography (pressure waveform I31). For example, markers indicating the positions of the upper esophageal sphincter and the lower esophageal sphincter may be added to the vertical axis.

[0081] Furthermore, even if the pressure measurements detected may be detected at discrete positions due to the number of pressure sensors 9 arranged, the pressure measurements can be made quasi-continuous in the spatial dimension. The pressure measurements can be made quasi-continuous by including interpolated pressure values ​​in the pressure measurements. Based on the quasi-continuous pressure measurements, a quasi-continuous visual representation (e.g., having a smooth transition) can be provided. Any of the appropriate visual representations described below may be quasi-continuous.

[0082] 9 and 10, the second support information I3 includes a basal LES pressure I32 detected by a pressure sensor 9 arranged on the lower esophageal sphincter side before the increase in intragastric pressure. Note that the second support information I3 is not limited to the pressure waveform I31 and the basal pressure I32, and may include the maximum and minimum pressure values ​​detected by the pressure sensor 9.

[0083] 9 to 11, the third support information I4 includes a waveform I41 of an aspiration sound based on the aspiration sound information detected by the microphone 8. Also, the third support information I4 includes a maximum sound pressure of the aspiration sound detected by the microphone 8, as shown in FIGS.

[0084] A user such as a doctor then checks the diagnostic support information I0 displayed on the display device 5 and diagnoses gastroesophageal reflux disease in the subject.

[0085] In step S4, a user such as a doctor checks the diagnostic support information I0 displayed on the display device 5, determines whether the state corresponds to Phase 1, and evaluates the valve function due to the structure of the stomach. For example, if the subject is healthy, the pressure waveform I21 will be a sloped pressure waveform as shown in (a) of Figure 11. On the other hand, if the subject is suspected of having an abnormality, the pressure waveform I21 will be a flat pressure waveform as shown in (d) of Figure 11. For this reason, a user such as a doctor checks, for example, the endoscopic image I1 and the first support information I2 that constitute the diagnostic support information I0, and evaluates the valve function due to the structure of the stomach.

[0086] In step S5, a user such as a doctor checks the diagnostic support information I0 displayed on the display device 5, determines whether or not the state corresponds to Phase 2, and evaluates the valve function of the lower esophageal sphincter. For example, if the subject is healthy, the SHS is observed and the contraction pressure of the lower esophageal sphincter is also observed. Therefore, a user such as a doctor checks, for example, the endoscopic image I1 and the first and second support information I2 and I3 constituting the diagnostic support information I0 to evaluate the valve function of the lower esophageal sphincter.

[0087] In step S6, a user such as a doctor checks the diagnostic support information I0 displayed on the display device 5, determines whether the state corresponds to Phase 3, and evaluates the acid clearance function due to esophageal peristalsis. For example, if the subject is healthy, belching occurs and the lower esophageal sphincter relaxes when the intragastric pressure is approximately 19 mmHg (see (a) to (c) of FIG. 11). On the other hand, if the subject is suspected of having an abnormality, the lower esophageal sphincter relaxes when the intragastric pressure is approximately 14 mmHg. Furthermore, if the subject is healthy, peristalsis in the esophagus is observed (see (c) of FIG. 11), and the SHS is again observed. For example, on the pressure topography (pressure waveform I31), it can be seen that as time progresses (the peristaltic movement moves to the right on the time axis, and the representation itself moves to the left), the contraction pressure in each part of the esophagus progresses from the upper to the lower part (from the upper esophageal sphincter to the lower esophageal sphincter).

[0088] On the other hand, if the subject is suspected of having an abnormality, no peristaltic movement is observed in the esophagus ((f) in FIG. 11). For this reason, a user such as a doctor will check, for example, the endoscopic image I1 and the first to third pieces of support information I2 to I4 that make up the diagnostic support information I0, to evaluate the acid clearance function due to esophageal peristalsis.

[0089] Then, in step S7, if a user such as a doctor suspects an abnormality in any of the valve function due to the stomach structure, the valve function due to the lower esophageal sphincter, and the acid clearance function due to esophageal peristalsis evaluated in steps S4 to S6, the user will diagnose that gastroesophageal reflux disease is suspected.

[0090] 9 and 10 includes diagnostic result information I6. The diagnostic result information I6 is information related to the diagnostic result obtained by automatically diagnosing whether or not the subject has gastroesophageal reflux disease (whether or not there is a suspicion of gastroesophageal reflux disease) by the processing device 4 based on the captured image, intragastric pressure information, esophageal pressure information, and belching sound information. The diagnostic result information I6 includes an evaluation result I61 that evaluates which phase the current phase is, an evaluation result I62 that evaluates whether or not the subject is in a state corresponding to each of Phases 1 to 3, and a diagnostic result I63 that evaluates whether or not there is gastroesophageal reflux disease (whether or not there is a suspicion of gastroesophageal reflux disease) based on the evaluation result I62.

[0091] The processing device 4 stores in memory the captured image, gastric pressure information, esophageal pressure information, and eructation information, which are processed in a time-synchronized manner based on the synchronization signal. That is, the captured image and various support information can be referenced in a time-synchronized state. Therefore, for example, a user such as a doctor can view the endoscopic image at a time specified by the user, as well as the various support information at that time.

[0092] [Regarding Positioning of the Insertion Portion of the Endoscope] Next, the positioning of the insertion portion 21 of the endoscope 2 in step S2 of Fig. 4 will be described. First, the configuration of the insertion portion 21 will be described. Fig. 12 is a partial enlarged view of the insertion portion 21 of the endoscope 2 shown in Fig. 1. As shown in Fig. 12, a reference marker M0 (first marker) indicating a positioning position located closer to the base end than the bending portion 25 is formed on the outer surface of the insertion portion 21. The reference marker M0 is formed on the outer skin of the insertion portion 21.

[0093] The positioning position indicates, for example, the axial position of the insertion section 21 that is aligned with the gastric cardia of the subject. Furthermore, the positioning position may indicate the axial position of the insertion section 21 for obtaining an appropriate field of observation by the image sensor 244. Furthermore, the positioning position may indicate the axial position of the insertion section 21 for including the gastric cardia of the subject in the field of observation by the image sensor 244 when the bending section 25 is bent. Furthermore, the positioning position may indicate a position for obtaining an observation field suitable for evaluating the valve function of the stomach and esophagus muscles located around the gastric cardia. Furthermore, the positioning position may indicate a position for obtaining an observation field suitable for evaluating the peristaltic function of the esophageal body of the subject.

[0094] The position of the fiducial marker M0 is determined according to the curvature of the bending portion 25 when it is bent. Specifically, the greater the curvature, the closer the position of the fiducial marker M0 is to the distal end, and the smaller the curvature, the closer the position of the fiducial marker M0 is to the proximal end. By determining the position of the fiducial marker M0 in this manner, the gastric cardia of the subject can be included in the field of view of the image sensor 244 when the bending portion 25 is bent.

[0095] Six memory markers M1 to M6 (second markers) are formed on the outer peripheral surface of the insertion section 21, located closer to the base end than the reference marker M0. The memory markers M1 to M6 are arranged at 5 mm intervals over a distance of 3 cm along the axial direction of the insertion section 21. In other words, the lengths L1 to L6 along the axial direction of the insertion section 21 are 5 mm. As a result, the memory markers M1 to M6 indicate the length of the insertion section 21 in the axial direction, with the reference marker M0 as the base point.

[0096] Furthermore, it is preferable that the reference marker M0 and the memory markers M1 to M6 be distinguishable by being formed in different colors, for example. Note that the memory markers M1 to M6 only need to be formed so that the length in the axial direction of the insertion portion 21 can be measured using the reference marker M0 as the base point, and for example, they may be arranged over a distance of 2 cm or more along the axial direction of the insertion portion 21. Furthermore, it is preferable that the memory markers M1 to M6 be arranged at equal intervals so that the length in the axial direction of the insertion portion 21 can be measured using the reference marker M0 as the base point, and they may be arranged at 5 mm intervals over a distance of 2 cm or more along the axial direction of the insertion portion 21.

[0097] Next, the positioning of the insertion section 21 of the endoscope 2 will be described. Fig. 13 is a diagram showing the state in which the insertion section 21 has been introduced into the stomach of the subject. As shown in Fig. 13, the insertion section 21 is advanced and retreated along the axial direction to align the reference marker M0 with the cardiac portion of the stomach of the subject.

[0098] Fig. 14 is a diagram showing the lower esophageal sphincter muscle shown in the endoscopic image I11. As shown in Fig. 14, by aligning the reference marker M0 with the position of the lower esophageal sphincter muscle included in the endoscopic image I11, the axial position of the insertion section 21 can be positioned so that the reference marker M0 shown in Fig. 13 is aligned with the cardiac region of the stomach of the examinee.

[0099] The processing device 4 may determine, based on the endoscopic image I11, whether the gastric cardia of the subject shown in the endoscopic image I11 substantially coincides with the reference marker M0, and output the determination result. The determination result may be notified to a user such as a doctor by, for example, superimposing a message on the endoscopic image I11 or by a voice message. This allows a user such as a doctor to more easily adjust the insertion portion 21 of the endoscope 2 to an appropriate position.

[0100] Subsequently, when gas is insufflated into the stomach as shown in step S3 of FIG. 4, the lower esophageal sphincter relaxes. FIG. 15 is a diagram showing the lower esophageal sphincter as seen in an endoscopic image I12. As shown in FIG. 15, when the lower esophageal sphincter in the endoscopic image I12 relaxes, some of the memory markers M1 to M6 become visible in addition to the reference marker M0. By counting the number of memory markers M1 to M6 that become visible in this state, the state of relaxation of the lower esophageal sphincter can be visually estimated. Specifically, if one of the memory markers M1 to M6 is visible, it can be confirmed that the lower esophageal sphincter is relaxed over a 5 mm range, and if two are visible, it can be confirmed that the lower esophageal sphincter is relaxed over a 10 mm range. In the endoscopic image I12 shown in FIG. 15, three markers, up to the memory marker M3, are visible, so it can be confirmed that the lower esophageal sphincter is relaxed over a 15 mm range. Similarly, the memory markers M1 to M6 can be used to evaluate the peristaltic function in the body of the esophagus of the subject.

[0101] According to the embodiment described above, since the reference marker M0 is formed on the insertion portion 21, the axial position of the insertion portion 21 of the endoscope 2 can be easily aligned to the positioning position, and therefore the insertion portion 21 of the endoscope 2 can be easily adjusted to an appropriate position.

[0102] When the positioning position is the axial position of the insertion portion 21 that is aligned with the cardiac portion of the stomach of the subject, the axial position of the insertion portion 21 of the endoscope 2 can be easily aligned to an appropriate position.

[0103] Furthermore, if the positioning position is a position in the axial direction of the insertion portion 21 for obtaining an appropriate observation field by the imaging element 244, an appropriate observation field can be easily obtained.

[0104] Furthermore, when the positioning position is a position in the axial direction of the insertion section 21 that allows the subject's gastric cardia to be included in the observation field of the imaging element 244 when the bending section 25 is bent, the subject's gastric cardia can be easily included in the observation field.

[0105] Furthermore, when the positioning position is a position for obtaining an observation field suitable for evaluating the valve function of the stomach and esophagus muscles located around the gastric cardia, it is possible to easily obtain an observation field suitable for evaluating the valve function of the stomach and esophagus muscles located around the gastric cardia.

[0106] Furthermore, if the positioning position is a position for obtaining an observation field suitable for evaluating the peristaltic function in the esophageal body of the subject, it is possible to easily obtain an observation field suitable for evaluating the peristaltic function in the esophageal body of the subject.

[0107] Furthermore, according to the embodiment, the memory markers M1 to M6 are formed on the insertion section 21, so that the valve function of the lower esophageal sphincter and the peristaltic function in the esophageal body can be appropriately evaluated.

[0108] Furthermore, according to the embodiment, the memory markers M1 to M6 are arranged at 5 mm intervals from the reference marker M0, and the range of relaxation of the lower esophageal sphincter can be quantitatively evaluated simply by counting the number of visible markers. This quantitative evaluation helps identify dysfunction of the lower esophageal sphincter in diagnosing gastroesophageal reflux disease (GERD).

[0109] 16 is a partial enlarged view of the insertion section 21 of the endoscope 2 according to Modification 1. A plurality of insertion length markers M10 (third markers) indicating the length of the insertion section 21 from the tip thereof are formed on the outer circumferential surface of the insertion section 21.

[0110] The insertion length markers M10 are provided along the entire length of the insertion section 21, for example, every 5 cm or every 10 cm from the tip of the insertion section 21, and enable measurement of the insertion length, which is the length to which the insertion section 21 is inserted into the subject's body cavity.

[0111] The reference marker M0 and the insertion length marker M10 are preferably distinguishable from each other by being formed in different colors, for example.Similarly, the reference marker M0, the memory markers M1 to M6, and the insertion length marker M10 are preferably distinguishable from each other by being formed in different colors, for example.

[0112] Furthermore, one of the insertion length markers M10 arranged in the axial direction of the insertion portion 21 may be changed in color to serve as the reference marker M0.

[0113] According to the variant example 1 described above, even in the case of an endoscope 2 in which an insertion length marker M10 is formed on the insertion portion 21, the axial position of the insertion portion 21 of the endoscope 2 can be easily aligned to the positioning position, and therefore the insertion portion 21 of the endoscope 2 can be easily adjusted to an appropriate position.

[0114] 17 is a partial enlarged view of the insertion section 21 of the endoscope 2 according to Modification 2. In Modification 2, the endoscope system 1 includes an overtube 211 through which the insertion section 21 of the endoscope 2 is inserted. The reference marker M0 and the memory markers M1 to M6 are formed on the outer peripheral surface of the overtube 211.

[0115] As in the above-described second modification, the reference marker M0 and the memory markers M1 to M6 may be formed on the outer peripheral surface of the overtube 211. In this case, as in the embodiment, the axial position of the insertion section 21 of the endoscope 2 can be easily aligned with the positioning position, and therefore the insertion section 21 of the endoscope 2 can be easily adjusted to an appropriate position.

[0116] In the above-described embodiment, the present invention has been described as a technology capable of identifying the position of the lower esophageal sphincter, but this is not limited to this. For example, the present invention can also identify the positions of the major sphincters present in the human digestive tract. Specifically, the present invention can identify the position of the external anal sphincter.

[0117] REFERENCE SIGNS LIST 1 Endoscope system 2 Endoscope 3 Light source device 4 Processing device 5 Display device 6 Air supply device 7 Gastric pressure measuring device 8 Microphone 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 211 Overtube 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 pickup element 245 Collective cable I0 Diagnosis support information I1, I11, I12 Endoscopic image I2 First support information I21 Pressure waveform I22 Current gastric pressure I23 Maximum gastric pressure I24 Basal gastric pressure I3 Second support information I31 Pressure waveform I32 Basal pressure I4 Third support information I41 Waveform I5 Time information I6 Diagnosis result information I61, I62 Evaluation result I63 Diagnosis result M0 Reference marker (first marker) M1 to M6 Memory markers (second markers) M10 Insertion length marker (third marker) TU Air supply tube

Claims

1. An endoscope system comprising: an insertion section having a tip section where an imaging element is located and a freely bendable bending section connected to the base end side of the tip section; and an operation section that accepts operations to bend the bending section, wherein a first marker indicating a positioning position located on the base end side of the bending section is formed on the outer peripheral surface of the insertion section.

2. The endoscope system according to claim 1, wherein the positioning position indicates the axial position of the insertion section that is aligned with the gastric cardia of the subject.

3. An endoscope system according to claim 1, wherein the positioning position indicates the axial position of the insertion section for obtaining an appropriate observation field by the imaging element.

4. The endoscopic system of claim 1, wherein the positioning position indicates the axial position of the insertion portion so that the imaging element's field of view includes the cardiac region of the stomach of the subject when the bending portion is bent.

5. An endoscopic system as described in claim 4, wherein the positioning position indicates a position for obtaining the observation field suitable for evaluating valve function of the stomach and esophagus muscles located around the gastric cardia.

6. An endoscope system according to claim 4, wherein the positioning position indicates a position for obtaining the observation field suitable for evaluating the peristaltic function in the esophageal body of the subject.

7. An endoscope system according to claim 1, wherein the position of the first marker is determined according to the curvature of the bending section when bent.

8. An endoscope system according to claim 7, wherein the first marker is positioned closer to the distal end as the curvature increases, and closer to the proximal end as the curvature decreases.

9. An endoscope system according to claim 1, wherein a plurality of second markers are formed on the outer peripheral surface of the insertion section and positioned closer to the base end than the first marker.

10. An endoscope system according to claim 9, wherein the second marker indicates the length of the insertion section in the axial direction from the first marker as a base point.

11. The endoscope system according to claim 9, wherein the second markers are arranged over a distance of 3 cm along the axial direction of the insertion section.

12. The endoscope system according to claim 9, wherein the second markers are arranged over a distance of 2 cm or more along the axial direction of the insertion section.

13. The endoscope system according to claim 9, wherein the second markers are arranged at 5 mm intervals over a distance of 2 cm or more along the axial direction of the insertion section.

14. The endoscope system according to claim 9, wherein the first marker and the second marker are distinguishable.

15. The endoscope system according to claim 1, wherein the first marker is formed on the outer skin of the insertion section.

16. An endoscope system according to claim 15, wherein a third marker indicating the length from the tip of the insertion section is formed on the outer circumferential surface of the insertion section.

17. The endoscope system according to claim 16, wherein the first marker and the third marker are distinguishable.

18. The endoscope system according to claim 16, wherein the first marker and the third marker are formed in different colors.

19. The endoscope system according to claim 1, further comprising an overtube through which the insertion section of the endoscope is inserted, and the first marker is formed on the outer peripheral surface of the overtube.

20. A control method for an endoscope system comprising: an insertion section having a tip section where an imaging element is located and a freely bendable bending section connected to the base end side of the tip section; an operation section that receives operations to bend the bending section; and a processor, wherein a first marker indicating a positioning position located on the base end side of the bending section is formed on the outer surface of the insertion section, the processor generating an endoscopic image based on the imaging signal output by the imaging element, determining based on the endoscopic image whether the gastric cardia of the examinee shown in the endoscopic image and the first marker approximately coincide with each other, and outputting the determination result.

Images