Accessory for a medical scoping device

Abstract

An accessory for a medical scoping device is provided. The accessory comprises: a tubular body for receiving a medical scoping device; and a first projecting element. The first projecting element moveable between: a retracted position where the first projecting element is substantially aligned with the tubular body; and an extended position wherein the first projecting element extends outwardly from the tubular body. The accessory further comprises: an actuator configured to selectively move the first projecting element between the retracted position and the extended position and between the extended position and the retracted position.

Description

[0001] ACCESSORY FOR A MEDICAL SCOPING DEVICE

[0002] Field

[0003] The present disclosure relates to an accessory for use with a medical device, such as an endoscope.

[0004] Background

[0005] Medical scoping devices are generally well known, and encompasses any or all of endoscopes, gastroscopes, colonoscopes, enteroscopes, sigmoidoscopes, panendoscopes, duodenoscopes, and bronchoscopes, but this list is non-exhaustive. Endoscopy involves inspecting the inside of a body lumen or cavity and includes procedures known as arthroscopy, cystoscopy, gastroscopy, uteroscopy and colonoscopy. Enteroscopy involves examination of the small intestine including the duodenum, jejunum and ileum. Such scoping devices are elongate flexible probes which may be inserted into the body directly or via a cannula or other guide device. Medical scoping devices can also include rigid surgical endoscopes or endotherapy devices such as biopsy forceps and polypectomy snares.

[0006] Typically accessories may be used with these medical scoping devices. These accessories may attach to a distal end of the medical scoping device, for improving movement of the medical scoping device and / or examination at a target location. Additionally, or alternatively, the accessory could be attached to a therapy device (such as an endotherapy device). A therapy device being one which is passed through a lumen of a further medical scoping device. Such a therapy device can be used to reach areas that the medical scoping device cannot itself reach.

[0007] For example, the anatomy of the intestine is such that the lining is formed into folds. In the small intestine the folds are essentially permanent and are not smoothed out when the intestine is extended. In contrast, extending of the colon results in the colonic folds collapsing. In all endoscopic examinations, folds present may hamper the endoscopist's ability to visualise the entire surface of the mucosa and in particular, detect pre-malignant and malignant lesions tucked away on the proximal face of these folds during extubation. An accessory for the medical scoping device can be provided to apply force to open these folds.

[0008] 17130966.JCP2.JCP2 However, existing accessories for medical scoping devices typically involve cantilevered arms which fold down during insertion of the medical scoping device, and then are pulled outwards as the medical scoping device is withdrawn. As a result, it is much easier to identify lesions which are on the rear surface of any folds, and not on the front surface.

[0009] There is therefore a need for an improved accessory for a medical scoping device.

[0010] WO 2011 / 148172 A2 discloses, according to its abstract, a cover having a plurality of moveable, external, angled projecting elements for use with flexible medical scoping devices such as endoscopes or enteroscopes. The disclosure includes the cover with an over cuff and use of the disposable removable covering in methods of medical scoping procedures or examinations. The disclosure also includes an applicator for assisting in placing the covering about or over a medical device and a kit of parts.

[0011] The cover is placed over an endoscope which is inserted into a patient. The projecting elements are moveable such that during insertion they are flattened to be approximately parallel to a longitudinal axis of the cover. When the endoscope is moved in a withdrawing direction, the projecting elements fan out and engage with colonic folds. This allows for lesions which are covered by these folds to be seen. A projecting element closing means may be provided, which is a sleeve that can be pulled downwards to hold the projecting elements in the flattened state to allow for withdrawal of the endoscope from the patient. This cover primarily assists with viewing lesions during a withdrawal motion of the endoscope, and does not assist with viewing lesions which may be covered during the insertion motion.

[0012] WO 2023 / 033859 A1 discloses, according to its abstract, an artificial intelligence system which is trained and used to detect procedure anomalies occurring during internal imaging procedures involving mechanically-enhanced or otherwise mechanically-altered tissue. An internal imaging device (e.g., endoscope) with a mechanical enhancement element alters tissue from its natural state or orientation such that regions of interest on the tissue may be distinguished from the surrounding tissue. Anomaly procedures associated with the alteration of the tissue and / or use of the internal imaging device can be detected by the artificial intelligence system, and remedial actions can be alerted and / or taken automatically.

[0013] 17130966.JCP2.JCP2 US 10 959 627 B2 discloses, according to its abstract, a system which may include an expandable member, and a plurality of sensors disposed on an outer surface of the expandable member and circumferentially spaced apart from one another, wherein each of the plurality of sensors includes a first emitter configured to emit light of a first wavelength, and a detector configured to detect light, and a controller coupled to the plurality of sensors.

[0014] The arms disclosed in US 10 959 627 B2 are only ever actuated in unison. There is no disclosure of individual arms being actuated separately to one another.

[0015] US 2022 0338812 A1 discloses, according to its abstract, a medical device which may comprise a plurality of prongs, each of the prongs having a sensor configured to detect a flow of fluid; and a sleeve disposed radially outward of the plurality of prongs. The sleeve may be configured to move proximally and distally relative to the plurality of prongs to transition the plurality of prongs from a contracted configuration to an expanded configuration.

[0016] US 6 544 226 B1 discloses, according to its abstract, a tissue heating element attached to a carrier for treating a tissue region in a body. The carrier is intended, in use, to be temporarily mounted to an exterior of a catheter body, such as an endoscope. The catheter body is deployed, with the carrier mounted on it, into the targeted tissue region. The tissue heating element is operated, e.g., to form one or more tissue lesions, after which the catheter body is retrieved from the targeted tissue region. The carrier can then be removed from the catheter body, allowing the catheter body to be subsequently used for another purpose.

[0017] US 2014 0046139 A1 discloses, according to its abstract, an overtube device that gives diagnostic and / or therapeutic access to body cavities using natural orifices of the body. The overtube includes an elongate flexible body having a distal portion deflectable in response to activation of a control cable. Proximal features of the overtube include an insufflations port and seals. In some examples, retractor elements are including on the distal portion of the overtube.

[0018] GB 2 627 960 A discloses, according to its abstract, an accessory for fitting over a shaft of a medical scoping device comprising a tubular body with proximal and distal ends and

[0019] 17130966.JCP2.JCP2 outer and inner surfaces. At least one projecting element on the outer surface is movable between a retracted position adjacent to the tubular body and an extended position in which the projecting element extends radially outwardly from the tubular body. An expandable member acts on the projecting element to move it between the retracted position and the extended position. Each projecting element may comprise an elongate arm with a base and a free end, wherein the base is joined to the tubular body by a flexible connecting element.

[0020] WO 2023 008648 A1 discloses, according to its abstract, an endoscope cap comprising: a cap body which is coupled to the leading end of an endoscope to be inserted into a living body; an inflation / deflation part which is provided in the cap body to be inflated or deflated by air injection or suction; and an air supply part which injects air into or suctions air from the inflation / deflation part, wherein when the cap body reaches a target tissue in the living body, the air supply part injects air into the inflation / deflation part to inflate same, and the inflation / deflation part in the inflated state pushes away the target tissue in the living body.

[0021] Summary

[0022] An accessory for a medical scoping device is provided. The accessory comprises: a tubular body for receiving a medical scoping device; a first projecting element moveable between: a retracted position where the first projecting element is substantially aligned with the tubular body; and an extended position wherein the first projecting element extends outwardly from the tubular body, and an actuator configured to selectively move the first projecting element between the retracted position and the extended position and between the extended position and the retracted position.

[0023] This accessory can help the medical scoping device investigate anatomical structures during withdrawal and insertion. The accessory can also help identify anatomical structures to be investigated.

[0024] The actuator may be configured to selectively move the first projecting element between the retracted position and the extended position and between the extended position and the retracted position in vivo. Moving the projecting elements in vivo helps the user to manipulate the area being investigated. In vivo refers to the medical scoping device having been inserted into a body lumen / cavity of a patient.

[0025] 17130966.JCP2.JCP2 The accessory may further comprise a user control configured to control the actuator to move the first projecting element in response to a user input. This allows the user to manipulate the projecting element in order to investigate areas of interest.

[0026] The tubular body may comprise a passage for receiving the first projecting element, the actuator configured to selectively retract the first projecting element into the passage in the retracted position, and expel at least a portion of the first projecting element from the passage in the extended position. When retracted in this manner, the projecting element is effectively sheathed and does not affect movement of the medical scoping device.

[0027] The passage may be a bore in the tubular body. This is an effective way to sheath the projecting element.

[0028] The actuator may comprise a guide wire positionable along the medical scoping device and engaging with the first projecting element, the guide wire for pushing and / or pulling the first projecting element between the retracted position and the extended position and between the extended position and the retracted position (vice versa). Such a guide wire can actuate the projecting element, while being readily controlled by the user of the medical scoping device.

[0029] The guide wire may comprise an arcuate slider engaging with the first projecting element, the arcuate slider surrounding at least a portion of the tubular body and slidably mounted thereon. Preferably, the arcuate slider extends around at least a half of the circumference of the tubular body. This is an effective way to incorporate a guide wire, which controls the projecting element.

[0030] The first projecting element may comprise a magnetic portion and the actuator comprises an electromagnet, or vice versa, the electromagnet selectively magnetizable to move the first projecting element between the retracted position and the extended position and between the extended position and the retracted position. This is another way to actuate the projecting element, which may be more easily controlled by a controller or processor.

[0031] The accessory may further comprise a sensor arranged to detect a position of the first projecting element. The sensor detecting the position of the first projecting element can also assist in automatically controlling the projecting element.

[0032] 17130966.JCP2.JCP2 The accessory may further comprise a plurality of projecting elements including the first projecting element, each of the projecting elements moveable between: a retracted position where the projecting element is substantially aligned with the tubular body; and an extended position where the projecting element extends outwardly from the tubular body. A plurality of projecting elements can assist the medical scoping device in investigating more regions of interest.

[0033] Each projecting element may be independently moveable between the retracted position and the extended position and between the extended position and the retracted position. Independent meaning that the first projecting element may be moved without a second projecting element (or another projecting element) also moving. Of course, the projecting elements may also be moved together, but that it is possible to move them individually. Such control of each projecting element allows the accessory to be more effective in exposing regions of interest.

[0034] In this context, each projecting element may be independently / individually / selectively moveably between the retracted position and the extended position and between the extended position and the retracted position. That is, in a situation with a first projecting element and a second projecting element, the first projecting element may be moved between the retracted position and the extended position and between the extended position and the retracted position, without the second projecting element (or any other projecting element) being moved.

[0035] A partially extended, or intermediate, position may be defined as a position of a projecting element between the retracted position and the (fully) extended position. The or each projecting element may be actuatable to such a partially extended position.

[0036] The partially extended position can be characterised based on a percentage of extension of the projecting element - 0% being the retracted position and 100% being the (fully) extended position. One or more of the projecting elements may be actuated to a different partially extended position to another of the projecting elements. For example, a first projecting element may be at a 50% partially extended position, and a second projecting element may be at a 75% partially extended position.

[0037] 17130966.JCP2.JCP2 The arcuate slider may engage each projecting element for pushing and / or pulling each projecting element between the retracted position and the extended position and between the extended position and the retracted position (vice versa). In other words, the arcuate slider may engage two or more of the plurality of projecting elements for pushing and / or pulling the two or more of the plurality of projecting elements between the retracted position and the extended position and between the extended position and the retracted position. This arcuate slider controls movement of plurality of the projecting elements, thereby allowing a single guide wire to control movement of multiple protection elements.

[0038] The accessory may comprise a plurality of actuators including the first actuator, each actuator configured to selectively move a corresponding projecting element between the retracted position and the extended position and between the extended position and the retracted position. Individual actuators can then be used to control one or more of the projecting elements, this means that only the projecting elements which are in a region of interest can be put in the extended position.

[0039] Each projecting element may comprise a magnetic portion and each actuator may comprise an electromagnet, or vice versa, each electromagnet selectively magnetizable to move the corresponding projecting element between the retracted position and the extended position and between the extended position and the retracted position. This is an effective way to control a plurality of projecting elements.

[0040] Each actuator may be configured to independently move the corresponding projecting element between the retracted position and the extended position and between the extended position and the retracted position. Individually actuating projecting elements means that only the projecting elements which are in a region of interest can be put in the extended position.

[0041] The accessory may further comprise: a sensor arranged to detect an operating parameter; and a controller (or processor) configured to control the actuator to move the first projecting element between the retracted position and the extended position and between the extended position and the retracted position in response to the operating parameter. This can help assist the user of the medical scoping device by (at least partially) automating deployment of the projecting elements.

[0042] 17130966.JCP2.JCP2 The controller may be configured to individually control each actuator to move the respective projecting element between the retracted position and the extended position and between the extended position and the retracted position in response to the operating parameter. Individually actuating projecting elements means that only the projecting elements which are in a region of interest can be put in the extended position.

[0043] The operating parameter may comprise one or more of: a direction of movement of the accessory; a force or pressure on the first projecting element; a distance between the accessory and a surface; and / or anatomical structure. These are suitable parameters which can indicate where projecting elements should be extended or retracted.

[0044] A medical scoping assembly is provided. The medical scoping assembly comprises: a medical scoping device; and the accessory as discussed herein, the accessory at a distal end of the medical scoping device.

[0045] This medical scoping device can investigate anatomical structures during withdrawal and insertion. The medical scoping device can also help identify anatomical structures to be investigated.

[0046] The medical scoping device and the accessory may be unitary. This means that the advantages of the accessory are inherently provided with the medical scoping device, avoiding the need for a separate component. By unitary it is meant that the parts are formed as a single component. This could include permanently affixed parts.

[0047] A medical scoping system is provided. The medical scoping system comprising: the accessory as discussed herein, or the medical scoping assembly as discussed herein; and an artificial intelligence system configured to control movement of the projecting element between the retracted position and the extended position and between the extended position and the retracted position based on the operating parameter. Such a system can allow for effective investigation of regions of interest - particularly when combined with individually controllable projecting elements.

[0048] The artificial intelligence system may be at least partially provided on a remote device, and the accessory comprises a transmitter for transmitting the operating parameter to the remote device. This allows for processing to be performed on the remote device which may

[0049] 17130966.JCP2.JCP2 be better configured to perform the artificial intelligence processing. In some cases, the artificial intelligence system may be (fully) provided on the remote device. The remote device may be, for example, a computer.

[0050] Alternatively, the artificial intelligence system may be provided locally on the accessory and / or the medical scoping device. For example, on a local processor thereof.

[0051] A method of using the medical scoping assembly as discussed herein is provided. The method comprises the steps of: inserting the medical scoping device into a patient in an insertion direction, with the first projecting element in the retracted position; moving the first projecting element from the retracted position to the extended position with the actuator.

[0052] This method can help the medical scoping device investigate anatomical structures during withdrawal and insertion. The accessory can also help identify anatomical structures to be investigated. The method can specifically be performed in vivo. For the avoidance of doubt, the method can also be used to investigate (for example) pipework or other cavities which are not inside a patient.

[0053] The moving of the first projecting element from the retracted position to the extended position with the actuator may be while inserting the medical scoping device. This allows for the identification of structures during insertion, for example on an insertion side of a fold in an intestine.

[0054] The accessory may further comprise a second projecting element, the second projecting element moveable between: a retracted position where the first projecting element is substantially aligned with the tubular body; and an extended position wherein the first projecting element extends outwardly from the tubular body, wherein the first projecting element is moved from the retracted position to the extended position independently of the second projecting element. Independent meaning that the first projecting element may be moved without the second projecting element (or another projecting element) also moving. Such control of each projecting element allows the accessory to be more effective in exposing regions of interest.

[0055] The accessory may comprise: a sensor arranged to detect an operating parameter; and a controller configured to control the actuator to move the first projecting element between

[0056] 17130966.JCP2.JCP2 the retracted position and the extended position and between the extended position and the retracted position in response to the operating parameter. The moving of the first projecting element from the retracted position to the extended position with the actuator may be in response to the operating parameter. This can help the operator by (at least partially) automating the deployment of the projecting element(s).

[0057] The operating parameter may comprise one or more of: a direction of movement of the accessory; a force or pressure on the first projecting element; a distance between the accessory and a surface; and / or anatomical structure. These are suitable parameters which can indicate where projecting elements should be extended or retracted.

[0058] The method may further comprise: controlling movement of the first projecting element between the retracted position and the extended position and between the extended position and the retracted position based on the operating parameter using an artificial intelligence system. Such a system can allow for effective investigation of regions of interest - particularly when combined with individually controllable projecting elements. As noted above, the artificial intelligence system may be provided locally on the accessory and / or medical scoping device, or (at least partially) on a remote device.

[0059] The method may further comprise the step of: at least partially withdrawing the medical scoping device from the patient in a withdrawal direction opposite to the insertion direction, with the first projecting element in the extended position. This allows for the identification of structures during withdrawal, for example on a withdrawal side of a fold in an intestine.

[0060] The method may further comprise, after at least partially withdrawing the medical scoping device, the steps of: inserting the medical scoping device into the patient in the insertion direction; and moving the first projecting element from the extended position to the retracted position with the actuator. This can mean that the projecting element does not inhibit further insertion of the medical scoping device.

[0061] Brief Description of the Drawings

[0062] The present description makes reference, by way of example only, to the accompanying drawings in which:

[0063] Figure 1 shows a schematic perspective view of an accessory for a medical scoping device and a medical scoping device;

[0064] 17130966.JCP2.JCP2 Figures 2A to 2B show further schematic perspective views of the accessory of Figure 1 ;

[0065] Figure 3 shows a further schematic perspective view of an accessory for a medical scoping device and a medical scoping device;

[0066] Figure 4 shows a schematic cross-section of an intestine;

[0067] Figures 5A to 5C show close-up schematic views of an accessory for a medical scoping device, with projecting elements progressively extending from the accessory;

[0068] Figure 6 shows a further schematic perspective view of an accessory for a medical scoping device and a medical scoping device;

[0069] Figure 7 shows a close-up schematic view of an accessory for a medical scoping device, with projecting elements extending from the accessory;

[0070] Figure 8 shows a further close-up schematic view of an accessory for a medical scoping device, with projecting elements extending from the accessory;

[0071] Figure 9 shows a close-up schematic view of a projecting element for an accessory for a medical scoping device; and

[0072] Figure 10 shows a schematic of a medical scoping device with the accessory attached thereto, being progressed through an intestine.

[0073] Detailed Description

[0074] Figures 1 to 3 show schematics of a first example of an accessory 100. The accessory 100 is for a medical scoping device 50. In certain cases, the accessory 100 may be referred to as a medical scoping device accessory 100.

[0075] The medical scoping device 50 may be any type of device, including endoscopes, gastroscopes, colonoscopes, enteroscopes, sigmoidoscopes, panendoscopes, duodenoscopes, and bronchoscopes, but this list is non-exhaustive. The medical scoping device 50 could be a therapy device which is inserted through a lumen of a further medical scoping device. For example, the medical scoping device 50 could be an endotherapy device which is inserted through an endoscope.

[0076] Endoscopy involves inspecting the inside of a body lumen or cavity and includes procedures known as arthroscopy, cystoscopy, gastroscopy, uteroscopy and colonoscopy. Enteroscopy involves examination of the small intestine including the duodenum, jejunum and ileum. Such medical scoping devices 50 are elongate flexible probes which may be inserted into the body directly or via a cannula or other guide device. Medical scoping

[0077] 17130966.JCP2.JCP2 devices 50 can also include rigid surgical endoscopes or endotherapy devices such as biopsy forceps and polypectomy snares.

[0078] In general, the medical scoping device 50 may comprise an imaging device 54 for viewing a region where the medical scoping device 50 has been inserted. The imaging device 54 could be, for example, a camera 54.

[0079] The medical scoping device 50 comprises an elongate shaft for insertion into a patient’s body. This medical scoping device 50 comprises a proximal end and a distal end. In use, the distal end is the end of the medical scoping device 50 which is inserted into the patient’s body. The imaging device 54 is therefore located at or adjacent to the distal end of the medical scoping device 50. In use, the proximal end of the medical scoping device 50 is the end outside of the patient’s body, nearest the operator. When the distal end of the medical scoping device 50 is inside a patient’s body it may be referred to as being in vivo.

[0080] In the example of Figures 1 to 3, the accessory 100 and the medical scoping device 50 are separate items. However, it is also anticipated that the accessory 100 and the medical scoping device 50 may be unitary - i.e. formed together.

[0081] The medical scoping device 50 may be controlled with a scoping control 60 such as shown in Figure 3. This allows the operator to manipulate the medical scoping device 50 (particularly the distal end thereof) including in vivo.

[0082] The accessory 100 for the medical scoping device 50 comprises a tubular body 10. This tubular body 10 is suitable for receiving the medical scoping device 50 - for example the shaft thereof. This can specifically be the distal end of the medical scoping device 50. In certain cases, an inner diameter of the tubular body 10 of the accessory 100 may be substantially the same as an outer diameter of the medical scoping device 50 so as to attach the accessory 100 thereto. For example, the inner diameter tubular body 10 of the accessory 100 may be smaller than the outer diameter of the medical scoping device 50, with the tubular body 10 resiliently flexible. This allows the tubular body 10 of the accessory 100 to be stretched in order to receive the medical scoping device 50. The restorative force of the tubular body 10 can then hold the accessory 100 to the medical scoping device 50.

[0083] 17130966.JCP2.JCP2 The tubular body 10 has an inner surface which is the surface of the tubular body 10 facing the medical scoping device 50 in use. The tubular body 10 has an opposite outer surface which faces away from the medical scoping device 50 in use.

[0084] The tubular body 10 is generally shaped as a cylinder, with a longitudinal direction extending along the length of the tubular body 10. A central longitudinal axis extends along this direction between the end faces of the cylinder. The tubular body 10 also defines a radial direction, extending perpendicular from the central longitudinal axis towards the outer surface of the tubular body 10.

[0085] In cases where the accessory 100 and the medical scoping device 50 are unitary the tubular body 10 may be a part of the medical scoping device 50, and may receive internal components thereof such as the imaging device 54.

[0086] In Figure 1 , the tubular body 10 is shown partially transparent so that internal components of the accessory 100 can be seen. Figures 2A and 2B show the tubular body 10 as opaque, as would likely be the case for a manufactured accessory 100 according to the present disclosure.

[0087] The accessory 100 further comprises one or more projecting elements 20. This could be, as shown in Figures 1 to 3, a plurality of projecting elements 20. There will be at least one projecting element 20 which can be denoted the first projecting element 20. In cases with a plurality of projecting elements 20, each projecting element 20 can be denoted with ordinal numbering (i.e. first, second, third, etc.). Any reference to a single projecting element 20 may equally be applicable to each other projecting element 20 in examples with multiple projecting elements 20, and vice-versa.

[0088] In examples with a plurality of projecting elements 20, these may be arranged with rotational symmetry about the accessory 100. That is, when viewed from the distal end of the accessory 100, each projecting element 20 may be equally rotationally spaced. For example, with N projecting elements 20 these may be arranged with N-fold rotational symmetry. In other words, each projecting element 20 may be spaced by (360 / N)° from one another.

[0089] 17130966.JCP2.JCP2 Each projecting element 20 may be at least partially deformable. For example formed of silicone. The silicon may have a rigid core to increase its strength, such as a metal core. The silicone can then surround this rigid core. Each projecting element 20 may have a deployed length (i.e. an amount they extend radially outward of the tubular body 10) of between 10 to 20 mm.

[0090] Each projecting element 20 is moveable between a retracted position and an extended position, and between the extended position and the retracted position. Figures 1 and 2A show the projecting elements 20 in the extended position. Figure 2B shows the projecting elements in the retracted position.

[0091] Each projecting element 20 may be individually (i.e. independently) moveable between the retracted position and the extended position (and vice-versa). That is, independently to the movement of any other projecting element 20. In some cases, one or more projecting elements 20 may be arranged to move with each other between the retracted position and the extended position (and vice-versa).

[0092] Each projecting element 20 can be moved to a partially extended (or intermediate) position between the retracted position and the (fully) extended position. The retracted position and extended position will be described in detail with respect to Figures 5A to 5C. Figures 1 , 2A and 3 show the projecting elements 20 in the (at least partially) extended position.

[0093] A partially extended position can be defined based on a percentage of extension of the projecting element - 0% being the retracted position and 100% being the (fully) extended position. In other words, this percentage may be calculated as a length of the projecting element 20 which is extending outwardly from the tubular body 10 in the partially extended position (LPE), divided by a (maximum) length of the projecting element 20 which is extending outwardly from the tubular body 10 in the (fully) extended position (LE). In other words: pE LE

[0094] 17130966.JCP2.JCP2 In some cases, in the retracted position the projecting element 20 may still extend from the tubular body 10 by a negligible amount (LR). In which case, the calculation of the partial extension percentage would be:

[0095] LpE ~ LR E ~ LR

[0096] A projecting element 20 in the retracted position is substantially aligned with the tubular body 10. This includes aligned with the tubular body 10. In other words, substantially aligned with or parallel to the central longitudinal axis of the tubular body 10. In other words, each projecting element 20 in the retracted position does not significantly protrude beyond the outer surface of the tubular body 10 of the accessory 100. In this retracted position, the projecting element 20 does not interact with surrounding body tissue when the accessory 100 and medical scoping device 50 are being inserted / withdrawn from a patient’s body.

[0097] A projecting element 20 in the extended position extends outwardly from the tubular body 10. For example, this may be (at least partially) in the radial direction. In other words, the projecting element 20 in the extended position extends beyond the outer surface of the tubular body 10. The projecting element 20 may extend with a radial component and a longitudinal component. In this extended position, the projecting element 20 is suitable for interacting with surrounding body tissue when the accessory 100 and medical scoping device 50 are being inserted / withdrawn from a patient’s body.

[0098] In certain examples, in the retracted position the projecting element 20 may be within the tubular body 10. That is, not extending outwardly therefrom. For example, the tubular body 10 may comprise a passage 12 which receives the projecting element 20. There may be a passage 12 for each projecting element 20. The passage 12 may be formed, for example, as a bore in the tubular body - between its inner surface and outer surface. In the retracted position the projecting element 20 is drawn into the passage 12, such as shown in Figure 2B. In the extended position, at least a portion of the projecting element 20 is expelled from the passage 12, such as shown in Figures 1 and 2A.

[0099] The accessory 100 further comprises an actuator 30 which is configured to selectively move the (at least first) projecting element 20 between the retracted position and the extended position and between the extended position and the retracted position. The

[0100] 17130966.JCP2.JCP2 actuator 30 may specifically be configured to move the projecting element 20 when it is in vivo (i.e. inserted into a patient’s body).

[0101] A user control 32 may be provided, the user control 32 configured to control the actuator 30 to move the projecting element 20 in response to a user input. The user input may be a user command to move the projecting element 20.

[0102] As explained in more detail below, a single actuator 30 may move a plurality (including all of the plurality) of the projecting elements 20 between the retracted position and the extended position and between the extended position and the retracted position. For example, a sub-set of the projecting elements 20 may be grouped together and moved by a single actuator 30. This sub-set could correspond, for example, to a group of projecting elements 20 which are adjacent to one another.

[0103] Alternatively, each projecting element 20 may have a corresponding actuator 30 which is configured to move that specific projecting element 20 between the retracted position and the extended position and between the extended position and the retracted position. There may be a corresponding user control 32 for each actuator 30, or a single user control 32 may be able to (individually or collectively) control multiple actuators 30.

[0104] Figure 1 shows a schematic of a first example of actuator 30. In this case, the actuator 30 takes the form of a guide wire. That is, a wire which has sufficient rigidity to transfer a pushing force. In use, the guide wire is positioned to extend along the medical scoping device 50 such as shown in Figure 3. This may be along an outer surface of the medical scoping device 50, or within the medical scoping device 50.

[0105] The guide wire 30 engages with the projecting element 20 and acts to push and / or pull the projecting element 20 to move between the retracted position and the extended position and between the extended position and the retracted position (vice versa). Figure 1 shows an example where the guide wire 30 pushes the projecting element 20 to the extended position, and pulls the projecting element 20 to the retracted position. This guide wire 30 may be referred to as a manual actuator 30.

[0106] There may be a separate guide wide 30 for each projecting element 20. Alternatively, a plurality (including all) of the projecting elements 20 may be acted on by a single guide wire

[0107] 17130966.JCP2.JCP2 30. Figure 1 shows such an example. As shown in the example of Figure 1 , the guide wire 30 may comprise an arcuate slider 34. The slider 34 is arcuate in that it extends in an arc about the tubular body 10. This may be on the outer surface of the tubular body 10, or embedded within the tubular body 10. The slider 34 engages with at least the first projecting element 20, or a plurality (including all) of the projecting elements 20. The guide wire 30, including the slider 34, moves - thereby moving the projecting elements 20.

[0108] The slider 34 may extend in a complete circumference of the tubular body 10, or any portion thereof. In certain cases, there may be a plurality of sliders 34 each extending over a portion of the circumference. This portion may be at least half of a circumference of the tubular body 10. In such cases there may be a single guide wire 30 driving each slider 34 together, or each slider 34 may have a corresponding guide wire 30 so as to be independently driveable. Each slider 34 may engage a subset of the projecting elements 20.

[0109] The tubular body 10 may comprise one or more guide rails 36 for guiding movement of the guide wire 30 and / or the slider 34. This guide rail 36 can ensure that the guide wire 30 and / or slider 34 moves substantially longitudinally.

[0110] In such cases with a guide wire 30, there may be a user input 32 in the form of a manual slider, such as a thumb slider. Effectively, this operates like a syringe where the manual slider is moved in a chamber, which drives the guide wire 30 and hence the projecting element 20 between the retracted position and the extended position. Figure 3 shows how this manual slider can be particularly effective. The operator holds the scoping control 60 in the palm of their hand using their fingers. This leaves their thumb free to operate the user input 32 to move the projecting element(s) 20.

[0111] Figure 4 shows a schematic of an intestine 1 , with a fold 2 formed on the inner wall of the intestine 1 . Of course, the present disclosure is not solely limited to intestines 1 , but this schematic is used to show how the accessory 100 can improve detection. As shown in Figure 4, a fold 2 is formed in the wall of the intestine 1 . There are anatomical structures 3 (also identified as anomalies) either side of this fold 2. These anatomical structures 3 could be, for example, lesions.

[0112] 17130966.JCP2.JCP2 Figure 4 shows an insertion direction I for a medical scoping device 50. This is the direction that the medical scoping device 50 moves as it progressively enters the patient. In the example of an intestine 1 , this means that the patient’s anus will be to the right-hand side of Figure 4. Figure 4 also shows a withdrawal direction W which is the direction that the medical scoping device 50 moves as it progressively is removed from the patient. The insertion direction I and withdrawal direction W are opposite to one another.

[0113] In conventional systems (i.e. not in accordance with the present disclosure), the projecting elements 20 are configured to collapse during insertion when the medical scoping device 50 moves in the insertion direction I. As a result, when the medical scoping device 50 moves in the insertion direction I, the fold 2 is not engaged by the projecting elements 20. This means that the anatomical structure 3 on the insertion side or front side of the fold 2 (the right hand side in Figure 4) may not be identified as the fold 2 is not moved. When the medical scoping device 50 is moved in the withdrawal direction W, the projecting elements 20 fan out and engage with the fold 2, thereby moving it to assist in identifying the anatomical structure 3 on the withdrawal side or rear side of the fold 2 (the left hand side in Figure 4).

[0114] Instead, with the accessory 100 of the present disclosure the projecting elements 20 can be used to engage with the fold 2 as the medical scoping device moves in both the withdrawal direction W and the insertion direction I. As a result, the accessory 100 can help identify anatomical structures 3 on the withdrawal side of the fold 2 and on the insertion side of the fold 2.

[0115] Figures 5A to 5C show a further example of an actuator 30 for the accessory 100. Unless expressly stated otherwise, any disclosure relating to the accessory 100 of Figures 1 to 3 is equally applicable to the accessory 100 of Figures 5A to 5C, and vice-versa. The actuator 30 comprises an electromagnet 38 and the projecting element 20 comprises a magnetic portion 24. The magnetic portion 24 may be any portion of the projecting element 20, such as the entirety thereof. In certain examples, the magnetic portion 24 may be no more than 20% of a length of the projecting element 20.

[0116] Of course, it is possible to reverse these such that the actuator 30 comprises a magnetic portion and the projecting element 20 comprises an electromagnet, with the relevant changes to the system disclosed herein.

[0117] 17130966.JCP2.JCP2 The electromagnet 38 is selectively magnetizable (by applying a current thereto). This then interacts with the magnetic portion 24 of the projecting element 20 in order to drive the projecting element 20 between the retracted position and the extended position and between the extended position and the retracted position.

[0118] The projecting element 20 may be biased towards the extended position or the retracted position, with the magnetic interaction of the electromagnet 38 and the magnetic portion 24 acting to move the projecting element 20 against this bias to the other position.

[0119] Alternatively, the polarity of the electromagnet 38 may be switchable so as to switch between movement directions of the projecting element 2O.\

[0120] As shown in Figures 5A to 5C, the electromagnet 38 may be adjacent to the passage 12 of the tubular body 10. For example, the electromagnet 38 may extend along the side of the passage 12. The electromagnet 38 may be either side of the passage 12.

[0121] In examples with a plurality of projecting elements 20, each of these may have a magnetic portion 24. There may then be a single electromagnet 38 which can drive each projecting element 20, or a plurality of electromagnets 38 each driving one or more projecting element 20.

[0122] Figure 5A shows the projecting element 20 in the retracted position. Figure 5B show the projecting element 20 in a partially extended position. Figure 5C show the projecting element 20 in a fully extended position.

[0123] The projecting element 20 may be positioned at any point between the retracted position and the fully extended position. This can be used based on, for example, a proximity of tissue.

[0124] This actuator 30 of Figures 5A to 5C can be referred to as an electric actuator 30.

[0125] Figure 6 shows a schematic of how an electric actuator 30 may be controlled. A user control 32 is provided in the form of one or more buttons 32. These button(s) receive a user input (by pressing) and the projecting element 20 is selectively moved in response thereto.

[0126] 17130966.JCP2.JCP2 Figure 6 further shows a controller 70 (or processor). This controller 70 is in electrical communication with the actuator 30, such as via wire 33. The controller 70 is configured to control the actuator 30 so as to move the projecting element 20 between the retracted position and the extended position and between the extended position and the retracted position in response to the operating parameter. This controller 70 may be part of a larger controller for the medical scoping device 50, or may be a separate controller.

[0127] It is noted that the buttons 32 user input could also be used with a guide wire 30 as the actuator 30. For example, a motor may drive movement of the guide wire 30 with the buttons 32 controlling the motor. In this sense, the controller 70 could also be used to control operation of the guide wire 30 in examples of the accessory 100 using a guide wire 30.

[0128] Equally, the manual user input 32 could be used to control the electric actuator 30. For example, by sensing movement of the manual slide and controlling the electromagnet 38 in response thereto.

[0129] Figure 7 shows an example accessory 100 which is generally the same as the accessory of Figures 5A to 5C, but the electromagnet 38 is provided on only one side of the passage 12. Otherwise, this operates in the same manner as the accessory 100 of Figures 5A to 5C.

[0130] Figure 8 shows a further example accessory 100 which is generally the same as the accessory of Figure 7 (and by extension the accessory 100 of Figures 5A to 5C). However, in this case the accessory 100 further comprises a sensor 39. Figure 9 shows a close-up isolated view of the projecting element 20, electromagnet 38, and sensor 39.

[0131] The sensor 39 being arranged to detect a position of the projecting element 20. This position sensing can be used in controlling the accessory 100.

[0132] The sensor 39 can additionally or alternatively sense a force applied to the projecting element 20.

[0133] The sensor 39 may be, for example, an optical sensor or an electronic sensor. In Figure 8, each projecting element 20 has a corresponding sensor 39 (and electromagnet 38). However, this is not always the case.

[0134] 17130966.JCP2.JCP2 Additionally, or alternatively, the accessory 100 may comprise one or more sensors arranged to detect an operating parameter. That is, a parameter relating to the use of the accessory 100 and / or medical scoping device 50. This could include, for example, a direction of movement of the accessory 100 (and / or the medical scoping device 50); a force or pressure on the first projecting element 20; a distance between the accessory 100 (and / or the medical scoping device 50) and a surface; and / or anatomical structure 3 (or the presence thereof).

[0135] The force or pressure on the first projecting element 20 means that the element 20 can be retracted if it is experiencing too large a force, which could indicate the projecting element 20 potentially damaging the surface it is contacting. For example, this could be an inner surface of a patient such as the intestine wall or colon wall. In some cases, a force threshold can be changed or overridden by an operator. This could allow more force to be applied if the operator considers it appropriate.

[0136] The direction of movement corresponds to whether the medical scoping device 50 is being inserted into a patient’s body, or withdrawn from the patient’s body. The distance between the accessory 100 (and / or the medical scoping device 50) and a surface may be a surface of the user’s body. For example, an interior wall of the intestine or colon.

[0137] An anatomical structure 3 may mean that the sensor is suitable for identifying the (presence of the, and / or characteristics of the) anatomical structure 3. For example, this could be via machine vision of a signal returned from the imaging device 54. The anatomical structure 3 could be any structure which may be of interest, such as a pre- malignant lesion, a malignant lesion, and / or a polyp.

[0138] Likewise, the distance between the accessory 100 (and / or the medical scoping device 50) and a surface could itself be sensed using the imaging device 54. Again, potentially using machine vision. Any other distance sensor could equally be used in the accessory 100.

[0139] In this sense, the controller 70 can take a reading from the sensor and control movement of the or each projecting element 20. In certain cases, the controller 70 may individually control operation of projecting elements 20 in isolation from one another. For example, if the sensor detects that the medical scoping device 50 is closer to a surface on one side,

[0140] 17130966.JCP2.JCP2 any projecting elements 20 on that side may be retracted compared to any projecting elements 20 on the other side.

[0141] In certain cases, an artificial intelligence (Al) system (or model) may be used to control actuation of the projecting elements 20 based on the sensed operating parameter(s). This could be trained, for example, on sensor data and manual user operations of the medical scoping device 50. For example, based on how a user choses to actuate the projecting elements 20. The training could also incorporate how anatomical structures 3 are identified and classified - such as what sorts of anatomical structures 3 are classified as malignant or pre-malignant. In this sense, the training data could include one or more of: photographs of an anatomical structure 3, characteristics of an anatomical structure 3, classification of an anatomical structure 3, user response to an anatomical structure 3, sensed operating parameter(s). This training may be performed on the controller 70, or on a separate processor or controller. In this way, a relationship may be identified between the sensed operating parameter(s) and the anatomical structure 3. Specifically, this relationship may identify which sensed operating parameter(s) are indicative of an anatomical structure 3 which requires further investigation. For example, because the anatomical structure 3 is (or appears to be) malignant or pre-malignant and hence is a risk to the patient, and / or because more information is required to make such a determination.

[0142] Such a trained system can then be used to control actuation of the projecting element(s) 20 based on the sensed operating parameter(s). For example, if the sensed operating parameter(s) indicate that the anatomical structure 3 is one which a user would typically investigate further, and / or one which would typically be classified as malignant or pre- malignant, the projecting element(s) may be moved to the (fully or partially) extended position so that the anatomical structure 3 can be investigated further.

[0143] Similarly, if the sensed operating parameter(s) are incomplete, or indicate that more information is required to make a decision on a classification of the anatomical structure, the projecting element(s) may be moved to the (fully or partially) extended position so that the anatomical structure 3 can be investigated further.

[0144] Collectively, the accessory 100 (and optionally the medical scoping device 50) and the artificial intelligence system may be defined as a medical scoping system. The artificial

[0145] 17130966.JCP2.JCP2 intelligence system may be provided locally on the accessory 100 and / or the medical scoping device 50 (or across both components).

[0146] In further examples, at least some of the artificial intelligence system may be provided on a remote device, such as a remote computer. This may mean, for example, that some processing is performed locally on the accessory 100 (and / or medical scoping device 50), and that some is performed on the remote device. Alternatively, all of the artificial intelligence system processing may be performed on the remote device.

[0147] In this sense, the accessory 100 (and / or the medical scoping device 50) may comprise a transmitter for transmitting the sensed operating parameter(s) to the remote device. This may be a wired transmitter, which could include a direct wired connection to the remote device. Alternatively, or additionally, this may be a wireless transmitter (such as Wi-Fi, Bluetooth, etc.).

[0148] In certain cases, training of the artificial intelligence system may be performed on a remote device. This can take advantage of the increased processing power available in a remote device. The trained artificial intelligence system can then be incorporated on the accessory 100 and / or the medical scoping device 50.

[0149] Figure 10 shows the accessory 100 attached to a medical scoping device 50, being progressed through an intestine 1 . Of course, the present disclosure is not solely limited to intestines 1 , but this is used to show how the accessory 100 can improve detection. As can be seen, the intestine 1 comprises a number of folds 2.

[0150] For the following discussion, an upper direction is defined towards the top of Figure 10. In this case, the medical scoping device 50 is being angled upward (in Figure 10) such that it is closer to the wall of the intestine 1 in this direction. This could be, for example, because the user is interested in examining the wall of the intestine 1 in this area.

[0151] The projecting elements 20 which are closest to the wall of the intestine 1 (i.e. in an upper region) are extended, to allow them to interact with the folds 2 in this region. The projecting elements which are furthest from the wall of the intestine 1 are retracted, to prevent them from restricting movement of the medical scoping device 50.

[0152] 17130966.JCP2.JCP2 The projecting elements 20 in this upper region may be manually actuated by a user of the medical scoping device 50. Alternatively, they may be automatically extended based on the one or more sensors discussed herein. Equally, they may be extended based on a hybrid approach where the sensors are used to inform the user and manual input / override is taken into account.

[0153] For example, the relevant operating parameter being detected could be a distance between the accessory 100 (or the medical scoping device 50) and the surface of the intestine 1 . When it is detected that the accessory 100 is within a certain distance of the surface of the intestine 1 (and / or that the accessory 100 is moved in this direction towards the surface), corresponding projecting elements 20 can be actuated to the extended position. This could be based on the machine vision discussed herein.

[0154] A medical scoping assembly is also provided. This assembly comprises the accessory 100 as discussed herein and the medical scoping device 50, with the accessory at the distal end of the medical scoping device 50. For example, with the accessory 100 attached to this distal end of the medical scoping device 50. As noted above, the accessory 100 and the medical scoping device 50 may be separate components or may be integral or unitary with one another.

[0155] The medical scoping assembly is used in a method by first inserting the medical scoping device 50 into a patient in an insertion direction I. The insertion direction I being the direction the device 50 moves in as it progressively enters the patient. For example, this could be along a patient’s intestine or colon 1 . For this insertion, the or each projecting element 20 is in the retracted position.

[0156] Then, when the medical scoping device 50 is in a position where there may be something obstructed, the projecting element 20 is moved from the retracted position to the extended position, with the actuator 30.

[0157] This could be based on an operator reviewing a video feed from the medical scoping device 50, and actuating the projecting element 20 when they see something they deem of interest. However, in further cases there may be a machine vision system arranged to

[0158] 17130966.JCP2.JCP2 identify an anatomical structure 3 which may be of interest, and deploy the projecting element 20 to explore this anatomical structure 3.

[0159] In certain cases, where there are a plurality of projecting elements 20 it may be the case that only some of the projecting elements 20 are moved to the extended position. For example, this could be based on the location of an anatomical structure 3, a force or pressure on the first projecting element 20; and / or a distance between the accessory 100 and a surface.

[0160] For example, a projecting element 20 in the region of a detected anatomical structure 3 may be deployed.

[0161] The projecting element 20 may be moved from the retracted position to the extended position while inserting the medical scoping device 50. That is, while the device 50 is moving in the insertion direction I that moves the medical scoping device 50 further into the patient. This allows the front side of folds to be explored.

[0162] The accessory 100 may comprise: one or more sensors arranged to detect an operating parameter. The accessory 100 then further comprises a controller 70 configured to control the actuator 30 to move the projecting element 20 between the retracted position and the extended position and between the extended position and the retracted position in response to the operating parameter. That is, the controller 70 can automatically control movement of the projecting element 20. Particularly, the moving of the projecting element 20 from the retracted position to the extended position with the actuator 30 may be in response to the operating parameter.

[0163] The automatic control of the projecting element 20 can be overridden by a user override. For example, a notification may be generated to the user when the controller 70 is going to control the actuator 30 to move the projecting element 20. The user of the medical scoping device 100 can then override this if they do not want the projecting element 20 to be moved. In certain cases, user confirmation may be required before the controller 70 can control the actuator 30. Alternatively, the controller 70 may be permitted to control the actuator 30 unless the user overrides this and prevents the control.

[0164] 17130966.JCP2.JCP2 The operating parameter may be any parameter relating to the use of the accessory 100 and / or medical scoping device 50. This could include, for example, a direction of movement of the accessory 100 (and / or the medical scoping device 50); a force or pressure on the first projecting element 20; a distance between the accessory 100 (and / or the medical scoping device 50) and a surface; and / or anatomical structure 3.

[0165] The present accessory 100 allows for the medical scoping device 50 to be used in both an insertion direction I and a withdrawal direction W to explore folds 2.

[0166] In this sense, after beginning to withdraw the medical scoping device 50 (with the projecting element 20 extended) and folds 2 may be manipulated. This allows the conventional use of the medical scoping device 50 and accessory 100 to see behind the rear side of folds 2.

[0167] Equally, the projecting element 20 may be in the extended position as the medical scoping device 50 moves in the insertion direction I, thereby allowing the medical scoping device 50 and accessory 100 to see behind the front side of folds 2

[0168] The direction of the medical scoping device 50 may be changed from the insertion direction I to the withdrawal direction W (or vice-versa). The projecting element 20 can then be automatically retracted to allow for further insertion or withdrawal. Alternatively, a user may override this or the withdrawal of the projecting element 20 may not be automatic and may require a user input before it takes place.

[0169] These methods allow the medical scoping device 50 and accessory 100 to be used to view more areas than previous systems.

[0170] 17130966.JCP2.JCP2

Claims

CLAIMS:1 . An accessory for a medical scoping device, the accessory comprising: a tubular body for receiving a medical scoping device; a first projecting element moveable between: a retracted position where the first projecting element is substantially aligned with the tubular body; and an extended position wherein the first projecting element extends outwardly from the tubular body, and an actuator configured to selectively move the first projecting element between the retracted position and the extended position and between the extended position and the retracted position.

2. The accessory of claim 1 , wherein the actuator is configured to selectively move the first projecting element between the retracted position and the extended position and between the extended position and the retracted position in vivo.

3. The accessory of any preceding claim, further comprising a user control configured to control the actuator to move the first projecting element in response to a user input.

4. The accessory of any preceding claim, wherein the tubular body comprises a passage for receiving the first projecting element, the actuator configured to selectively retract the first projecting element into the passage in the retracted position, and expel at least a portion of the first projecting element from the passage in the extended position.

5. The accessory of claim 4, wherein the passage is a bore in the tubular body.

6. The accessory of any preceding claim, wherein the actuator comprises a guide wire positionable along the medical scoping device and engaging with the first projecting element, the guide wire for pushing and / or pulling the first projecting element between the retracted position and the extended position and between the extended position and the retracted position.

7. The accessory of claim 6, wherein the guide wire comprises an arcuate slider engaging with the first projecting element, the arcuate slider surrounding at least a portion of the tubular body and slidably mounted thereon.17130966.JCP2.JCP2preferably, the arcuate slider extends around at least a half of the circumference of the tubular body.

8. The accessory of any preceding claim, wherein the first projecting element comprises a magnetic portion and the actuator comprises an electromagnet, or vice versa, the electromagnet selectively magnetizable to move the first projecting element between the retracted position and the extended position and between the extended position and the retracted position.

9. The accessory of any preceding claim, further comprising a sensor arranged to detect a position of the first projecting element.

10. The accessory of any preceding claim, further comprising a plurality of projecting elements including the first projecting element, each of the projecting elements moveable between: a retracted position where the projecting element is substantially aligned with the tubular body; and an extended position where the projecting element extends outwardly from the tubular body.1 1 . The accessory of claim 10, wherein each projecting element is independently moveable between the retracted position and the extended position and between the extended position and the retracted position.

12. The accessory of claim 10 or 11 , wherein the actuator is according to claim 7 and the arcuate slider engages two or more of the plurality of projecting elements for pushing and / or pulling the two or more of the plurality of projecting elements between the retracted position and the extended position and between the extended position and the retracted position.

13. The accessory of claim 10 or 11 , comprising a plurality of actuators including the first actuator, each actuator configured to selectively move a corresponding projecting element between the retracted position and the extended position and between the extended position and the retracted position.17130966.JCP2.JCP214. The accessory of claim 13, wherein each projecting element comprises a magnetic portion and each actuator comprises an electromagnet, or vice versa, each electromagnet selectively magnetizable to move the corresponding projecting element between the retracted position and the extended position and between the extended position and the retracted position.

15. The accessory of claim 13 or 14, wherein each actuator is configured to independently move the corresponding projecting element between the retracted position and the extended position and between the extended position and the retracted position.

16. The accessory of any preceding claim, further comprising: a sensor arranged to detect an operating parameter; and a controller configured to control the actuator to move the first projecting element between the retracted position and the extended position and between the extended position and the retracted position in response to the operating parameter.

17. The accessory of claim 16, when dependent on claim 13, wherein the controller is configured to individually control each actuator to move the respective projecting element between the retracted position and the extended position and between the extended position and the retracted position in response to the operating parameter.

18. The accessory of claim 16 or 17, wherein the operating parameter comprises one or more of: a direction of movement of the accessory; a force or pressure on the first projecting element; a distance between the accessory and a surface; and / or anatomical structure.

19. A medical scoping assembly comprising: a medical scoping device; and the accessory of any preceding claim at a distal end of the medical scoping device.

20. The medical scoping assembly of claim 19, wherein the medical scoping device and the accessory are unitary.17130966.JCP2.JCP221 . A medical scoping system comprising: the accessory of claim 17 or 18, or the medical scoping assembly of claim 19 or 20 when dependent on claims 17 or 18; and an artificial intelligence system configured to control movement of the projecting element between the retracted position and the extended position and between the extended position and the retracted position based on the operating parameter.

22. The medical scoping system of claim 21 , wherein the artificial intelligence system is at least partially provided on a remote device, and the accessory comprises a transmitter for transmitting the operating parameter to the remote device.

23. A method of using the medical scoping assembly of claim 19 or 20, comprising the steps of: inserting the medical scoping device into a patient in an insertion direction, with the first projecting element in the retracted position; and moving the first projecting element from the retracted position to the extended position with the actuator.

24. The method of claim 23, wherein the moving of the first projecting element from the retracted position to the extended position with the actuator is while inserting the medical scoping device.

25. The method of any of claims 23 to 24, wherein the accessory further comprises a second projecting element, the second projecting element moveable between: a retracted position where the first projecting element is substantially aligned with the tubular body; and an extended position wherein the first projecting element extends outwardly from the tubular body, wherein the first projecting element is moved from the retracted position to the extended position independently of the second projecting element.

26. The method of any of claims 23 to 25, wherein the accessory comprises: a sensor arranged to detect an operating parameter; and a controller configured to control the actuator to move the first projecting element between the retracted position and the extended position and between the extended position and the retracted position in response to the operating parameter,17130966.JCP2.JCP2wherein the moving of the first projecting element from the retracted position to the extended position with the actuator is in response to the operating parameter.

27. The method of claim 26, wherein the operating parameter comprises one or more of: a direction of movement of the accessory; a force or pressure on the first projecting element; a distance between the accessory and a surface; and / or anatomical structure28. The method of claim 26 or 27, wherein the method further comprises: controlling movement of the first projecting element between the retracted position and the extended position and between the extended position and the retracted position based on the operating parameter using an artificial intelligence system.

29. The method of any of claims 23 to 28, further comprising the step of: at least partially withdrawing the medical scoping device from the patient in a withdrawal direction opposite to the insertion direction, with the first projecting element in the extended position.

30. The method of claim 29, further comprising, after at least partially withdrawing the medical scoping device, the steps of: inserting the medical scoping device into the patient in the insertion direction; and moving the first projecting element from the extended position to the retracted position with the actuator.17130966.JCP2.JCP2

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