JP4517321B2 - Overtube - Google Patents

Description

Ｂ．１００ｍｍＨｇでラテックスバルーンを拡張し、引き抜いた際の粘膜損傷の有無を見たが、肉眼的に全く損傷は認めず。
以上の結果から小腸内視鏡用のバルーンとしてはラテックス性の柔らかいもので、拡張圧は４０−１００ｍｍＨｇ特に５０−６０ｍｍＨｇが最適と考えられた。
【００１３】
臨床使用経験
本発明による方法を用いて、１９９９年６月〜１９９９年１２月の間に４症例に対して小腸内視鏡を施行した。その内訳は別表に示す。４例中３例は出血源不明の消化管出血に対して行われ、１例は蛋白漏出性胃腸症の精査目的に試行された。はじめの３例では有効長１０３ｃｍの短い内視鏡を用いたにもかかわらず、３症例すべてにおいてトライツ靱帯より、約３０−４０ｃｍまでの挿入が可能であり、２症例において出血点の確認、１症例において狭窄部の確認と目的達成が可能であった。それ以深の挿入不能は内視鏡の有効長不足のためであり、腸管屈曲のためではなかった。第４症例では有効長２ｍの内視鏡と１４０ｃｍのオーバーチューブを用いたところ、盲腸までの内視鏡挿入が可能であり、バウヒン弁から約１ｍのところにメッケル憩室と思われる憩室と、その開口部の遠位側縁に潰瘍形成を認め、出血源と診断した。
表中の内視鏡 ＸＰ−２４０：Ｏｌｙｍｐｕｓ ＸＰ−２４０（有効長１０３ｃｍ、外径７．７ｍｍ）
ＳＩＦ−Ｑ２４０：Ｏｌｙｍｐｕｓ ＳＩＦ−Ｑ２４０（有効長２００ｃｍ、外径９．８ｍｍ）

【００１４】
【発明の効果】
この発明により、これまでの方法では内視鏡挿入が出来なかったような深部小腸等にも内視鏡の挿入が可能となり、診断、治療の両面から有用性が高いと考えられる。具体的には原因不明の消化管出血、造影Ｘ線検査により指摘された小腸病変、慢性の下痢又は吸収障害の診断目的、小腸出血に対する内視鏡的止血術、小腸ポリープ、粘膜腫瘍に対する内視鏡的切除術、小腸の狭窄病変に対する拡張術やステンティング等の治療目的に使用可能と考えられる。本発明の使用により、これまでは開腹手術を必要としたものも内視鏡治療が行える可能性を秘めている。本発明は小腸以外でも例えば通常の方法で挿入不可能な症例における大腸内視鏡検査等に使用可能である。また、本発明のチューブ挿入後チューブを残して内視鏡を抜去し、様々な処置具のルートとしても使用可能である。
【図面の簡単な説明】
【図１】内視鏡挿入補助用バルーン付きチューブの先端部。
【図２】内視鏡挿入補助用バルーン付きチューブの中央部。
【図３】内視鏡挿入補助用バルーン付きチューブの近位端部。
【図４】内視鏡に装着して実際に使用する際の略図である。
【符号の説明】
１ チューブ先端バルーン
２ チューブ先端部
３ バルーン拡張用エアルート：バルーン内圧モニタリング機能を備えたエア供給装置に連結。
４ チューブ本体
５ 潤滑剤のルート
６ 潤滑剤注入用ポート
７ チューブ手元のにぎり
８ チューブ近位端括約弁
９ 内視鏡
１０内視鏡先端バルーン[0001]
BACKGROUND OF THE INVENTION
The present invention relates to gastrointestinal endoscopy as a medical technique, and relates to an endoscope and other auxiliary tools for inserting a body cavity observation tool and a treatment tool.
[0002]
[Prior art]
As a conventional endoscope insertion aid, there is a sliding over tube for keeping the intestine straight. The present invention relates to “Endoscope-equipped balloons used for gastrointestinal endoscopy, sliding tubes with balloons, and methods for using them” (Japanese Patent Application No. 10-140358) filed on April 13, 1998. Which is mainly used in the same way.
[0003]
[Problems to be solved by the invention]
When inserting an endoscope into a deep intestinal tract represented by a small intestine endoscope, as the endoscope is inserted, the intestinal tract forms a loop, and the insertion force is not transmitted to the endoscope tip, so that There is a problem that insertion becomes impossible. Conventionally, this is considered to be a problem that the intestinal tract forms a loop, and a rigid sliding tube has been used for assisting insertion in order to straighten it. However, the range of the intestinal tract that can be straightened is limited, and even when such a tube is used in combination, the insertion range of the endoscope in the small intestine endoscope is at most about 1 m from the Tritz ligament.
[0004]
[Means for Solving the Problems]
The real reason why it is difficult to insert deep into the endoscope is not to say that the intestinal tract will bend, but to bend the bent intestinal tract, and hold it with a balloon to prevent intestinal extension. An endoscope insertion method using a soft sliding tube was devised. The invention of claim 1 is used for assisting insertion of an endoscope, an intracorporeal observation instrument, and a treatment instrument. In an overtube with a balloon, the balloon is latex and the pressure is 40 to 100 mmHg. When the balloon is expanded with the pressure, the outer peripheral contact surface of the balloon that contacts the inner wall of the intestine uniformly applies pressure to the inner wall, and the outer peripheral contact surface grips the inner wall with a predetermined gripping force. It is characterized by. The invention of claim 2 is used for assisting insertion of an endoscope, an intracorporeal observation instrument, and a treatment instrument. In an overtube with a balloon, the balloon is latex and the pressure is 50 to 60 mmHg. When the balloon is expanded with the pressure, the outer peripheral contact surface of the balloon that contacts the inner wall of the intestine uniformly applies pressure to the inner wall, and the outer peripheral contact surface grips the inner wall with a predetermined gripping force. It is characterized by. According to a third aspect of the present invention, in the first or second aspect of the present invention, the predetermined gripping force is a force of 70 g weight or more . According to a fourth aspect of the present invention, in any one of the first to third aspects, the pressure during expansion is monitored by measuring the internal pressure of the balloon .
[0005]
DETAILED DESCRIPTION OF THE INVENTION
The present invention uses the sliding tube with a balloon safely and effectively in “Endoscope-mounted balloon for use in gastrointestinal endoscopy, balloon-equipped sliding tube, and method for using them” (Japanese Patent Application No. 10-14358). This is a specific point for this purpose.
[0006]
The overtube with balloon in the present invention is not intended to keep the intestine straight with its rigidity, but to prevent extension of the bent intestine. Therefore, the tube in the present invention is a material that does not stretch, and if it has followability, rigidity is not necessary, and a soft material is preferable.
[0007]
The balloon in the present invention is required to have a sufficient gripping force without damaging the intestinal tract and the like. Therefore, it is preferable that a uniform pressure is applied to the intestinal tract with a wide contact area when the balloon is inflated. Specifically, a soft and durable material such as latex used in condoms is preferable.
[0008]
The pressure suitable for balloon expansion in the present invention is a pressure that does not damage the intestinal tract and the like and can provide a sufficient gripping force. The actual expansion pressure is considered to be optimal at 40-100 mmHg, especially 50-60 mmHg.
[0009]
In the present invention, monitoring the expansion pressure of the balloon is necessary for safety measures. Since the air supply tube to the balloon of the present invention is thin and long, there is a difference between the air supply pressure and the balloon internal pressure. Therefore, a method of calculating the balloon internal pressure by measuring the air pressure and the air flow rate and subtracting the pressure difference calculated from the air flow rate from the air pressure is useful. It is desirable to monitor by directly measuring the pressure in the balloon if technically possible.
[0010]
In the present invention, in order to smoothly insert the endoscope, it is necessary to minimize the frictional resistance between the overtube and the endoscope. As a device for that purpose, we considered a mechanism that can always supply a lubricant such as olive oil. The distal end of the overtube is slightly tapered so that there is no gap with the endoscope. By doing so, the backflow of gastrointestinal fluid into the tube is prevented, and at the same time, the outflow of lubricant is minimized. Moreover, by doing in this way, the damage by the entrapment of a mucous membrane can also be prevented. A sphincter valve for preventing backflow is installed at the proximal end of the upper tube to prevent backflow of gastrointestinal fluid and lubricant. A port that opens in the middle of the overtube is provided so that the lubricant can be constantly supplied. It is convenient to provide a mechanism for storing a lubricant such as a balloon and automatically gradually supplying it to a port outside the lubricant supply route.
Other measures to reduce frictional resistance include the use of low-friction materials such as Teflon, coating of such materials on the outer surface of the endoscope and the inner surface of the overtube, and numerous longitudinal grooves on the inner surface of the overtube. A method of reducing the contact area can be considered.
[0011]
【Example】
Experiment Using Dog's Small Intestine In order to examine the balloon material and expansion pressure suitable for the present invention, experiments were conducted using the dog's small intestine. Opening under general anesthesia, inserting a silicone and latex balloon attached to the tip of a 10mm diameter and 15cm long rod from the incision in the jejunum. I investigated.
[0012]
Experimental results A. Relationship between expansion pressure and gripping force in two types of balloons

B. The latex balloon was expanded at 100 mmHg, and the presence or absence of mucosal damage was observed when it was pulled out, but no damage was visually observed.
From the above results, it was considered that the balloon for a small intestine endoscope is soft and latex, and the expansion pressure is optimally 40-100 mmHg, especially 50-60 mmHg.
[0013]
Clinical Use Experience Using the method according to the present invention, a small intestine endoscope was performed on 4 cases between June 1999 and December 1999. The breakdown is shown in the attached table. Three of the four cases were performed for gastrointestinal bleeding with unknown source of bleeding, and one was tried for the purpose of examining protein-losing gastroenteropathy. Despite the use of a short endoscope with an effective length of 103 cm in the first three cases, all three cases can be inserted up to approximately 30-40 cm from the Tritz ligament. It was possible to confirm the stenosis and achieve the purpose in the case. The deeper inability to insert was due to lack of the effective length of the endoscope, not due to bowel flexion. In the 4th case, using an endoscope with an effective length of 2 m and an overtube of 140 cm, an endoscope can be inserted up to the cecum, and a diverticulum considered to be a Meckel diverticulum about 1 m from the Bauhin valve, Ulcer formation was observed at the distal edge of the opening, and the patient was diagnosed with a bleeding source.
Endoscope XP-240 in table: Olympus XP-240 (effective length 103 cm, outer diameter 7.7 mm)
SIF-Q240: Olympus SIF-Q240 (effective length 200 cm, outer diameter 9.8 mm)

[0014]
【The invention's effect】
According to the present invention, it is possible to insert an endoscope into a deep small intestine or the like that could not be inserted by a conventional method, and it is considered highly useful in terms of both diagnosis and treatment. Specifically, gastrointestinal bleeding of unknown cause, small intestine lesions pointed out by contrast X-ray examination, diagnosis purpose of chronic diarrhea or absorption disorder, endoscopic hemostasis for small intestinal bleeding, small intestine polyp, endoscopy for mucosal tumor It can be used for therapeutic purposes such as mirror resection, dilatation of the small intestine, and stenting. The use of the present invention has the potential to perform endoscopic treatments that previously required laparotomy. The present invention can be used for, for example, colonoscopy in cases other than the small intestine that cannot be inserted by a normal method. Further, the endoscope can be used as a route for various treatment instruments by leaving the tube after insertion of the tube of the present invention and removing the endoscope.
[Brief description of the drawings]
FIG. 1 shows a distal end portion of a tube with a balloon for assisting insertion of an endoscope.
FIG. 2 is a central portion of a tube with a balloon for assisting insertion of an endoscope.
FIG. 3 is a proximal end portion of a tube with a balloon for assisting insertion of an endoscope.
FIG. 4 is a schematic view when the endoscope is actually used after being attached to the endoscope.
[Explanation of symbols]
1 Tube tip balloon 2 Tube tip 3 Balloon expansion air route: Connected to an air supply device equipped with a balloon internal pressure monitoring function.
4 Tube body 5 Lubricant route 6 Lubricant injection port 7 Nigiri at the hand of the tube 8 Tube proximal end sphincter valve 9 Endoscope 10 Endoscope tip balloon

Claims (4)

Used to assist the insertion of endoscopes, in-vivo observation tools, and treatment tools, while holding the intestinal tract with a balloon to prevent intestinal extension and inserting the endoscope, in-vivo observation tool, and treatment tool In an overtube with a balloon,
The balloon expands at a pressure of 40 to 100 mmHg, and the outer peripheral contact surface of the balloon that contacts the inner wall of the intestine when expanded at the pressure follows the intestine without damaging the intestine. The balloon is formed of a soft material such as latex used for a condom so that pressure is evenly applied to a wide contact area, and the inner wall is gripped with a predetermined gripping force on the outer peripheral contact surface of the balloon. Over tube characterized by. Used to assist the insertion of endoscopes, in-vivo observation tools, and treatment tools, while holding the intestinal tract with a balloon to prevent intestinal extension and inserting the endoscope, in-vivo observation tool, and treatment tool In an overtube with a balloon,
The balloon expands at a pressure of 50 to 60 mmHg, and the outer peripheral contact surface of the balloon that comes into contact with the inner wall of the intestine when expanded at the pressure follows the intestine without damaging the intestine. The balloon is formed of a soft material such as latex used for a condom so that pressure is evenly applied to a wide contact area, and the inner wall is gripped with a predetermined gripping force on the outer peripheral contact surface of the balloon. Over tube characterized by.   The overtube according to claim 1 or 2, wherein the predetermined gripping force is a force of 70 g or more.   The overtube according to any one of claims 1 to 3, wherein a pressure during expansion is monitored by measuring an internal pressure of the balloon.

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