JP2000102542A - Ligating instrument for endoscope - Google Patents

Abstract

PROBLEM TO BE SOLVED: To provide a ligating instrument for endoscope capable of surely moving a lesion part into an inner cavity of a dispenser and surely ligate the same. SOLUTION: A plurality of ligating bands 13-17 are supported in a state that they are expanded to an outer peripheral surface of a dispenser 4 mountable on a distal end of an endoscope, and the independent displacement filaments respectively engaged with this ligating band and having the proximal ends extended to a proximal side operating part of the endoscope are mounted. An outer channel 6 capable of inserting the independent displacement filaments, having the distal end fixed to the dispenser, and extended along the axial direction of the endoscope is mounted, and a device operating part 8 capable of connecting the proximal end of the outer channel, and moving the independent displacement filaments in the proximal direction is mounted.

Description

DETAILED DESCRIPTION OF THE INVENTION

[0001]

BACKGROUND OF THE INVENTION 1. Field of the Invention The present invention relates to a ligating apparatus for an endoscope for continuously ligating a living tissue at the time of treating a stomach, esophageal varices, or performing a polyp or mucosal resection.

[0002]

2. Description of the Related Art In general, as a device capable of continuously ligating living tissue, for example, US Pat. No. 5,398,844.
There is a configuration disclosed in the specification. As shown in FIG. 21, the ligating device a includes a dispenser b attachable to the distal end of an endoscope, and a plurality of ligating bands c1 to c6 supported in an expanded state on the outer peripheral surface of the dispenser b.
And a ligating band c that can be inserted through the lumen d inside the endoscope.
Consisting of independent displacement filaments e1 to e6 which are independently connected to one of 1 to c6. A plurality of sets of the filaments e1 to e6 extend through the lumen d of the endoscope to the operation section of the endoscope.

An operator sucks a living tissue into a dispenser b through a lumen d of an endoscope. Thereafter, by pulling each set of filaments e1 to e6 toward the hand,
A ligating band c1 corresponding to each filament e1 to e6
Send c6 to the distal side of dispenser b and ligate band c1
~ C6 can be sequentially removed to ligate a plurality of living tissues.

[0004]

However, in the configuration disclosed in the above-mentioned U.S. Pat. No. 5,398,844, a plurality of filaments e1 to e6 are inserted inside the lumen d of the endoscope. Therefore, the lumen of the lumen d is narrowed. Therefore, when the inside of the dispenser b is decompressed through the lumen d and the tissue is moved to the inside of the dispenser b, the air circulation in the lumen of the lumen is obstructed, and as a result, it takes time until the movement of the tissue is completed.

[0005] In the treatment of gastric and esophageal varices, or in cases of polyps and mucosal resection, it is often difficult to confirm the lesion due to adhesion of blood, blood clots, mucus and the like. In such a case, it is often performed to send water at a high pressure through the lumen d of the endoscope to peel off and wash the deposits on the mucous membrane. However, as described above, since the filaments e1 to e6 are inserted into the lumen d, water supply is hindered, and both the water supply amount and the water pressure are significantly reduced, which causes a problem that cleaning is hindered. .

Further, US Pat. No. 5,398,844 mentioned above.
In the specification, when assembling the ligating device to the endoscope, the filaments e1 to e6 must be inserted into the lumen d from the distal end of the endoscope.
It is necessary to perform an operation of inserting the extension into the operation section of the endoscope. However, when urgent treatment such as treatment of a ruptured varicose vein is required, there is a problem that quick treatment cannot be performed due to complicated assembly.

SUMMARY OF THE INVENTION The present invention has been made in view of the above circumstances. It is an object of the present invention to enable simple and quick assembly while satisfying the function of continuous ligation of living tissue. An object of the present invention is to provide a ligation procedure for an endoscope having a high suction capacity and a high water supply capacity.

[0008]

In order to achieve the above object, the present invention provides an endoscope ligating device for ligating a part of a tissue in a body in combination with an endoscope. A supporting means attachable to the proximal end, a plurality of ligating bands supported in an extended state on the outer peripheral surface of the supporting means, and engaging with each of the ligating bands, and a proximal end near the endoscope. An actuator channel extending to the position side operation unit, an external channel which can be inserted into the actuator unit, and a distal end is fixed to the support unit, and extends along the axial direction of the endoscope, Operating means capable of connecting a proximal end of the external channel and imparting a proximal movement to the actuator means.

According to the above construction, assembling is completed only by fixing each part of the support means, the ligating band, the external channel through which the actuator means is inserted, and the device operation part to the outer surface of the endoscope. The surgeon guides the endoscope to a target site in the body cavity, feeds water through the lumen of the endoscope as needed, and cleans around the target site. After confirming the target portion, the supporting means is brought into contact with the target portion, a negative pressure is applied through the lumen of the endoscope, and the living tissue is sucked into the supporting means. Thereafter, by pulling each set of actuator means toward the hand side, each actuator means sends a corresponding ligating band to the distal side of the supporting means, and removes the ligating bands in order to ligate a plurality of living tissues. .

[0010]

Embodiments of the present invention will be described below with reference to the drawings. 1 to 11 show a first embodiment, FIG. 1 is an overall perspective view of an endoscope ligation device, FIG. 2 is a longitudinal side view of a distal end portion of the device, and FIG. 3 is a view from the arrow B direction in FIG. 4 and 5 are views showing a state in which the filament is engaged with the ligating band, FIG. 6 is a side view and a plan view of the operation unit of the ligating device, and FIG. 7 is along the line DD in FIG. Sectional view,
8 to 12 are explanatory diagrams of the operation.

The ligating apparatus 1 for an endoscope includes a dispenser 4 as a supporting means which can be attached to the distal end portion 3 of the endoscope 2 and an external channel 6 which can be fixed to an outer surface of a body insertion portion 5 of the endoscope 2. And an operation unit 8 that can be fixed to the operation unit 7 of the endoscope 2
It is composed of

As shown in FIGS. 2 to 5, the endoscope 2 is provided with a lumen 9 penetrating in the axial direction from the distal end portion 3 to the device operation section 8. The dispenser 4 includes a support 11 attached to the distal end 3 of the endoscope 2 via a connector 10, and an outer peripheral surface 12 of the support 11 has five ligating bands 13 to 17 is supported in a stretched state.

A plurality of independent displacement filaments 18-22 as actuator means have distal ends 23-27 which engage respective corresponding ligating bands 13-17. The independent displacement filaments 18 to 22 are connected to the ligating band 13.
After engaging 17, it is introduced into the interior of the dispenser 4 through the distal end 28 of the dispenser 4.

After that, it extends outside the dispenser 4 through a communication hole 29 provided between the support 11 and the connector 10 and a seal 30 fixed to the communication hole 29, and is inserted into the inside of the external channel 6. Have been.

The ligating bands 13 to 17 can be expanded to the outer diameter of the support 11 and have a sufficient restoring force to separate the living tissue from the support 11, such as polyisoprene rubber and natural rubber. The dimensions are 1.5 to 2 mm in inner diameter and 4 to 6 mm in outer diameter.

The independent displacement filaments 18 to 22 are bifurcated at the distal end, and each has a pair of engaging portions 35a to 39.
a, 35b to 39b are formed. And support 1
One distal end 28 includes filament engaging portions 35a-39.
a, notches 40a-44 with which 35b-39b can engage
a, 40b to 44b are arranged. At this time, the notches 40a, 41a, 42a, 43a, and 44a are arranged adjacent to each other at a slight interval in the circumferential direction.

On the other hand, the notches 40a and 40b to 44a and 44b are all arranged at an angle of 180 °. Filament engaging portion 35a inside support 11
~ 39a, 35b ~ 39b are corresponding notches 40a ~
The support distal end 28 is folded back by engaging with 44 a, 40 b to 44 b respectively, and is located on the outer peripheral surface 12 of the support 11. Thereafter, the engagement portions 35a-39a, 35b-39b extend proximally to the corresponding ligating bands 13-17, respectively.

Next, the loops are joined to the ligating bands 13 to 17 to form a loop, and again pass under the ligating bands 13 to 17 and cut out along the outer peripheral surface 45 to form notches 40a to 44a and 40b to 44.
Return to b. Filament engaging portions 35a to 39a, 35b
-Ends 45a-49a, 45b-49 at the distal end of
b are fixed, and the ends 45a to 49a, 45b to 49b
Are engaged with and fixed to the notches 40a to 44a and 40b to 44b, respectively.

The outer channel 6 is flexible and has a sufficient durability against the operation of the independent displacement filaments 18 to 22, for example, polyvinyl chloride resin, tetrafluoroethylene, ethylene tetrafluoride-ethylene. It is composed of a copolymer resin, a tightly wound coil and the like. When a close-wound coil is adopted, polyethylene, tetrafluoroethylene-hexafluoroethylene copolymer, tetrafluoroethylene-perfluoroalkoxyethylene copolymer, etc. are applied to the outer surface of the coil so as not to damage the body cavity. It is desirable to provide a coating. And since the independent displacement filaments 18 to 22 slide independently on the inner surface,
It is formed of a material having a smooth surface and a small coefficient of friction, for example, a resin such as ethylene tetrafluoride.

The opening 50 of the external channel 6, which is located at the connection between the external channel 6 and the support 11, smoothly expands in the radial direction so as not to damage the inside of the body cavity, and the angle is reduced as much as possible. Is formed.

The seal 30 is composed of independent displacement filaments 18 to
22 is formed of a material having a sufficient elastic restoring force, for example, a silicone rubber, a polyisoprene rubber, a natural rubber or the like, so as to be able to shut off the air flow of the inner diameter of the communication hole 29 in a state where the sliding member 22 is slidably inserted. ing.

The support 11 has a sufficient strength not to deform the support of the ligating bands 13 to 17, but has a level of transparency that does not hinder observation by the endoscope 2, such as polycarbonate. It is formed of polystyrene, acrylic resin, or the like.

The device operating section 8 includes a winding handle 51.
A winding drum 52 fixed coaxially with a winding handle 51; a mounting pedestal 53 that can be engaged with the operation unit 7 of the endoscope 2;
4.

A plurality of meshing teeth 55 are formed on a part of the circumference of the drum 52, and a claw 56 engaging with the meshing teeth 55 is fixed to the operation portion main body. Meshing teeth 5
5 has a shoulder 57 on only one side, and the pawl 56 engages only with the shoulder 57. By matching the direction of the shoulder 57 with the winding direction (C) of the independent displacement filaments 18 to 22, the handle 51 can rotate in the (C) direction.
Rotation in the reverse direction is impossible.

The proximal sides of the independent displacement filaments 18-22 are movably connected on a loop 63 by connecting rings 58-62. A winding wire 64 is fixed to the proximal end of the loop 63, and a drum engaging portion 65 is fixed to the proximal end of the wire 64. The lengths of the independent displacement filaments 18 to 22 are shortened in the order of 18 to 22, and the independent displacement filaments 18 to 22 respectively engage with the ligating bands 13 to 17 in order from the distal side.

The independent displacement filaments 18 to 22 have sufficient strength against the pulling force applied when the ligating bands 13 to 17 are detached from the support body 11 and have sufficient slipperiness for independent sliding. It is formed of a material having a small surface friction coefficient, for example, ethylene tetrafluoride yarn having an outer diameter of 0.2 to 0.5 mm.

Next, the operation of the first embodiment will be described with reference to FIGS.
1 will be described. The surgeon attaches the dispenser 4 to the distal end portion 3 of the endoscope 2, the device operation unit 8 to the endoscope operation unit 7, and then attaches the external channel 6 to the endoscope insertion unit 5. The endoscope 2 is inserted while observing the lesion in the body cavity, and the support distal end 28 is positioned in contact with the lesion. Here, the operator depressurizes the lumen of the dispenser 4 through the lumen 9 of the endoscope, and moves the lesioned part into the inside of the dispenser 4. Since the air flow inside and outside the communication hole 29 through which the independently displaceable filaments 18 to 22 are inserted is blocked by the seal 30, the inner cavity of the dispenser 4 is effectively depressurized.

Next, the operator operates the handle 51 of the device operating section 8.
Is rotated, the drum 52 also follows and rotates, and the wire 64 engaged by the drum engaging portion 65 is wound around the circumference of the drum 52. At this time, a pulling force acts on the wire 64 to try to rotate the drum 52 in a direction opposite to the winding direction (C). However, since the claw 56 is engaged with the shoulder 57, the drum 52 is engaged. It does not rotate in the opposite direction than the combined position.

As the wire 60 is wound around the circumference of the drum 52, the shortest independently displaceable filament 18 moves proximally through the loop 63. Accordingly, the engagement portion 35 at the distal end of the independent displacement filament 18
The distal-most ligating band 13 engaging the loop formed by a and 35b is displaced distally and slid to the support distal end 28. By further winding the wire 64,
The ligating band 13 is disengaged from the distal end 28, and the ligating band 13 contracts due to elasticity to a diameter before expansion. Thus, the dispenser 4 is moved by the contracted ligating band 13 '(see FIG. 10).
The lesion that has been moved into the inside is ligated at its base.

At the same time, the ends 45a, 45b and the adjacent engaging portions 35a, 35b are disengaged from the notches 40a, 40b, so that the engagement between the engaging portions 35a, 35b and the ligating band 13 is released. Then, by further winding the wire 64, the independent displacement filament 18 separates from the dispenser 4 and is drawn into the lumen of the external channel 6.

Subsequently, the surgeon moves the endoscope 2 to another lesion, and moves the lesion into the dispenser 4. If a clot or mucus adheres around the lesion and obstructs the observation of the lesion, water is pumped through the endoscope lumen 9 to remove and wash these deposits. After confirming the lesion with the endoscope, the wire 64 is further wound around the circumference of the drum 52, and the independent displacement filament 19 having the next shorter length is moved to the proximal side through the loop 63. Accordingly, the ligating band 14 on the distal side, which is engaged with the loop formed by the engaging portions 36a and 36b, is displaced in the distal direction, and comes off the distal end 28 to ligate the lesion.

Subsequently, the independent displacement filaments 20 to
22, the engaging portions 37a to 39a, 37b to 39b, and the ligating bands 15 to 17 are sequentially displaced, respectively, and a total of five lesions are continuously ligated.

According to the present embodiment, since the independent displacement filaments 18 to 22 are inserted into the lumen of the external channel 6, the entire duct space of the endoscope lumen 9 can be utilized. As a result, the lesion can be more reliably moved to the lumen of the dispenser 4 and the ligation can be performed more reliably. Even when blood clots or mucus adherence is observed around the lesion, the water-supply effect using the endoscope lumen 9 is strong, so that these adherents can be quickly and reliably peeled off and washed. Thus, the effect of improving the efficiency of treatment can be expected.

Further, the product can be packed in a state where the dispenser 4, the external channel 6, and the device operation unit 8 are integrally assembled. Therefore, the surgeon connects the device to the distal end portion 3 of the endoscope 2,
Since the assembly can be completed only by fixing each of the insertion section 5 and the operation section 7, it is possible to quickly proceed to the treatment, and to greatly improve the therapeutic effect in the case of an urgent treatment. Becomes possible.

FIGS. 12 to 16 show a second embodiment.
The same components as those in the first embodiment are denoted by the same reference numerals, and description thereof is omitted. FIG. 12 is a configuration diagram of the independent displacement filament, and FIGS. 13 to 16 are operation explanatory diagrams.

In the second embodiment, there is no loop 63, and the independent displacement filaments 66a to 70a and 66b to 70b are directly connected to the wire 75. The independent displacement filaments 66a to 70a and 66b to 70b are connected in order from the distal side of the ligating bands 13 to 17, respectively. The total length is made shorter in the order of the independent displacement filaments 66 to 70, and the remaining portions 71 a to 7 b of the independent displacement filaments 67 a to 70 a and 67 b to 70 b are assembled in the dispenser 4.
4a, 71b to 74b are inserted into the outer channel 6 in a folded state.

Next, the operation of the second embodiment will be described with reference to FIGS. As the wire 75 is wound on the circumference of the drum 52, the shortest independent displacement filaments 66a and 66b move to the proximal side, and the distalmost ligating band 13 moves in the distal direction. Then, the lesion is removed from the dispenser 4 and the lesion is ligated. At this time, the independent displacement filaments 67a to 70a and 67b to 70b engaged with the remaining ligating bands 14 to 17 on the proximal side are pulled by the remaining portions 71a to 74a and 71b to 74b being moved to the proximal side. Not receive. Therefore, the ligating band 1
While the 3 is moving, the remaining ligating bands 14 to 17 do not move on the support 11.

Subsequently, the next lesion is moved into the inside of the dispenser 4, and the wire 75 is further wound on the circumference of the drum 52, so that the pulling force is applied only to the independently-displaced filaments 67a and 67b having the next shorter length. Then, the distal ligating band 14 moves to the proximal side and comes off the dispenser 4 to ligate the next lesion. Subsequently, the independent displacement filaments 68a to 70a, 68b to 70b and the ligating bands 15 to 17 are sequentially displaced in order, and a total of five lesions are successively ligated.

According to the present embodiment, the same effects as those of the first embodiment can be obtained. FIGS. 17 to 20 show the third embodiment. The same components as those in the first embodiment are denoted by the same reference numerals, and the description thereof will be omitted. FIG. 17 is a vertical sectional side view of the tip of the apparatus, and FIGS.

The third embodiment does not include the loop 63 and the independent displacement filaments 18 to 22, and has two wires 76 and 77.
Are directly connected to the ligating bands 13-17. The wires 76 and 77 are superimposed on the outer peripheral surface 12 of the support 11 at an angle of 180 °, and include a first portion located on the outer peripheral surface 12 and a second portion disposed inside.

A series of longitudinally spaced nodes 78a-82a, 78b-82b are also secured to the wires 76, 77, respectively, and the nodes 78a, 78b are
The nodes 79a and 79b engage with the ligating band 14, respectively, and the nodes 78a to 82a and 78b to 82b
Is always located proximal to the ligating bands 13-17. A sliding operation is provided between the wires 76 and 77 and the support 11 by the device operating unit 8 to remove each of the ligating bands 13 to 17 in a desired controlled order.

The wires 76 and 77 are connected to the ligating bands 13 to 17.
Between the ligating bands, the length of the wires 76, 77 between the ligating bands is determined by the distance from the distal end 28 of the support 11 to the furthest ligating band 13 and the ligating band 1
3 and the distance from the remaining ligating bands 14 to 17 located on the proximal side.

Next, the operation of the third embodiment will be described with reference to FIGS. The surgeon attaches the dispenser 4 to the distal end 3 of the endoscope 2 and fixes the external channel 6 through which the wires 76 and 77 have been inserted to the insertion section 5 of the endoscope. The cord fixed end 25 is fixed to the take-up drum 52 of the device operation unit 8, and then the device operation unit 8 is connected to the operation unit 7 of the endoscope 2.
Attach to

When the wires 76 and 77 are wound on the circumference of the drum 52, the most distal ligating band 13 is wound.
Is associated with the distal movement of the joined nodes 78a, 78b,
Slide to the distal end 28. By further winding the wires 76 and 77, the ligating band 13 is detached from the distal end 28, and the ligating band 13 contracts to the diameter before expansion by elasticity. Therefore, the support 11 is provided by the contracted ligating band 13 '.
The lesion that has been moved into the inside is ligated at its base.

During this time, the slack wires 76 ', 77' between the ligating bands 13, 14 are straightened to absorb the movement of the wires 76, 77, and the pulling force is reduced by the joint 79.
a, 79b. Therefore, the ligating bands 14-1
7 does not move on the outer peripheral surface 12 of the support.

According to the present embodiment, the same effects as in the first embodiment can be obtained. According to the above-described configuration, the following configuration is obtained. (Supplementary Note 1) In a ligation device for an endoscope for ligating a part of a tissue in a body in combination with an endoscope, a support means attachable to a distal end of the endoscope, and an outer peripheral surface of the support means A plurality of ligating bands supported in an expanded state, actuator means engaging with each of the ligating bands, and having a proximal end extending to a proximal operation section of the endoscope; and An external channel extending along the axial direction of the endoscope, and a proximal end of the external channel being connectable to the actuator means. An operating means capable of imparting a proximal movement.

(Supplementary Note 2) The ligating apparatus for an endoscope according to Supplementary Note 1, wherein the actuator means comprises a plurality of independent displacement means connected to each of the predetermined number of ligating bands.

(Supplementary note 3) The supplementary note 2, wherein each of the plurality of independent displacement means includes a plurality of independent displacement filaments each having a distal end attached to a corresponding one of the ligating bands. Ligation device for endoscopes.

(Supplementary note 4) The support means may have an edge portion at a distal end, and each of the plurality of independent displacement filaments may extend from one proximal operating means in a distal direction of the distal edge portion. The ligating device for an endoscope according to claim 1, wherein a loop is formed around the corresponding ligating band, and the distal end portion is removably attached to the supporting means.

(Supplementary Note 5) The actuator means is composed of one or more flexible wire elements which come into contact with all of the predetermined number of ligating bands, and the flexible wire elements are provided at points of contact with the ligating bands. 2. The ligating device for an endoscope according to claim 1, further comprising a remaining portion having a predetermined length between the ligating device.

(Supplementary note 6) The ligature for an endoscope according to Supplementary note 1 or 5, wherein a plurality of engaging portions that engage with each of the ligating bands are fixed to the flexible wire element. apparatus. According to Supplementary Notes 1 to 6, the dispenser, the external channel through which the independently displaceable filament is inserted, and the device operation unit are already assembled integrally, and the assembly is completed only by fixing each unit to the outer surface of the endoscope. The surgeon guides the endoscope to a target site in the body cavity, feeds water through the lumen of the endoscope as needed, and cleans around the target site. After confirming the target area, contact the dispenser with the target area,
Negative pressure is applied through the lumen of the endoscope to aspirate living tissue into the dispenser. Thereafter, by pulling each set of independent displacement filaments toward the hand side, each independent displacement filament sends the corresponding ligating band to the distal side of the dispenser, and by sequentially removing the ligating bands, the living tissue at a plurality of locations is ligated. .

[0052]

As described above, according to the present invention,
Since the actuator means is inserted into the lumen of the external channel, the entire duct space of the endoscope lumen can be utilized, so that the decompression effect of the lumen of the support means is increased, and the lesion of the support means is more reliably inserted. To perform reliable ligation.

Even when blood clots or mucus adherence is observed around the affected part, the effect of water supply using the lumen of the endoscope is strong.
Washing is possible, and the effect of improving treatment efficiency can be expected.

Further, the product can be packed in a state where the dispenser as the support means, the external channel, and the device operation unit are integrally assembled. Therefore, the surgeon can complete the assembly simply by fixing the mounting to the distal end portion, the insertion portion, and the operation portion of the endoscope. In this case, the therapeutic effect can be greatly improved.

[Brief description of the drawings]

FIG. 1 is an overall perspective view of an endoscope ligating apparatus showing a first embodiment of the present invention.

FIGS. 2A and 2B show a front end portion of the apparatus according to the embodiment, wherein FIG. 2A is a longitudinal side view, and FIG.

FIG. 3 is a view as seen from the direction of arrow B in FIG. 2;

FIG. 4 is a longitudinal side view showing a state in which the independent displacement filament is engaged with the ligating band of the embodiment.

FIG. 5 is a longitudinal side view showing a state in which the independent displacement filament is engaged with the ligating band of the embodiment.

FIG. 6 is a side view and a plan view of an operation unit of the endoscope of the embodiment.

FIG. 7 is a sectional view taken along line DD of FIG. 6;

FIG. 8 is an operation explanatory view of the embodiment.

FIG. 9 is an operation explanatory view of the embodiment.

FIG. 10 is an operation explanatory view of the embodiment.

FIG. 11 is an operation explanatory view of the embodiment.

FIG. 12 is a view showing a connection state between an independently displaceable filament and a wire according to a second embodiment of the present invention.

FIG. 13 is an operation explanatory view of the embodiment.

FIG. 14 is an operation explanatory view of the embodiment.

FIG. 15 is an operation explanatory view of the embodiment.

FIG. 16 is an operation explanatory view of the embodiment.

FIG. 17 is a longitudinal sectional side view of a device tip portion showing a third embodiment of the present invention.

FIG. 18 is an operation explanatory view of the embodiment.

FIG. 19 is an operation explanatory view of the embodiment.

FIG. 20 is an operation explanatory view of the embodiment.

FIG. 21 is a side view of a conventional endoscope ligation device.

[Explanation of symbols]

 DESCRIPTION OF SYMBOLS 1 ... Ligation apparatus for endoscopes 2 ... Endoscope 3 ... End part 4 ... Dispenser 5 ... Insertion part 6 ... External channel 7 ... Operation part 8 ... Device operation part 13-17 ... Ligation band 18-22 ... Independent displacement filament

Claims (1)

[Claims] 1. An endoscope ligation device for ligating a part of a tissue in a body in combination with an endoscope, wherein: a support means attachable to a distal end of the endoscope; and an outer peripheral surface of the support means A plurality of ligating bands supported in an expanded state, an actuator means engaging with each of the ligating bands, and a proximal end extending to a proximal operation section of an endoscope; and An external channel extendable along an axial direction of the endoscope, the external channel being penetrable therein and having a distal end fixed to the support means, and a proximal end of the external channel being connectable to the actuator means; And an operating means capable of imparting a proximal movement to the endoscope.