Endoscope system, evaluation support method, and evaluation support program

Abstract

This endoscope system comprises: an endoscope having an insertion portion in which an imaging element is disposed at a distal end; a gas supply device that supplies a gas via a gas supply channel provided in the insertion portion; and a processor. The processor detects a muscle positioned at a gastroesophageal junction in a captured image captured by the imaging element during gas supply by the gas supply device, generates time-series information in which a detection result of the muscle positioned at the gastroesophageal junction is associated with time, and generates, on the basis of the time-series information, evaluation support information for supporting evaluation of a function of the muscle positioned at the gastroesophageal junction.

Description

Endoscope system, evaluation support method, and evaluation support program

[0001] The present invention relates to an endoscope system, an evaluation support method, and an evaluation support program.

[0002] Gastroesophageal reflux disease (GERD) is a pathological condition caused by the reflux of gastric contents rich in gastric acid into the esophagus. Conventionally, an endoscope system using an endoscope has been proposed as a system for diagnosing gastroesophageal reflux disease (see, for example, Patent Document 1). In the endoscope system described in Patent Document 1, the insertion portion of the endoscope is inserted into the stomach, the gastroesophageal junction is set to be imaged using the endoscope, and air is supplied into the stomach. Then, in this endoscope system, based on the pressure change in the stomach detected during the air supply into the stomach and the state of the gastroesophageal junction observed from the captured image captured using the endoscope, the function of the lower esophageal sphincter is evaluated.

[0003] Further, the anti-reflux mechanism at the gastroesophageal junction includes Collar Sling Muscle fibers, Clasp Muscle fibers, and the lower esophageal sphincter. And there are cases where the functions of Collar Sling Muscle fibers and Clasp Muscle fibers, which are muscles located at the gastroesophageal junction, are extracted and evaluated by an endoscope system.

[0004] International Publication No. 2021 / 166127

[0005] The evaluation of the function of the muscles located at the gastroesophageal junction is performed by a user such as a doctor who observes the captured image captured during the air supply into the stomach. Therefore, for users such as doctors with little experience, it may be difficult to appropriately evaluate the function of the muscles located at the gastroesophageal junction.

[0006] The present invention has been made in view of the above, and an object thereof is to provide an endoscope system, an evaluation support method, and an evaluation support program that can support the evaluation of the function of the muscles located at the gastroesophageal junction.

[0007] To solve the above-mentioned problems and achieve the objective, the endoscope system according to the present invention comprises an endoscope having an insertion section with an image sensor positioned at its tip, an air supply device that supplies gas through an air supply tube provided in the insertion section, and a processor. The processor detects muscles located at the gastroesophageal junction in the image captured by the image sensor when air is supplied by the air supply device, generates time-series information relating the detection result of the muscles located at the gastroesophageal junction to time, and generates evaluation support information that supports the evaluation of the function of the muscles located at the gastroesophageal junction based on the time-series information.

[0008] The endoscope system according to the present invention comprises a light source that emits illumination light, which is narrowband light that emphasizes vascular structures; an endoscope that emits the illumination light from the tip of an insertion part inserted into a subject and images the subject with an image sensor located at the tip of the insertion part; an air supply device that supplies gas through an air supply tube provided in the insertion part; and a processor. The processor detects vascular structures contained in the muscle located at the gastroesophageal junction in the image captured by the image sensor, generates time-series information that associates the detection results of vascular structures contained in the muscle located at the gastroesophageal junction with time, and generates evaluation support information that supports the evaluation of the function of the muscle located at the gastroesophageal junction based on the time-series information.

[0009] The evaluation support method according to the present invention involves inserting the insertion part of an endoscope into the stomach, enabling imaging of the gastric cardia using the endoscope, insufflating air into the stomach, detecting the muscles located at the gastroesophageal junction in the images captured using the endoscope during air insufflation into the stomach, generating time-series information that associates the detection results of the muscles located at the gastroesophageal junction with time, and generating evaluation support information that supports the evaluation of the function of the muscles located at the gastroesophageal junction based on the time-series information.

[0010] The evaluation support program according to the present invention causes a processor to detect muscles located at the gastroesophageal junction in an image of the gastric cardia taken using an endoscope with an insertion portion inserted into the stomach during air insufflation into the stomach, generate time-series information relating the detection result of the muscles located at the gastroesophageal junction to time, and generate evaluation support information that supports the evaluation of the function of the muscles located at the gastroesophageal junction based on the time-series information.

[0011] According to the present invention, an endoscopic system, an evaluation support method, and an evaluation support program can be realized that can support the evaluation of the function of muscles located at the gastroesophageal junction.

[0012] Figure 1 is a diagram illustrating the configuration of an endoscope system according to an embodiment. Figure 2 is a diagram illustrating the configuration of an endoscope system according to an embodiment. Figure 3 is a diagram illustrating the configuration and arrangement of a pressure sensor. Figure 4 is a diagram illustrating a diagnostic method for gastroesophageal reflux disease according to an embodiment. Figure 5 is a diagram illustrating a diagnostic method for gastroesophageal reflux disease according to an embodiment. Figure 6 is a diagram illustrating a diagnostic method for gastroesophageal reflux disease according to an embodiment. Figure 7 is a diagram illustrating a diagnostic method for gastroesophageal reflux disease according to an embodiment. Figure 8 is a diagram illustrating a diagnostic method for gastroesophageal reflux disease according to an embodiment. Figure 9 is a diagram illustrating an example of the display of diagnostic support information. Figure 10 is a diagram illustrating an example of the display of diagnostic support information. Figure 11 is a diagram illustrating an example of the display of diagnostic support information. Figure 12 is a diagram illustrating an evaluation support method according to an embodiment. Figure 13 is a diagram illustrating an evaluation support method according to an embodiment.

[0013] The embodiments for carrying out the present invention (hereinafter referred to as "embodiments") will be described below with reference to the drawings. However, the present invention is not limited to the embodiments described below. Furthermore, in the drawings, the same parts are denoted by the same reference numerals.

[0014] [Configuration of the Endoscope System] Figures 1 and 2 show the configuration of the endoscope system 1 according to an embodiment. The endoscope system 1 is used in the medical field and is a system for diagnosing gastroesophageal reflux disease in a patient using an endoscope 2. As shown in Figures 1 and 2, the endoscope system 1 comprises an endoscope 2, a light source device 3, a processing device 4, a display device 5, an air insufflation device 6, a gastric pressure measuring device 7, and a microphone 8.

[0015] In this embodiment, the endoscope 2 is a so-called flexible endoscope. Part of this endoscope 2 is inserted into the living body, images are captured within the living body, and an image signal generated by the imaging is output. As shown in Figure 1, the endoscope 2 comprises an insertion section 21, an operating section 22, and a universal cord 23.

[0016] The insertion portion 21 is a part that is inserted into the living body and is at least partially flexible. As shown in Figures 1 and 2, the insertion portion 21 comprises a tip portion 24, a flexible curved portion 25 (Figure 1) composed of a plurality of curved pieces connected to the base end of the tip portion 24, and a long, flexible flexible tube portion 26 (Figure 1) connected to the base end of the curved portion 25. An image sensor 244 (Figure 2) is built into the tip portion 24. The insertion portion 21 is inserted into the body cavity of the subject and uses the image sensor 244 to image subjects such as living tissue located in a position where external light cannot reach.

[0017] Here, a pressure sensor 9 is provided on the outer circumferential surface of the insertion portion 21 to detect the pressure applied to the outer circumferential surface. The detailed configuration and arrangement of the pressure sensor 9 will be explained later in the section "Configuration and Arrangement of the Pressure Sensor".

[0018] The operating unit 22 is connected to the proximal end portion of the insertion unit 21. The operating unit 22 receives various operations on the endoscope 2. As shown in Figure 1, the operating unit 22 includes a bending knob 221 that bends the bending unit 25 in the vertical and horizontal directions, a treatment instrument insertion unit 222 that extends from the operating unit 22 to the tip of the insertion unit 21 and inserts treatment instruments such as biopsy forceps, electrosurgical units and examination probes into the body cavity of the subject, an air supply line 223 (Figure 2) that extends from the operating unit 22 to the tip of the insertion unit 21 and supplies air into the body cavity of the subject, and a plurality of switches 224 for operating peripheral equipment such as an air supply device 6 and a water supply device (not shown).

[0019] The universal cord 23 incorporates at least a light guide 241 (Figure 2) and a bundled cable 245 (Figure 2) that bundles one or more signal lines. The light guide 241 is made of fiberglass or the like and forms a light guide path for the light emitted by the light source device 3. As shown in Figure 1, the universal cord 23 branches at the end opposite to the end connected to the operation unit 22. At the branched end of the universal cord 23, there is a connector 231 that can be attached to the light source device 3 and a connector 232 that can be attached to the processing unit 4. A part of the light guide 241 extends from the end of the connector 231. The universal cord 23 transmits the illumination light emitted from the light source device 3 to the tip 24 via the connector 231 (light guide 241), the operation unit 22, and the flexible tube section 26. The universal cord 23 also transmits the image signal captured by the image sensor 244 provided at the tip 24 to the processing unit 4 via the connector 232. The bundled cable 245 includes signal lines for transmitting image signals, signal lines for transmitting drive signals for driving the image sensor 244, and signal lines for sending and receiving information including unique information about the endoscope 2 (image sensor 244). In this embodiment, it is described as transmitting electrical signals using signal lines, but optical signals may be transmitted, or signals may be transmitted between the endoscope 2 and the processing unit 4 by wireless communication.

[0020] The exit end of the light guide 241 is inserted into the tip portion 24. As shown in Figure 2, this tip portion 24 includes an illumination lens 242, a light-gathering optical system 243, and an image sensor 244 provided at the imaging position of the optical system 243, which receives the light gathered by the optical system 243, converts it into an electrical signal via photoelectricity, and performs predetermined signal processing.

[0021] The optical system 243 is composed of one or more lenses and forms an observation image on the light-receiving surface of the image sensor 244. The optical system 243 may also have an optical zoom function to change the angle of view and a focus function to change the focal point.

[0022] The image sensor 244 converts light from the optical system 243 into electrical signals (image signals). This image sensor 244 is made up of multiple pixels arranged in a matrix, each having a photodiode that stores charge according to the amount of light, and a capacitor that converts the charge transferred from the photodiode into a voltage level. The image sensor 244 generates electrical signals by converting the light incident on it through the optical system 243 into electrical signals, and sequentially reads out the electrical signals generated by pixels arbitrarily set as readout targets from among the multiple pixels, and outputs them as image signals. This image sensor 244 can be realized using, for example, a CCD (Charge Coupled Device) image sensor or a CMOS (Complementary Metal Oxide Semiconductor) image sensor.

[0023] For the sake of clarity, in the following explanation, the image signal generated by the image sensor 244 will be referred to as the captured image.

[0024] Here, the endoscope 2 has a memory (not shown) that stores data including execution programs and control programs for the image sensor 244 to perform various operations, as well as identification information for the endoscope 2. This identification information includes the endoscope 2's unique information (ID), year of manufacture, specifications, and transmission method. The memory may also temporarily store images generated by the image sensor 244.

[0025] As shown in Figure 2, the light source device 3 comprises a light source unit 31, an illumination control unit 32, and a light source driver 33.

[0026] The light source unit 31 emits light under the control of the illumination control unit 32. This light source unit 31 emits light having a visible light wavelength range (white light (illumination light)). This light source unit 31 can be implemented using an LED (Light Emitting Diode) light source, as well as a laser light source, xenon lamp, halogen lamp, or any other light source. The light source unit 31 may also have one or more lenses. The light generated by the light source unit 31 is then emitted from the tip of the tip unit 24 toward the subject via the light guide 241 and illumination lens 242.

[0027] Furthermore, the light emitted from the light source unit 31 is not limited to white light; it may also be narrowband light having a specific wavelength range, or excitation light that excites substances contained in the object being observed.

[0028] The light source driver 33, under the control of the lighting control unit 32, supplies current to the light source unit 31, thereby causing the light source unit 31 to emit light.

[0029] The processing unit 4 corresponds to the processor according to the present invention. As shown in Figure 2, the processing unit 4 comprises an image processing unit 41, a synchronization signal generation unit 42, an input unit 43, a control unit 44, and a storage unit 45.

[0030] The image processing unit 41, under the control of the control unit 44, performs predetermined image processing on the captured image received from the endoscope 2 to generate an endoscopic image.

[0031] Examples of image processing performed by the image processing unit 41 include optical black subtraction (clamping), white balance adjustment, demosaicing, color correction matrix processing, gamma correction, YC processing to convert RGB signals into luminance chromatic difference signals (Y, Cb / Cr signals), digital gain adjustment to multiply digital gain, noise reduction, and filtering to enhance structure.

[0032] Furthermore, the image processing unit 41 generates first support information based on the pressure signal (intragastric pressure information) detected by the intragastric pressure measuring device 7, under the control of the control unit 44.

[0033] Furthermore, the image processing unit 41 generates second support information based on the pressure signal (esophageal support information) detected by the pressure sensor 9, under the control of the control unit 44.

[0034] Furthermore, the image processing unit 41 generates third support information based on the signals (aspiration information) related to the aspiration sound collected by the microphone 8, under the control of the control unit 44.

[0035] 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. This diagnostic support information is output to the display device 5 and displayed on the display device 5.

[0036] Further details regarding the first to third support information and diagnostic support information will be explained in "Examples of Displaying Diagnostic Support Information" below.

[0037] 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 an ASIC (Application Specific Integrated Circuit) or various arithmetic circuits that perform specific functions.

[0038] The synchronization signal generation unit 42 generates a clock signal (synchronization signal) that serves as the reference for the operation of the processing unit 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. As a result, the light source device 3, the image processing unit 41, the control unit 44, and the endoscope 2 operate in synchronization with each other based on the generated synchronization signal.

[0039] The input unit 43 is realized using a keyboard, a mouse, a switch, or a touch panel, and receives various operations for instructing the operation of the endoscope system 1. Note that the input unit 43 may include a switch provided in the operation unit 22 or a portable terminal such as an external tablet-type computer.

[0040] The control unit 44 is configured using a general-purpose processor such as a CPU or a dedicated processor such as various arithmetic circuits that execute specific functions such as an ASIC.

[0041] The storage unit 45 stores data including various programs executed by the control unit 44 and various parameters necessary for the processing of the control unit 44. The various programs can also be recorded on a computer-readable recording medium such as a hard disk, a flash memory, a CD-ROM, a DVD-ROM, or a flexible disk and widely distributed. Note that the various programs can also be obtained by downloading them via a communication network. The communication network mentioned here is realized, for example, by an existing public line network, a LAN (Local Area Network), a WAN (Wide Area Network), etc., and can be either wired or wireless.

[0042] 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, a hard disk, etc. that store arithmetic parameters, data, etc. for each process.

[0043] In this embodiment, the light source device 3 and the processing device 4 are provided in separate housings, but it is not limited to this, and they may be integrally provided in the same housing.

[0044] The display device 5 displays the display image received from the processing device 4 (image processing unit 41) via a video cable. This display device 5 is configured using a monitor such as a liquid crystal or an organic EL (Electro Luminescence).

[0045] The air supply device 6 regulates the pressure of the gas supplied from a gas supply source (not shown, e.g., a carbon dioxide gas cylinder) to a predetermined pressure and discharges it into the space where the tip of the insertion portion 21 is located from the tip of the insertion portion 21 through the air supply pipeline 223. As shown in FIG. 1, this air supply device 6 includes an air supply portion 61, a flow rate measurement portion 62, and a control portion 63.

[0046] Although specific illustrations are omitted, the air supply portion 61 includes a primary pressure reducer, a secondary pressure reducer, and a flow rate control valve. These primary pressure reducer, secondary pressure reducer, and flow rate control valve are connected in sequence by an air supply pipeline formed of silicon, fluororesin, or the like. The gas supplied from a gas supply source not shown passes through the air supply pipeline in sequence through the primary pressure reducer, secondary pressure reducer, and flow rate control valve, and after being adjusted to a predetermined pressure and flow rate, it is discharged from the air supply tube TU (FIG. 1) via the flow rate measurement portion 62. The control portion 63 controls the flow rate control valve provided in the air supply portion 61 to adjust the flow rate of the gas supplied to the endoscope 2 to a predetermined value. The flow rate control valve is, for example, a type of electromagnetic drive valve and is constituted by a regulating valve using an electromagnetic coil in the drive portion. By controlling the position of the plunger according to the magnitude of the current flowing through the electromagnetic coil, the opening degree of the valve portion is controlled, and the flow rate of the gas flowing in the air supply pipeline is adjusted to a predetermined value.

[0047] The intragastric pressure measurement device 7 corresponds to the internal pressure sensor according to the present invention. This intragastric pressure measurement device 7 detects the pressure inside the space where the tip is located via the pressure measurement probe 71 inserted through the treatment tool insertion portion 222 to the tip of the insertion portion 21. Then, a signal regarding the pressure detected by the intragastric pressure measurement device 7 (hereinafter referred to as intragastric pressure) (hereinafter referred to as intragastric pressure information) is output to the processing device 4.

[0048] The microphone 8 is disposed at the throat or the like of the subject and collects the aspiration sound (gulp sound) emitted from the esophagus of the subject. Then, a signal regarding the aspiration sound collected by the microphone 8 (hereinafter referred to as aspiration sound information) is output to the processing device 4.

[0049] [Regarding the configuration and arrangement of the pressure sensor] Figure 3 is a diagram illustrating the configuration and arrangement of the pressure sensor 9. The pressure sensor 9 is configured to detect pressure by a known method, for example, a resistive pressure sensor or a capacitive 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 of the central axis along the axial direction of the insertion portion 21. Note that the pressure sensor 9 is not limited to a circular pressure sensor; a point-type pressure sensor provided only on a part of the entire circumference in the rotational direction may also be used.

[0050] The pressure sensors 9 are arranged on the outer surface of the insertion portion 21 at 1 cm intervals, totaling 36 sensors, along the axial direction of the insertion portion 21, as shown in Figure 3. This ensures that when the insertion portion 21 is inserted into the stomach, the pressure sensors 9 are positioned to detect contraction and relaxation pressures at various points within the esophagus, from the upper to the lower esophageal sphincter.

[0051] Furthermore, the pressure sensors 9 are not limited to 36; for example, there may be 6 or more, 12 or more, or even more sensors arranged.

[0052] Here, the pressure sensor 9 can be positioned at a predetermined distance from one or more other pressure sensors 9 that are closest to it. Optionally, the spacing between each pressure sensor 9 can be approximately the same. This spacing may be 3 centimeters or less, for example, 2 centimeters or less, for example, 1 centimeter, or even less than 1 centimeter.

[0053] The pressure signal detected by the pressure sensor 9 described above (hereinafter referred to as esophageal pressure information) is output to the processing unit 4.

[0054] [Method for Diagnosing Gastroesophageal Reflux Disease] Next, a method for diagnosing gastroesophageal reflux disease will be described. Figures 4 to 8 are diagrams illustrating a method for diagnosing gastroesophageal reflux disease according to an embodiment. Specifically, Figure 4 is a flowchart illustrating the method for diagnosing gastroesophageal reflux disease. Figure 5 is a cross-sectional view showing the area around the gastric cardia, illustrating steps S1 to S3. Note that in Figure 5, for the sake of explanation, the pressure sensor 9 provided on the outer surface of the insertion part 21 is not shown. Figures 6 and 7 are diagrams showing the structure of the stomach and esophagus. Figure 6 is a cross-sectional view showing the structure of the stomach and esophagus. Figure 7 is a view of the stomach and esophagus from the outside. Figure 8 is a diagram showing images taken in Phase 1 to Phase 3, which correspond to the dynamic changes that occur when air is insufflated into the stomach (during pneumoperitoneum).

[0055] First, the user, such as a physician, inserts the insertion part 21 into the person being examined through a natural opening, such as the mouth or nose, and guides the insertion part 21 into the stomach through the esophagus, as shown in Figure 5 (Step S1).

[0056] After step S1, the user, such as a physician, operates the bending knob 221 (bending operation) to set the gastric cardia as the observation field of view (step S2). In step S2, in response to the operation of the bending knob 221, the insertion section 21 is set into a J-shape with its tip pointing towards the gastric cardia, as shown in Figure 5. Also in step S2, the position of the insertion section 21 of the endoscope 2 in the forward and backward directions is adjusted so that the reference marker is located at the gastric cardia. In this state, the pressure sensor 9 is positioned to detect the contraction and relaxation pressures at various points inside the esophagus from the upper esophageal sphincter to the lower esophageal sphincter. Details of the reference marker will be explained later in "Positioning of the Endoscope Insertion Section".

[0057] After step S2, the user, such as a physician, operates switch 224 to start insufflating air from the air insufflation device 6 into the stomach through the air insufflation tube 223 (step S3). In Figure 5, the increase in gastric pressure due to air insufflation is represented by a white arrow.

[0058] During insufflation of air into the stomach (pneumoperitoneum), if the subject is healthy, the following three dynamic changes occur: Phase 1 to Phase 3. Before explaining Phases 1 to 3, the structure of the stomach and esophagus will be described with reference to Figures 6 and 7.

[0059] The Intramural Anti-Reflux Barrier Complex (IM-ARB complex), which is part of the anti-reflux mechanism at the gastroesophageal junction, is composed of three main components: Collar Sling Muscle fibers (Figure 7), Clasp Muscle fibers (Figure 7), and the lower esophageal sphincter (Figures 6 and 7).

[0060] Collar sling muscle fibers are obliquely running muscles located along the greater curvature of the stomach (Figure 6), forming a sling-like structure that surrounds the upper part of the stomach (Figure 7). These collar sling muscle fibers function to prevent stomach contents from refluxing into the esophagus by constricting the gastric cardia. From inside the stomach, the collar sling muscle fibers can be identified as a gastroesophageal flap valve (Figure 6). This gastroesophageal flap valve (GEFV) is a projection within the gastroesophageal junction, created by the acute angle between the esophagus and the gastric cardia, and is a type of mucosal flap valve (MFV). An MFV located at the gastroesophageal junction is called a gastroesophageal flap valve. An MFV is a part where the mucosa is formed in a flap shape. The morphology of the gastroesophageal flap valve changes with the contraction and relaxation of muscles such as collar sling muscle fibers and clasp muscle fibers.

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

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

[0063] Phase 1 begins with zero air insufflation into the stomach. In Phase 1, as shown in Figures 8(a) and 8(b), the gastroesophageal flap valve and the longitudinal folds of the lesser curvature are observed. These longitudinal folds of the lesser curvature are mucosal folds that extend longitudinally along the inner wall of the stomach. Their morphology changes with the contraction and relaxation of muscles such as clasp muscle fibers, and they gradually stretch and flatten as gastric pressure increases. In Phase 1, the esophageal mucosa is not observed. Then, in Phase 1, as the air insufflation into the stomach increases, as shown in Figure 8(b), the longitudinal folds of the lesser curvature are stretched, the gastroesophageal flap valve gradually flattens, and its legs spread, but the esophageal mucosa is not observed.

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

[0065] Phase 2 is the phase that occurs after Phase 1. In Phase 2, as shown in Figure 8(c), the esophageal mucosa is observed beyond the squamous columnar junction (Figure 6, Squamocolumnar Junction (SCJ)). This SCJ is the point where the squamous epithelium of the esophagus and the columnar epithelium of the stomach intersect, located at the gastroesophageal junction (GEJ), and marks the boundary between different epithelial cells of the digestive tract. The GEJ is located near the boundary between the esophagus and the stomach and is composed of various anatomical components that form a barrier to prevent reflux of gastric contents. Collar sling muscle fibers, clasp muscle fibers, lower esophageal sphincter, gastroesophageal flap valve, and the SCJ are all included in the GEJ. If the subject is healthy, the Scope Holding Sign (SHS) is observed. This SHS refers to the phenomenon in which the insertion portion 21 is held in place by the contraction of the lower esophageal sphincter when the intragastric pressure increases. The state shown in Figure 8(c) is SHS.

[0066] In other words, Phase 2 makes it possible to evaluate the valve function (reflux prevention mechanism) of the lower esophageal sphincter.

[0067] Phase 3 is the phase that occurs after Phase 2. In Phase 3, the intragastric pressure exceeds the contractile force of the lower esophageal sphincter, causing relaxation of the lower esophageal sphincter. In Figure 8(d), the arrows indicate that gas leaks into the esophagus (causing an aerating sound) due to the relaxation of the lower esophageal sphincter. If the subject is healthy, peristaltic waves will then descend from the upper esophagus, and SHS will be observed again.

[0068] In other words, Phase 3 makes it possible to evaluate the acid clearance function mediated by esophageal peristalsis.

[0069] After step S3, the user, such as a physician, determines whether the state corresponds to Phase 1 described above based on the diagnostic support information displayed on the display device 5, and evaluates the valve function (state of the gastric cardia) due to the gastric structure (step S4). Details of this evaluation method will be described later.

[0070] After step S4, the user, such as a physician, determines whether the state corresponds to Phase 2 described above based on the diagnostic support information displayed on the display device 5, and evaluates the valve function of the lower esophageal sphincter (state of the lower esophageal sphincter) (step S5).

[0071] After step S5, the user, such as a physician, determines whether the patient is in a state corresponding to Phase 3 described above, based on the diagnostic support information displayed on the display device 5, and evaluates the acid clearance function by esophageal peristalsis (the state of peristaltic movement in the esophagus) (step S6).

[0072] Further details regarding the diagnostic support information will be explained in the section "Examples of Displaying Diagnostic Support Information" below.

[0073] After step S6, the user, such as a physician, diagnoses gastroesophageal reflux disease based on the evaluation results from steps S4 to S6 (step S7).

[0074] [Examples of Display of Diagnostic Support Information] Next, we will explain the diagnostic support information. Figures 9 to 11 are diagrams illustrating examples of the display of diagnostic support information I0. Specifically, Figure 9 is a diagram showing an example of diagnostic support information I0 displayed on the display device 5 when the person being examined is healthy. Figure 10 is a diagram showing an example of diagnostic support information I0 displayed on the display device 5 when the person being examined is suspected of having gastroesophageal reflux disease. Figures 11(a) to 11(c) are diagrams showing examples of the first to third support information I2 to I4 that constitute diagnostic support information I0 when the person being examined is healthy. Figures 11(d) to 11(f) are diagrams showing examples of the first to third support information I2 to I4 that constitute diagnostic support information I0 when the person being examined is suspected of having gastroesophageal reflux disease.

[0075] As shown in Figures 9 to 11, the processing unit 4 generates an endoscopic image I1 by performing predetermined image processing on the image received from the endoscope 2 when air is insufflated into the stomach by the air insufflation device 6. The processing unit 4 also generates first support information I2 based on the gastric pressure information detected by the gastric pressure measuring device 7 during the air insufflation. Furthermore, the processing unit 4 generates second support information I3 based on the esophageal pressure information detected by the pressure sensor 9 during the air insufflation. The processing unit 4 also generates third support information I4 based on the aspiration sound information collected by the microphone 8 during the air insufflation. Finally, the processing unit 4 generates diagnostic support information I0 for diagnosing gastroesophageal reflux disease based on the endoscopic image I1, the first to third support information I2 to I4, and time information I5 related to the air insufflation time into the stomach by the air insufflation device 6 (hereinafter referred to as pneumoperitoneum time).

[0076] Here, the processing unit 4 processes the captured image, gastric pressure information, esophageal pressure information, and aspiration sound information in a time-synchronized manner based on the synchronization signal generated by the synchronization signal generation unit 42. The processing unit 4 also processes the esophageal pressure information detected by the pressure sensors 9 in a time-synchronized manner based on the synchronization signal.

[0077] The first support information I2 includes a pressure waveform I21 showing the change in pressure (intragastric pressure) based on the increase in intragastric pressure due to air delivery into the stomach by the air delivery device 6, as shown in Figures 9 to 11. The first support information I2 also includes the current intragastric pressure (Current IGP) I22, the maximum intragastric pressure (Maximum IGP) I23 when the intragastric pressure increases, and the basal intragastric pressure (Basal IGP) I24 before the increase in intragastric pressure, as shown in Figures 9 and 10. 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 the pressure gradient obtained by dividing the pressure difference by the pneumoperitoneum time.

[0078] Furthermore, the current intragastric pressure I22, the maximum intragastric pressure I23 when intragastric pressure increases, and the basal intragastric pressure I24 before the increase in intragastric pressure may be represented using any appropriate representation, such as bar graphs, line graphs, contour graphs, other representations, or any appropriate combination thereof.

[0079] The second support information I3 includes a pressure waveform I31 showing the pressure changes detected by the pressure sensors 9, as shown in Figures 9 to 11. In this embodiment, the pressure waveform I31 is constructed using a pressure topography, as shown in Figures 11(c) and 11(f). Specifically, the pressure topography (pressure waveform I31) is a diagram in which time is the horizontal axis, and the pressure changes detected by the pressure sensors 9, which are positioned from the upper esophageal sphincter side to the lower esophageal sphincter side, are represented as a color pattern from the top to the bottom of the vertical axis.

[0080] Here, the color patterns shown in Figure 11(c) and Figure 11(f) can, for example, use blue to represent the low-pressure range and red to represent the high-pressure range. The temporal representation shown on the horizontal axis can move horizontally along the time dimension to show the passage of time within the time interval in which the displayed pressure value was measured. For example, the far right of the temporal representation can correspond to the most recent time within the time interval displayed in the temporal representation, and the far left can represent the earliest time. To show the passage of time within the time interval, the temporal representation moves continuously to the left on the screen, allowing the user to observe the representation of pressure measured in the esophagus over time. This continuous movement to the left allows the user to confirm the temporal changes in pressure at the displayed position (if any) and to confirm the occurrence of events that caused the pressure change (e.g., relaxation of the lower esophageal sphincter or peristalsis in the esophagus).

[0081] Furthermore, information indicating the location of the pressure sensor 9 within the esophageal tube may be added to the pressure topography (pressure waveform I31). For example, markers indicating the location of the upper and lower esophageal sphincters may be added to the vertical axis.

[0082] Furthermore, even if the pressure measurements detected by the number of pressure sensors 9 may be detected at discrete locations, 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 quasi-continuous pressure measurements, a quasi-continuous visual representation (e.g., one with smooth changes) can be provided. Any suitable visual representation described below may be quasi-continuous.

[0083] Furthermore, the second support information I3 includes the basal LES pressure I32 detected by the pressure sensor 9 located on the lower esophageal sphincter side before the rise in gastric pressure, as shown in Figures 9 and 10. Note that the second support information I3 is not limited to the pressure waveform I31 and the basal pressure I32; it may also include the maximum and minimum pressure values ​​detected by the pressure sensor 9, respectively.

[0084] The third support information I4 includes the waveform I41 of the eavesdropping sound based on the eavesdropping sound information detected by the microphone 8, as shown in Figures 9 to 11. The third support information I4 also includes the maximum sound pressure of the eavesdropping sound detected by the microphone 8, as shown in Figures 9 and 10.

[0085] Then, the user, such as a doctor, checks the diagnostic support information I0 displayed on the display device 5 and diagnoses the patient with gastroesophageal reflux disease.

[0086] In step S4, the user, such as a physician, 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 person being examined is healthy, the pressure waveform I21 will be a sloped pressure waveform as shown in Figure 11(a). On the other hand, if the person being examined is suspected of having an abnormality, the pressure waveform I21 will be a flat pressure waveform as shown in Figure 11(d). Therefore, the user, such as a physician, 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.

[0087] In step S5, the user, such as a physician, checks the diagnostic support information I0 displayed on the display device 5, determines whether the state corresponds to Phase 2, and evaluates the valve function of the lower esophageal sphincter. For example, if the person being examined is healthy, SHS will be observed, and the contraction pressure of the lower esophageal sphincter will also be observed. Therefore, the user, such as a physician, checks, for example, the endoscopic image I1, and the first and second support information I2 and I3 that constitute the diagnostic support information I0, and evaluates the valve function of the lower esophageal sphincter.

[0088] In step S6, the user, such as a physician, checks the diagnostic support information I0 displayed on the display device 5 and determines whether the state corresponds to Phase 3, and evaluates the acid clearance function by esophageal peristalsis. For example, if the person being examined is healthy, the gastric pressure will be around 19 mmHg, abrupt sounds will occur, and the lower esophageal sphincter will relax (Figures 11(a) to 11(c)). On the other hand, if the person being examined is suspected of having an abnormality, the gastric pressure will be around 14 mmHg and the lower esophageal sphincter will relax. Also, if the person being examined is healthy, peristaltic movement in the esophagus will be observed (Figure 11(c)), and SHS will be observed again. For example, on pressure topography (pressure waveform I31), as peristalsis progresses over time (to the right on the time axis, but the representation itself moves to the left), the contractile pressure in each part of the esophagus can be seen progressing from the top to the bottom (from the upper esophageal sphincter to the lower esophageal sphincter).

[0089] On the other hand, if an abnormality is suspected in the subject being examined, peristaltic movement in the esophagus will not be observed (Figure 11(f)). Therefore, users such as physicians can, for example, check the endoscopic image I1 and the first to third support information I2 to I4 that constitute the diagnostic support information I0 to evaluate the acid clearance function due to esophageal peristalsis.

[0090] Then, in step S7, if the user, such as a physician, suspects an abnormality in any of the valve function due to the gastric structure, the valve function due to the lower esophageal sphincter, or the acid clearance function due to esophageal peristalsis, which were evaluated in steps S4 to S6, the user diagnoses suspected gastroesophageal reflux disease.

[0091] Furthermore, the diagnostic support information I0 shown in Figures 9 and 10 includes diagnostic result information I6. The diagnostic result information I6 is information regarding the diagnostic result that the processing device 4 automatically diagnoses whether or not the person being examined has gastroesophageal reflux disease (or whether or not there is a suspicion of gastroesophageal reflux disease) based on the captured images, gastric pressure information, esophageal pressure information, and aspiration sound information. This diagnostic result information I6 includes an evaluation result I61 that evaluates which phase the current patient is in, an evaluation result I62 that evaluates whether or not the patient is in a state corresponding to each of Phases 1 to 3, and a diagnostic result I63 that evaluates whether or not the patient has gastroesophageal reflux disease (or whether or not there is a suspicion of gastroesophageal reflux disease) based on the evaluation result I62.

[0092] The processing unit 4 stores the captured image, gastric pressure information, esophageal pressure information, and aspiration sound information in memory, which are processed in a time-synchronized manner based on the synchronization signal. In other words, 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, along with the various support information for that timing.

[0093] [Evaluation support method to assist in the evaluation of the function of muscles located at the gastroesophageal junction] Next, an evaluation support method to assist in the evaluation of the function of muscles located at the gastroesophageal junction will be described. This evaluation support method can be used when evaluating the valve function due to the gastric structure in step S4 of Figure 4. Figures 12 and 13 illustrate the evaluation support method to assist in the evaluation of the function of muscles located at the gastroesophageal junction. Specifically, Figure 12 is a flowchart of the evaluation support method to assist in the evaluation of the function of muscles located at the gastroesophageal junction. Figure 13 is a diagram showing an example of detecting muscles located at the gastroesophageal junction.

[0094] First, the user, such as a physician, performs the processes shown in steps S1 to S3 of Figure 4. This directs the observation field of view of the image sensor 244 located at the tip of the insertion section 21 towards the gastric cardia, and air is started to be supplied into the stomach from the air insufflation device 6 through the air insufflation tube 223. Then, the image processing unit 41 performs predetermined image processing on the image captured by the image sensor 244 to generate an endoscopic image.

[0095] Then, the processing device 4 detects the muscles located at the gastroesophageal junction in the image (or endoscopic image) captured by the image sensor 244 during air insufflation by the air insufflation device 6 (step S11). The muscles located at the gastroesophageal junction are, for example, Collar Sling Muscle fibers and Clasp Muscle fibers located on the gastric side, but may also include the lower esophageal sphincter located on the esophageal side. The processing device 4 may also detect one of Collar Sling Muscle fibers, Clasp Muscle fibers, or the lower esophageal sphincter, or a combination of two or three of these. The processing device 4 may also detect the condition of the folds in the Collar Sling Muscle fibers, such as the height of the folds and the number of folds.

[0096] As shown in Figure 12, the processing device 4 detects, for example, the regions corresponding to Collar Sling Muscle fibers and Clasp Muscle fibers in the endoscopic images I11 to I13. Furthermore, the processing device 4 may also detect the area of ​​regions A1 to A3 surrounded by Collar Sling Muscle fibers (or regions corresponding to Clasp Muscle fibers) in the endoscopic images I11 to I13.

[0097] Next, the processing device 4 generates time-series information that associates the detection results of the muscle located at the gastroesophageal junction with time (step S12). However, the time-series information may include various types of information, such as gastric pressure information related to the pressure detected by the internal pressure sensor (gastric pressure measuring device 7), or esophageal pressure information related to the pressure detected by the pressure sensor 9.

[0098] Subsequently, the processing device 4 generates evaluation support information to assist in the evaluation of the function of the muscles located at the gastroesophageal junction based on the time-series information (step S13). The processing device 4 generates evaluation support information based on, for example, the time change in the area of ​​the region surrounded by Collar Sling Muscle fibers or the regions A1 to A3 corresponding to Clasp Muscle fibers. The processing device 4 may also generate evaluation support information based on the time change in the state of the folds in the Collar Sling Muscle fibers. The processing device 4 may also generate evaluation support information by associating the time change in the shape of the muscles located at the gastroesophageal junction with intragastric pressure or esophageal pressure. The evaluation support information may be, for example, information that assists in the evaluation of the function of the muscles located at the gastroesophageal junction, and may include, for example, information that notifies of abnormal values, or information that notifies the timing of the transition from the first stage (Phase 1) in which the muscles located at the gastroesophageal junction relax to the second stage (Phase 2) in which the lower esophageal sphincter relaxes. Furthermore, the processing device 4 may generate an image as evaluation support information, in which the region corresponding to the muscle located at the gastroesophageal junction in the captured image is highlighted.

[0099] The processing unit 4 detects, for example, the timing when the area of ​​the region surrounded by Collar Sling Muscle fibers or the region corresponding to Clasp Muscle fibers exceeds a threshold, as the timing for transitioning from Phase 1 to Phase 2. In Figure 12, regions A1 and A2 in endoscopic images I11 and I12 have areas smaller than the threshold and are in Phase 1. On the other hand, region A3 in endoscopic image I13 has an area greater than or equal to the threshold and is in Phase 2. Note that the area of ​​the observed object in the endoscopic image changes depending on the distance between the observed object and the image sensor 244. The processing unit 4 may compensate for the change in area due to distance, for example, based on the thickness of the insertion section 21 shown in endoscopic images I11 to I13. Alternatively, the area of ​​the observed object may be accurately measured using a binocular endoscope. Furthermore, the processing unit 4 may compensate for the change in area due to distance using AI (Artificial Intelligence) ranging technology. Additionally, the processing unit 4 may detect the timing for transitioning from Phase 1 to Phase 2 by scene recognition using AI or machine learning. Alternatively, the processing unit 4 may prompt the Large Language Model (LLM) to detect the timing of the transition from Phase 1 to Phase 2.

[0100] Then, the processing unit 4 outputs evaluation support information (step S14). For example, the processing unit 4 outputs an image that highlights the regions corresponding to the Collar Sling Muscle fibers and Clasp Muscle fibers. In addition, if the pressure detected by the gastric manometry device 7 is below a threshold (abnormal value) at the timing of the transition from Phase 1 to Phase 2, the processing unit 4 may superimpose a predetermined icon or message on the endoscopic image and display it on the display device 5.

[0101] Furthermore, the processing device 4 may receive an instruction input to modify the region corresponding to the muscle located at the gastroesophageal junction in the endoscopic image, and generate an image in which the modified region is highlighted according to the instruction input.

[0102] According to the embodiments described above, the processing device 4 generates evaluation support information that assists in the evaluation of the function of the muscles located at the gastroesophageal junction based on time-series information, thereby supporting the evaluation of the function of the muscles located at the gastroesophageal junction. As a result, even inexperienced physicians and other users can easily recognize the regions corresponding to the Collar Sling Muscle fibers and Clasp Muscle fibers, as well as the timing of the transition from Phase 1 to Phase 2, making it easier to evaluate the function of the muscles located at the gastroesophageal junction.

[0103] Furthermore, the light source device 3 may emit illumination light, which is narrowband light that emphasizes the vascular structure. In this case, the processing device 4 may detect the vascular structure contained in the muscle located at the gastroesophageal junction in the image captured by the image sensor 244. The processing device 4 may then generate time-series information that associates the detection result of the vascular structure contained in the muscle located at the gastroesophageal junction with time, and generate evaluation support information that supports the evaluation of the function of the muscle located at the gastroesophageal junction based on the time-series information. By emphasizing the vascular structure, the state of the muscle located at the gastroesophageal junction can be detected with high accuracy.

[0104] The above-described embodiment was explained as a technique that can identify the location of the lower esophageal sphincter, but it is not limited to that. For example, it can also identify the location of major sphincters in the human digestive tract. Specifically, it can identify the location of the external anal sphincter.

[0105] 1 Endoscope system 2 Endoscope 3 Light source device 4 Processing unit 5 Display device 6 Air supply device 7 Intragastric 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 Illumination 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 measuring probe 221 Bending knob 222 Treatment instrument insertion section 223 Air supply line 224 Switch 231, 232 Connector 241 Light guide 242 Illumination lens 243 Optical system 244 Image sensor 245 Cable A1, A2, A3 Area I0 Diagnostic support information I1, I11, I12, I13 Endoscopic images I2 First support information I21 Pressure waveform I22 Current intragastric pressure I23 Maximum intragastric pressure I24 Basal intragastric pressure I3 Second support information I31 Pressure waveform I32 Basal pressure I4 Third support information I41 Waveform I5 Time information I6 Diagnostic result information I61, I62 Evaluation results I63 Diagnostic result TU Air supply tube

Claims

1. An endoscope system comprising: an endoscope having an insertion section with an image sensor positioned at its tip; an air supply device that supplies gas through an air supply tube provided in the insertion section; and a processor, wherein the processor detects muscles located at the gastroesophageal junction in the image captured by the image sensor during air supply by the air supply device; generates time-series information relating the detection result of the muscles located at the gastroesophageal junction to time; and generates evaluation support information that supports the evaluation of the function of the muscles located at the gastroesophageal junction based on the time-series information.

2. The endoscopic system according to claim 1, wherein the muscle located at the gastroesophageal junction is Collar Sling Muscle fibers or Clasp Muscle fibers.

3. The endoscopic system according to claim 2, wherein the processor detects a region corresponding to the Collar Sling Muscle fibers or the Clasp Muscle fibers.

4. The endoscope system according to claim 2, wherein the processor generates the evaluation support information based on the time change of the area of ​​the region surrounded by the Collar Sling Muscle fibers or the region corresponding to the Clasp Muscle fibers.

5. The endoscopic system according to claim 2, wherein the processor generates the evaluation support information based on the time change of the state of the folds in the Collar Sling Muscle fibers.

6. The endoscope system according to claim 1, comprising an internal pressure sensor for detecting the pressure inside the space where the tip of the insertion portion is located, wherein the time-series information includes gastric pressure information relating to the pressure detected by the internal pressure sensor.

7. The endoscopic system according to claim 6, wherein the processor generates the evaluation support information based on the detection result of the muscle located at the gastroesophageal junction and the time change of the intragastric pressure information.

8. The endoscope system according to claim 1, comprising a pressure sensor for detecting the pressure applied to the outer circumferential surface of the insertion portion, wherein the time-series information includes esophageal pressure information relating to the pressure detected by the pressure sensor.

9. The endoscopic system according to claim 8, wherein the processor generates the evaluation support information based on the detection result of the muscle located at the gastroesophageal junction and the time change of the esophageal pressure information.

10. The endoscope system according to claim 1, wherein the evaluation support information includes information for reporting abnormal values.

11. The endoscope system according to claim 1, wherein the evaluation support information includes information that notifies the timing of the transition from a first stage in which the muscles located at the gastroesophageal junction relax to a second stage in which the lower esophageal sphincter relaxes.

12. The endoscopic system according to claim 11, wherein the processor detects the timing by AI (Artificial Intelligence) or scene recognition by machine learning.

13. The endoscope system according to claim 1, wherein the evaluation support information includes an image in which the region corresponding to the muscle located at the gastroesophageal junction in the captured image is highlighted.

14. The endoscopic system according to claim 13, wherein the processor receives an instruction input to modify a region in the captured image that corresponds to the muscle located at the gastroesophageal junction, and generates an image in which the modified region is highlighted in accordance with the instruction input.

15. An endoscope system comprising: a light source that emits illumination light which is narrowband light that emphasizes vascular structures; an endoscope that emits the illumination light from the tip of an insertion part inserted into a subject and images the subject with an image sensor located at the tip of the insertion part; an air supply device that supplies gas through an air supply tube provided in the insertion part; and a processor, wherein the processor detects vascular structures contained in the muscle located at the gastroesophageal junction in the image captured by the image sensor, generates time-series information that associates the detection results of vascular structures contained in the muscle located at the gastroesophageal junction with time, and generates evaluation support information that supports the evaluation of the function of the muscle located at the gastroesophageal junction based on the time-series information.

16. An evaluation support method comprising: inserting the insertion portion of an endoscope into the stomach; enabling imaging of the gastric cardia using the endoscope; insufflating air into the stomach; detecting the muscle located at the gastroesophageal junction in the image captured using the endoscope during air insufflation into the stomach; generating time-series information relating the detection result of the muscle located at the gastroesophageal junction to time; and generating evaluation support information to support the evaluation of the function of the muscle located at the gastroesophageal junction based on the time-series information.

17. An evaluation support program that causes a processor to perform the following processes: detect muscles located at the gastroesophageal junction in an image of the gastric cardia taken using an endoscope with an insertion portion inserted into the stomach during air insufflation into the stomach; generate time-series information relating the detection results of the muscles located at the gastroesophageal junction to time; and generate evaluation support information that supports the evaluation of the function of the muscles located at the gastroesophageal junction based on the time-series information.

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