EP2398375A1 - Gastroscope - Google Patents

Gastroscope

Info

Publication number
EP2398375A1
EP2398375A1 EP10704556A EP10704556A EP2398375A1 EP 2398375 A1 EP2398375 A1 EP 2398375A1 EP 10704556 A EP10704556 A EP 10704556A EP 10704556 A EP10704556 A EP 10704556A EP 2398375 A1 EP2398375 A1 EP 2398375A1
Authority
EP
European Patent Office
Prior art keywords
electrode
gastroscope
voltage
gastroscope according
electrical
Prior art date
Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
Withdrawn
Application number
EP10704556A
Other languages
German (de)
English (en)
Inventor
Stefan FÖRTSCH
Rainer Kuth
Karl-Heinz Maier
Current Assignee (The listed assignees may be inaccurate. Google has not performed a legal analysis and makes no representation or warranty as to the accuracy of the list.)
Siemens AG
Original Assignee
Siemens AG
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Priority claimed from DE102009009290A external-priority patent/DE102009009290A1/de
Priority claimed from DE102009023037A external-priority patent/DE102009023037A1/de
Priority claimed from DE201010006969 external-priority patent/DE102010006969A1/de
Application filed by Siemens AG filed Critical Siemens AG
Publication of EP2398375A1 publication Critical patent/EP2398375A1/fr
Withdrawn legal-status Critical Current

Links

Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B5/00—Measuring for diagnostic purposes; Identification of persons
    • A61B5/05—Detecting, measuring or recording for diagnosis by means of electric currents or magnetic fields; Measuring using microwaves or radio waves 
    • A61B5/053—Measuring electrical impedance or conductance of a portion of the body
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B1/00—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor
    • A61B1/00064—Constructional details of the endoscope body
    • A61B1/00071—Insertion part of the endoscope body
    • A61B1/0008—Insertion part of the endoscope body characterised by distal tip features
    • A61B1/00097—Sensors
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B1/00—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor
    • A61B1/273—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor for the upper alimentary canal, e.g. oesophagoscopes, gastroscopes
    • A61B1/2736—Gastroscopes
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B5/00—Measuring for diagnostic purposes; Identification of persons
    • A61B5/05—Detecting, measuring or recording for diagnosis by means of electric currents or magnetic fields; Measuring using microwaves or radio waves 
    • A61B5/053—Measuring electrical impedance or conductance of a portion of the body
    • A61B5/0538—Measuring electrical impedance or conductance of a portion of the body invasively, e.g. using a catheter
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B5/00—Measuring for diagnostic purposes; Identification of persons
    • A61B5/145—Measuring characteristics of blood in vivo, e.g. gas concentration, pH value; Measuring characteristics of body fluids or tissues, e.g. interstitial fluid, cerebral tissue
    • A61B5/14546—Measuring characteristics of blood in vivo, e.g. gas concentration, pH value; Measuring characteristics of body fluids or tissues, e.g. interstitial fluid, cerebral tissue for measuring analytes not otherwise provided for, e.g. ions, cytochromes
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B5/00—Measuring for diagnostic purposes; Identification of persons
    • A61B5/42—Detecting, measuring or recording for evaluating the gastrointestinal, the endocrine or the exocrine systems
    • A61B5/4222—Evaluating particular parts, e.g. particular organs
    • A61B5/4238—Evaluating particular parts, e.g. particular organs stomach
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B5/00—Measuring for diagnostic purposes; Identification of persons
    • A61B5/68—Arrangements of detecting, measuring or recording means, e.g. sensors, in relation to patient
    • A61B5/6846—Arrangements of detecting, measuring or recording means, e.g. sensors, in relation to patient specially adapted to be brought in contact with an internal body part, i.e. invasive
    • A61B5/6847—Arrangements of detecting, measuring or recording means, e.g. sensors, in relation to patient specially adapted to be brought in contact with an internal body part, i.e. invasive mounted on an invasive device
    • A61B5/6852—Catheters
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B18/04—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating
    • A61B18/12—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating by passing a current through the tissue to be heated, e.g. high-frequency current
    • A61B18/1206—Generators therefor
    • A61B2018/1246—Generators therefor characterised by the output polarity
    • A61B2018/126—Generators therefor characterised by the output polarity bipolar
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B2562/00—Details of sensors; Constructional details of sensor housings or probes; Accessories for sensors
    • A61B2562/02—Details of sensors specially adapted for in-vivo measurements
    • A61B2562/0209—Special features of electrodes classified in A61B5/24, A61B5/25, A61B5/283, A61B5/291, A61B5/296, A61B5/053
    • A61B2562/0215—Silver or silver chloride containing

Definitions

  • the invention relates to a gastroscope.
  • Such a gastroscope which is a flexible endoscope, is used to examine the upper gastrointestinal tract.
  • a common cause of discomfort in the upper gastrointestinal tract is a bacterial infestation of its organs.
  • infestation with Helicobacter pylori is responsible for a whole range of gastric diseases, which are accompanied by an increased secretion of stomach acid. These include, for example, type B gastritis, about 75% of gastric ulcers and almost all twelve-finger gut ulcers.
  • type B gastritis about 75% of gastric ulcers
  • almost all twelve-finger gut ulcers are important part of the diagnosis of gastric diseases.
  • Helicobacter pylori is detected via a breath test in which a patient is administered a C-13 masked urea.
  • the C-13 masked CO 2 resulting from the cleavage of urea (CO (NH 2 ) 2 ) into ammonia (NH 3 ) and carbon dioxide (CO 2 ) is detected in the exhaled air.
  • Other methods of detecting Helicobacter pylori are indicative of typical blood levels, such as
  • stomach for colonization with Helicobacter pylori Another way to examine the stomach for colonization with Helicobacter pylori is the so-called gastroscopy ("gastroscopy").
  • gastroscopy By means of a biopsy, the gastroenterologist takes a tissue sample (biopsy) from the gastric mucosa in order to examine it immediately or later for an infection with Helicobacter pylori.
  • a well-known examination procedure for the tissue sample is, for example, the Helicobacter urease test (HU test, HUT for short).
  • the biopsy is placed in a test medium (measuring solution), which consists of a nutrient solution for this bacterium, urea and an indicator (litmus).
  • the bacterium splits the urea (CO (NH2) 2) by urease into ammonia (NH3) and carbon dioxide (CO2). • The ammonia then colors the indicator red. The test result can be seen after a few minutes. The onset of color change from yellow to red is not clearly identifiable under unfavorable conditions.
  • An alternative to a gastroscopy performed by means of a flexible endoscope is the use of a so-called endoscopy capsule.
  • Such endoscopy capsule which is also referred to as a capsule endoscope or endocapsule, is designed as a passive endocapsule or as a navigable endocapsule.
  • a passive endoscopy capsule moves through the patient's intestine due to peristalsis.
  • a navigable endocapsule is known, for example, from the patent with the publication number DE 101 42 253 C1 and from the corresponding patent application with the publication number US 2003/0060702 A1, where it is referred to as "endo-robot” or "endo-robot”.
  • the Endoroboter known from these publications can by means of a
  • Magnetic field which is generated by an external (ie arranged outside the patient) magnetic system (coil system), be navigated in a hollow organ (eg gastrointestinal tract) of a patient.
  • An integrated system for position control which includes a position measurement of the endo-robot and an automatic control of the magnetic field or the coil currents, can automatically detect and compensate for changes in the position of the endorobot in the patient's hollow organ. be siert.
  • the endorobot can be specifically navigated to desired regions of the hollow organ.
  • This type of capsule endoscopy is therefore also referred to as MGCE (Magnetically Guided Capsule Endoscopy - magnetically guided capsule endoscopy).
  • the object of the present invention is to provide a gastroscope with which gastric mucosa can be examined for Helicobacter pylori in a very short time.
  • the gastroscope according to the invention has an insertion tube, at the distal end of which a sensor is arranged, the sensor having a first electrode made of a noble metal which is not vulnerable to acid (eg hydrochloric acid, phosphoric acid, sulfuric acid, gastric acid) and a second electrode made of silver and wherein between the first electrode and the second electrode, an electrical voltage can be applied and in the presence of ammonia between the first electrode and the second electrode, a change in an electrical variable is measurable.
  • a first electrode made of a noble metal which is not vulnerable to acid (eg hydrochloric acid, phosphoric acid, sulfuric acid, gastric acid)
  • a second electrode made of silver
  • the gastroscope according to claim 1 can be detected in a simple manner during the study directly in the gastrointestinal tract of a patient and without taking a tissue sample ammonia (NH 3 ).
  • the gastroscope according to claim 1 thus allows the patient only a low-stress study of gastric acid and the tissue of the gastric mucosa on Helicobacter pylori.
  • the electrical voltage between the first electrode and the second electrode is zero. This flows between the first The electrode and the second electrode no current. Between the first electrode and the second electrode, the potential, that is to say without current, is thus advantageously measured. This hardly causes ion migration in the stomach acid.
  • the electrical voltage between the first electrode and the second electrode is an AC voltage having a variably predeterminable frequency spectrum.
  • the ions migrate to the associated electrodes, the cations (eg ammonium NH 4 + ) to the cathode and the anions (eg chloride Cl " ) to the anode in the gastroscope according to claim 3, a complete charging of the first electrode (reference electrode) and complete charging of the second electrode (measuring electrode) reliably prevented, since at a sufficiently high frequency, the migration velocity of the ions in the gastric acid is almost zero.
  • the second electrode which according to the invention consists of silver (Ag), cyclically switches between destruction and a structure of the silver chloride layer (AgCl).
  • the zer disorder of the silver chloride layer and its structure can be measured, for example via an impedance measurement and compared cyclically.
  • the measurable potential differences and phase differences are characteristic of the presence of a urease activity, which can be concluded with a very high degree of certainty for the presence of Helicobacter pylori.
  • the frequency spectrum of the alternating voltage is modulated. This results in increased stability of the AC voltage, which increases the measurement accuracy and reduces the measurement time.
  • the electrical voltage between the first electrode and the second electrode is an applicable for a predetermined time DC voltage.
  • the predeterminable time for which a voltage can be applied by the user between the first electrode and the second electrode can be between zero seconds and continuously, wherein the user-selected electrical voltage can be zero volts or higher.
  • a time of zero seconds or a voltage of zero volts is a passive measurement. For deviating values, an active measurement is available.
  • electrical quantities e.g. Potentials, electrical currents or electrical resistances or their changes or variables derived from the electrical quantities (for example electrical conductivity) or their changes are measured.
  • the second electrode (measuring electrode) made of silver (Ag) in the gastroscope according to claim 1 must be etched by hydrochloric acid (HCl). This can, but does not have to be, done for the first time before the delivery of the gastroscope or the second electrode. However, it is also possible for the user to carry out the first-time HCl etching himself or to apply a corresponding silver chloride layer by means of a suitable electrolytic process. After its HCl etching or after its electrolytic deposition, the second electrode has on its surface a coating of silver chloride (AgCl) and is thus activated for the measurement for the detection of Helicobacter pylori.
  • HCl hydrochloric acid
  • the gastroscope according to claim 1 can be detected in a simple manner during the study directly in the gastrointestinal tract of the patient and without taking a tissue sample ammonia (NH 3 ).
  • the gastroscope according to the invention enables a simple control or a simple regulation of the sensor or its first electrode (reference electrode) and / or its second electrode (measuring electrode), for example by a baseline correction. Furthermore, a reproducible regeneration of the sensor, in particular of the second electrode, is possible after each examination.
  • the sensitivity of the sensor or its first electrode and / or its second electrode can be set in a simple manner. Sensitivity adjustment can be made before and during Helicobacter pylori examination.
  • platinum (Pt) and gold (Au) come into question.
  • the sensor After introducing the gastroscope according to the invention, the sensor detects ammonia (NH3) present in the gastric acid in the gastric mucosa and in the tissue of the gastric mucosa.
  • ammonia NH3
  • ammonia is a very strong indication of the presence of Helicobacter pylori, since ammonia is produced by the Helicobacter pylori bacteria by a split of urea by urease, in order to avoid the acidic Environment of the gastrointestinal tract, in particular the high concentration of acid in the stomach.
  • the second electrode (measuring electrode) made of silver (Ag) in the gastroscope according to claim 1 must be etched by hydrochloric acid (HCl). After its HCl etching, the second electrode has on its surface a coating of silver chloride (AgCl) and is thus activated for the measurement for the detection of Helicobacter pylori.
  • the activation of the second electrode is based on the following chemical reaction:
  • ammonia (NH 3 ) under normal circumstances in a hollow organ of the gastrointestinal tract, such as the stomach, due to the following neutralization reaction (formation of an ammonium cation by protonation of ammonia)
  • H + hydrogen nucleus
  • the salt AgCl (silver chloride) is split by ammonia into the silver-diamine complex [Ag (NH 3 ) 2 ] + and in chlorine Cl " .
  • [Ag (NH 3 ) 2] + is excellently soluble in water as a cation and is taken up by gastric acid, between the first electrode (reference electrode) and the second electrode
  • measuring electrode is according to advantageous embodiments of the gastroscope according to the invention either a zero voltage (claim 2) or there is an electrical see AC voltage with a variable predetermined frequency spectrum (claim 3). Alternatively, between the first electrode and the second electrode for a predetermined time a DC voltage applied (claim 4). In all cases, there is hardly any ion migration in the gastric acid (migration rate of the cations and the anions nearly zero).
  • the electrical variable (potential, electrical current, electrical resistance) measured between the first electrode (reference electrode) and the second electrode (measuring electrode) is logged, displayed and, if desired, transmitted to evaluation electronics.
  • evaluation electronics By a (automated) comparison of the measured value with predefined values, a possible infiltration of the gastric mucosa onto Helicobacter pylori can be reliably displayed.
  • the gastroscope according to the invention can thus be used again for the detection of Helicobacter pylori after any necessary recalibration of the sensor.
  • a calibration of the sensor can be done for example by a dosage of synthetic ammonia.
  • the gastroscope is removed and then disinfected.
  • an ammoniacal rinse solution e.g., ammoniacal disinfectant. If the gastroscope has a structurally suitable sensor, then the gastroscope can be completely sterilized by a suitable sterilization procedure and used for a new examination.
  • the gastroscope according to the invention permits a study of the gastric mucosa on Helicobacter pylori which is only of minor stress to the patient, and only when a suspicion of the presence of senescence of Helicobacter pylori tissue samples.
  • the removal of tissue samples may be performed by the gastroscope if it has a biopsy device.
  • the sole figure shows a gastroscope 1, which is a flexible endoscope and is used to examine the upper gastrointestinal tract.
  • the gastroscope 1 has a flexible insertion tube 2, on whose one end, namely the distal end 3, a sensor 4 is arranged.
  • the sensor 4 comprises a first electrode 5 (reference electrode) made of a noble metal, which is not vulnerable to hydrochloric acid, and a second electrode 6 (measuring electrode) made of silver (Ag).
  • Both electrodes 5 and 6 have in the embodiment shown at a constant distance from each other.
  • platinum (Pt) and gold (Au) come into question.
  • An electric voltage can be applied between the first electrode 5 and the second electrode 6, whereby, when ammonia is present, a change in an electrical quantity, for example, between the first electrode 5 and the second electrode 6 occurs. Potential, electrical current or electrical resistance, is measurable.
  • the sensor 4 or the first electrode 5 and / or the second electrode 6 are in the illustrated embodiment, frontal arranged at the distal end 3 of the insertion tube 2 of the gastroscope 1.
  • other arrangements of the sensor 4 or the first electrode 5 and / or the second electrode 6 are possible.
  • Side wall of the insertion tube 2 may be arranged that an increase in the diameter of the insertion tube 2 of the gastroscope 1 is not required.

Landscapes

  • Health & Medical Sciences (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Surgery (AREA)
  • Physics & Mathematics (AREA)
  • Molecular Biology (AREA)
  • General Health & Medical Sciences (AREA)
  • Engineering & Computer Science (AREA)
  • Biomedical Technology (AREA)
  • Heart & Thoracic Surgery (AREA)
  • Medical Informatics (AREA)
  • Biophysics (AREA)
  • Veterinary Medicine (AREA)
  • Animal Behavior & Ethology (AREA)
  • Pathology (AREA)
  • Public Health (AREA)
  • Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
  • Radiology & Medical Imaging (AREA)
  • Optics & Photonics (AREA)
  • Gastroenterology & Hepatology (AREA)
  • Endocrinology (AREA)
  • Physiology (AREA)
  • Endoscopes (AREA)
  • Measurement Of The Respiration, Hearing Ability, Form, And Blood Characteristics Of Living Organisms (AREA)

Abstract

L'invention concerne un gastroscope (1) comportant un tuyau d'introduction (2) dont l'extrémité distale (3) porte un détecteur (4). Le détecteur (4) comporte une première électrode (5) en métal précieux résistant à l'acide, et une deuxième électrode (6) en argent. Une tension électrique peut être appliquée entre la première électrode (5) et la deuxième électrode (6), et une variation d'une grandeur électrique peut être mesurée lorsque de l'ammoniaque est présent entre la première électrode (5) et la deuxième électrode (6). Un tel gastroscope permet de réaliser une analyse de l'acide gastrique et du tissu de la muqueuse stomacale quant à la présence d'Helicobacter pylori, n'affectant que peu le patient.
EP10704556A 2009-02-17 2010-02-15 Gastroscope Withdrawn EP2398375A1 (fr)

Applications Claiming Priority (4)

Application Number Priority Date Filing Date Title
DE102009009290A DE102009009290A1 (de) 2009-02-17 2009-02-17 Gastroskop
DE102009023037A DE102009023037A1 (de) 2009-05-28 2009-05-28 Gastroskop
DE201010006969 DE102010006969A1 (de) 2010-02-05 2010-02-05 Gastroskop
PCT/EP2010/051855 WO2010094651A1 (fr) 2009-02-17 2010-02-15 Gastroscope

Publications (1)

Publication Number Publication Date
EP2398375A1 true EP2398375A1 (fr) 2011-12-28

Family

ID=42091517

Family Applications (1)

Application Number Title Priority Date Filing Date
EP10704556A Withdrawn EP2398375A1 (fr) 2009-02-17 2010-02-15 Gastroscope

Country Status (6)

Country Link
US (1) US8909315B2 (fr)
EP (1) EP2398375A1 (fr)
JP (1) JP5295390B2 (fr)
CN (1) CN102316787A (fr)
MX (1) MX2011008665A (fr)
WO (1) WO2010094651A1 (fr)

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CN109171632B (zh) * 2018-08-22 2021-02-09 中南大学湘雅医院 一种方便取样的胃镜装置

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Also Published As

Publication number Publication date
JP2012517839A (ja) 2012-08-09
JP5295390B2 (ja) 2013-09-18
CN102316787A (zh) 2012-01-11
US20110313265A1 (en) 2011-12-22
WO2010094651A1 (fr) 2010-08-26
MX2011008665A (es) 2011-09-08
US8909315B2 (en) 2014-12-09

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