JP2003153911A - Endoscope system - Google Patents

Abstract

PROBLEM TO BE SOLVED: To provide an endoscope system enabling a dilatation of sufficient height to be formed on a mucous membrane, while facilitating excision as the dilatation, once formed, maintains its shape for a long time because of the viscosity of a gel. SOLUTION: The endoscope system includes a gel having viscosity- temperature characteristics such that its viscosity is high at body temperature and low below body temperature; an endoscope 1 having a channel in its inserted part; a gel-injection tube 12 having a needle 13 at its front end passed into the channel of the endoscope 1; a syringe 14 serving as a gel pressurizing means connected to the rear end of the tube 12 for pressurizing the gel to inject the gel using the needle 13 via the tube 12; and a means for controlling the temperature of the gel.

Description

Description: BACKGROUND OF THE INVENTION [0001] 1. Field of the Invention [0002] The present invention is employed when an bulge is formed in a living tissue in endoscopic mucosal resection (EMR). The present invention relates to an endoscope system. 2. Description of the Related Art Endoscopic mucosal resection (EMR) using snare and forceps as an endoscopic treatment for early-stage cancer occurring in the esophagus, stomach, large intestine, etc. of a living body is known, for example. It is introduced in the book "Endoscopic mucosal resection of the esophagus and stomach-Challenge the limits" published by Nippon Medical Center Co., Ltd. [0003] To explain an endoscopic mucosal resection using snare and grasping forceps, a tube having an injection needle is inserted into a first channel of the endoscope, and a snare is inserted into a second channel of the endoscope. It is inserted. The insertion portion of the endoscope is inserted from the oral cavity, and the distal end component is introduced into the stomach via the esophagus. While observing the inner wall with the observation window of the endoscope, approach the target lesion to the target component. Next, when the tube is pushed forward on the operation section side of the endoscope, the injection needle penetrates the mucous membrane and punctures the submucosal layer. In this state, when the physiological saline mixed with epinephrine is pressurized by the syringe, the physiological saline is locally injected into the submucosa from the tip opening of the injection needle through the tube. The submucosal layer of the lesion is separated from the muscular layer by the physiological saline, and a swollen portion is formed in the submucosal layer and the mucous membrane. Next, the snare ring is made to protrude from the distal end portion of the endoscope, and the snare ring is expanded and hooked so as to fit into the bulge. On the other hand, on the operation unit side of the endoscope, the tube is pulled, and the tube having the injection needle is withdrawn from the first channel. Next, the grasping forceps is inserted through the forceps insertion port into the first channel, and the bulge portion, which is projected from the distal end constituting portion of the insertion portion and snare is hooked, is grasped by the grasping forceps. In this state, when the grasping forceps is pulled in, the bulging portion is stretched upward, so that the snare is simultaneously narrowed, and when a high-frequency current is applied to the snare, the bulging portion is cut off at the foot of the bulging portion. [0007] When the grasping forceps is pulled in at the operation unit side of the endoscope while the incised mucous membrane, that is, the lesion is grasped by the grasping forceps, the mucous membrane having the lesion is completely exfoliated from normal living tissue. The mucous membrane having the lesion can be taken out of the body together with the grasping forceps through the first channel. [0008] However, in all of the endoscopic mucosal resections, a local injection of physiological saline containing a small amount of epinephrine is performed to exfoliate the mucous membrane and the muscular layer, Part is formed. However, since the viscosity of the physiological saline is low, the height of the bulge of the mucous membrane cannot be sufficiently obtained. Therefore, when snareing is subsequently hooked on the bulge, it is difficult to snare, or when excision is performed by snareing, residual excision occurs. There is a risk of being involved. In addition, even if a bulge of the mucous membrane is formed, physiological saline may be absorbed with time and the bulge may atrophy before mucosal resection, and a quick procedure is required. On the other hand, in order to increase the viscosity of physiological saline, it has been attempted to mix hyaluronic acid and glucose. However, when physiological saline is injected with a syringe, the viscosity is high and the injection requires power. However, there is a problem that it takes time to reach the injection needle at the distal end of the tube. The present invention has been made in view of the above circumstances, and an object thereof is to form a bulge having a sufficient height on a mucous membrane to be excised during endoscopic mucosal resection. It is an object of the present invention to provide an endoscope system which can perform a mucosal resection easily. [0012] In order to achieve the above object, the present invention provides a gel having a viscosity-temperature characteristic that has a high viscosity at body temperature and a low viscosity at or below body temperature, and a channel at an insertion portion. An endoscope having a gel injection tube having an injection needle at the distal end inserted into a channel of the endoscope, and connected to the base end of the tube to pressurize the gel and through the tube. An endoscope system comprising a gel pressurizing means for injecting with a syringe needle and a means for controlling the temperature of the gel. A gel having a viscosity-temperature characteristic that has a high viscosity at body temperature and a low viscosity at or below body temperature is temperature-controlled, so that when the gel is locally injected, the viscosity of the gel is low and the gel is injected under the mucous membrane. The viscosity of the gel thus obtained is increased, and a sufficiently high bulge can be formed on the mucous membrane. Once formed, the bulge maintains its shape longer due to the viscosity of the gel, so that resection can be easily performed. Embodiments of the present invention will be described below with reference to the drawings. 1 to 3 show a first embodiment, and FIG.
(A) is a perspective view of the entire endoscope, (b) is an enlarged perspective view of a portion A, FIG. 2 is a longitudinal side view of a syringe, and FIG. 3 is an explanatory view of an endoscopic mucosal resection. As shown in FIG. 1, an endoscope 1 includes an operation unit 2.
And an insertion section 3 and a universal cord 4 connected to the operation section 2. The insertion section 3 includes a flexible section 5
, A bending portion 6 and a distal end portion 7, and the distal end portion 7 is provided with an observation window 8, an illumination window 9, a forceps channel opening 10, and the like. The forceps channel port 10 communicates with a forceps insertion port 11 provided in the operation section 2 through a forceps channel (not shown) inserted in the insertion section 3. A tube 12 is inserted into the forceps insertion port 11, and an injection needle 13 protruding from the forceps channel port 10 is provided at the tip of the tube 12. A syringe 14 as a pressurizing means is connected to the proximal end of the tube 12 so that a gel described later can be introduced into the injection needle 13 through the tube 12 by the syringe 14. Injection needle 13
Is cut at an acute angle so that it is easy to puncture the living tissue and to easily inject the gel into the living tissue. FIG. 2 shows the syringe 14, which comprises a syringe body 15 and a piston 16 inserted into the syringe body 15. The syringe 14 is provided with a gel temperature control device 18 as a means for controlling the temperature of the gel 17, and the gel 1 stored in the syringe 14 is provided.
7 is kept in a cooled state, and the viscosity is kept substantially unitary. The gel 17 contained in the syringe 14 has a high viscosity at body temperature and a low viscosity below body temperature, and has a viscosity-temperature characteristic. The gel 17 contained in the syringe 14 is, for example, 5 ° C. It is cooled to a low degree, has a low viscosity, and can be injected with a small force when injected by the piston 16. Next, an endoscopic mucosal resection (EMR) will be described with reference to FIG. FIG. 3 shows a method for resecting a lesion such as early cancer that has occurred on the inner wall of the stomach of a living body. The inner wall 20 of the stomach is composed of a muscular layer 21, a submucosal layer 22, and a mucous membrane 23. This is a case where a lesion 24 has occurred in a part of the mucous membrane 23. The insertion portion 2 of the endoscope 1 is inserted from the oral cavity, and the distal end component 7 is introduced into the stomach via the esophagus. While observing the inner wall 20 through the observation window 8 of the endoscope 1, the distal end component 7 approaches the target lesion 24. In this state, a tube 12 having an injection needle 13 at the distal end from a forceps insertion port 11 provided in the operation unit 2 is provided.
Is inserted, the tube 12 is pushed through the forceps channel, and the injection needle 13 is projected from the forceps channel opening 10. Further, a syringe 14 containing the gel 17 is connected to the proximal end of the tube 12. In this case, with the tube 12 having the injection needle 13 previously inserted into the forceps channel of the endoscope 1, the insertion portion 2 of the endoscope 1 is inserted into the body cavity without projecting the injection needle 13 from the forceps channel opening 10. May be inserted. As shown in FIG. 2A, after the distal end component 7 of the endoscope 1 approaches the lesion 24, when the tube 12 is pushed forward on the operation unit 2 side, the injection needle 13 penetrates the mucous membrane 23. The submucosal layer 22 is punctured. When the gel 17 is pressurized by the syringe 14 in this state, the gel 17 is passed through the tube 12 from the distal end opening of the injection needle 13 to the submucosal layer 2.
2. Since the gel 17 injected into the submucosal layer 22 is heated by body temperature, the viscosity of the gel 17 increases. As shown in FIG. 2B, once the injection needle 13 is removed, the location is changed and the gel 17 is locally punctured into the submucosal layer 22 and the gel 17 is locally injected into the submucosal layer 22. The lower layer 22 is peeled off from the muscle layer 21, and a bulge portion 25 is formed on the submucosal layer 22 and the mucous membrane 23.
(C) shows a case where the gel 17 is locally injected three times, and the number of times of local injection may be appropriately selected according to the area of the lesion 24, and a large amount of the gel 17 is injected at one time even in one local injection. The bulge portion 25 may be formed by performing the above operation. After the gel 17 has been injected, the tube 12 is pulled on the operation unit 2 side of the endoscope 1 and the tube 12 having the injection needle 13 is pulled out from the forceps channel. And
A needle-like scalpel 26 is inserted from the forceps insertion port 11 to the distal end of the operation wire.
Is inserted, and the needle scalpel 26 is made to protrude from the distal end component 7 of the insertion portion 2. Then, as shown in FIG.
A needle-like scalpel 26 is punctured into the mucous membrane 23 around the
Is repeated, an incision 28 is formed in the mucous membrane 23 as shown in (e). At this time, since the submucosal gel 17 is heated by body temperature and maintained at a high viscosity, it does not flow out of the incision portion 28, and the height of the bulge portion 25 is maintained. It is easy and there is no risk of damaging the muscle layer 21. After the incision of the mucous membrane 23 is completed, the incision forceps 27 is pulled on the operation unit 2 side of the endoscope 1 and the incision forceps 27 having the needle-like scalpel 26 is extracted from the forceps channel. And
The grasping forceps 29 are inserted from the forceps insertion opening 11 and the grasping portion 30 is inserted.
From the distal end component 7 of the insertion section 2. And
As shown in (f), the dissected mucosa 23, that is, the mucous membrane 23 around the lesion 24 is gripped by the gripper 30 of the gripping forceps 29. Then, the grasping forceps 2 is provided on the operation unit 2 side of the endoscope 1.
9, the mucous membrane 23 having the lesion 24 is completely separated from the normal living tissue as shown in (g), and the mucous membrane 23 having the lesion 24 is extracorporeally removed together with the grasping forceps 29 via the forceps channel. Can be taken out. After the lesion 24 is excised, the remaining gel 17 is washed and removed with cooling water such as physiological saline cooled to a temperature lower than the body temperature. It is to be noted that bleeding from the incision can be prevented by mixing a small amount of epinephrine as a hemostatic agent in the gel 17 in the above embodiment. Further, when the gel 17 contains, for example, indigo carmine as a dye, when the gel 17 is injected under the mucous membrane of the lesion, the gel 17 can be observed through the mucous membrane, and the colored gel 17 can be observed. 17 can be easily confirmed, and the incision becomes easy. In the above embodiment, the case where the insertion portion 2 of the endoscope 1 has one forceps channel has been described. However, in an endoscope having a plurality of forceps channels, the tube 12 and the incision forceps 27 are used. In addition, the labor for replacing the grasping forceps 29 with the forceps channel can be omitted, the procedure time can be shortened, and the operator and the caregiver can perform the procedure in a cooperative play. FIG. 4 shows a second embodiment, in which a syringe 3
0 is a vertical side view. The syringe 30 includes a syringe body 31 and a piston 32 inserted into the syringe body 31, and the gel 17 stored in the syringe body 31 can be poured out by the piston 32. A known Peltier element 33 is provided on the outer periphery of the syringe body 31 as a means for controlling the temperature of the gel 17. The gel 17 is cooled by the Peltier effect so that the viscosity of the gel 17 is kept low. FIG. 5 shows a third embodiment of the present invention, in which (a) is a schematic configuration diagram of an endoscope system, and (b) is a cross-sectional view taken along line BB. The endoscope 41 includes an operation unit 42 and an operation unit 4.
Insertion part 43 and universal cord 44 connected to 2
It is composed of A forceps channel 46 is provided from the operation section 42 to the distal end configuration section 45 of the insertion section 43. Further, a water supply conduit 48 is provided from the connector portion 47 of the universal cord 44 to the inside of the universal cord 44 and to the forceps channel 46. The connector 47 is provided with a pump 49 as a cooling water supply source.
, And the pump 49 communicates with the cooling water tank 50. The tube 12 for gel injection shown in the first embodiment is inserted through the forceps channel 46. The inner diameter of the forceps channel 46 is much larger than the outer diameter of the tube 12, A cooling water passage 51 is formed between the outer periphery of the forceps channel 46 and the inner periphery of the forceps channel 46. According to the present embodiment, when the gel 17 is injected through the tube 12, the cooling water is supplied from the cooling water tank 50 by the pump 49, so that the cooling water is inserted through the cooling water passage 51. It is guided to the tip component 45 of the part 43. Therefore, the gel 17 in the tube 12 is cooled by the cooling water, the viscosity of the gel 17 can be kept low, and the amount of power required when the gel 17 is poured out by the syringe 14 can be reduced. Further, according to the present embodiment, even if the gel accumulates in the tube 12 and the mucous membrane becomes high due to the body temperature when the gel is repeatedly extracted multiple times as in the embodiment of FIG. 3, the gel is cooled again. Thus, the viscosity of the gel can be reduced. FIG. 6 shows a fourth embodiment, and describes an endoscopic mucosal resection different from the first embodiment. FIG.
As shown in (a), the endoscope 1 has a first channel 6.
A first and a second channel 62 are provided. The tube 12 having the injection needle 13 is inserted through the first channel 61, and the snare ring 63 is inserted through the second channel 62. The insertion section 2 of the endoscope 1 is inserted from the oral cavity, and the distal end component 7 is introduced into the stomach via the esophagus. While observing the inner wall 20 through the observation window 8 of the endoscope 1, the distal end component 7 approaches the target lesion 24. As shown in (b), after the distal end component 7 of the endoscope 1 approaches the lesion 24, when the tube 12 is pushed forward on the operation unit 2 side, the injection needle 13 penetrates the mucous membrane 23. The submucosal layer 22 is punctured. In this state, (c)
When the gel 17 is pressurized by the syringe 14, the gel 17 is locally injected into the submucosal layer 22 from the distal end opening of the injection needle 13 through the tube 12 as shown in FIG. Since the gel 17 injected into the submucosal layer 22 is heated by body temperature, the viscosity of the gel 17 increases and the submucosal layer 22 of the lesion 24 is separated from the muscular layer 21 by the gel 17, and the submucosal layer 22 and the mucous membrane An bulge portion 25 is formed at 23. Next, as shown in (d), the snare ring 63 is made to protrude from the distal end component 7 of the endoscope 1, and the snare ring 63 is expanded and hooked so as to fit into the bulge portion 25. . On the other hand, on the operation unit 2 side of the endoscope 1, the tube 12 is pulled, and the tube 12 having the injection needle 13 is withdrawn from the first channel 61. As shown in (e), a bulge in which the grasping forceps 64 is inserted from the forceps insertion opening 11 into the first channel 61 and protrudes from the distal end component 7 of the insertion portion 2 and the snare ring 63 is hooked. The part 25 is gripped by the gripping forceps 64. When the grasping forceps 64 is pulled in this state, the bulging portion 25
Is stretched upward, so that the snare 63
When a high-frequency current is supplied to the snare ring 63, the swelling portion 25 is cut off at the foot. As shown in (f), the incised mucous membrane 23,
In other words, when the grasping forceps 64 is retracted on the operation unit 2 side of the endoscope 1 in a state where the lesion 24 is grasped by the grasping forceps 64, the mucous membrane 23 having the lesion 24 is completely separated from normal living tissue, The mucous membrane 23 having the lesion 24 can be taken out of the body together with the grasping forceps 64 via the first channel 61. Finally, as shown in (g), a cooling water supply tube 65 is inserted into the first channel 61, and the gel 17 remaining with cooling water such as physiological saline cooled to a temperature lower than the body temperature is removed. Wash and remove. FIG. 7 shows a fifth embodiment, which describes an endoscopic mucosal resection different from the first and fourth embodiments.
As shown in FIG. 7A, the endoscope 1 is provided with a first channel 61, a second channel 62, and a suction conduit 66. The tube 12 having the injection needle 13 is inserted through the first channel 61, and the snare ring 63 is inserted through the second channel 62. Further, a transparent cap 67 is attached to the distal end component 7 of the endoscope 1, and a snare ring 63 is housed inside the transparent cap 67. The insertion section 2 of the endoscope 1 is inserted from the oral cavity, and the distal end component 7 is introduced into the stomach via the esophagus. While observing the inner wall 20 through the observation window 8 of the endoscope 1, the distal end component 7 approaches the target lesion 24. As shown in FIG. 5B, after the distal end component 7 of the endoscope 1 approaches the lesion 24, when the operation unit 2 pushes the tube 12, the injection needle 13 passes through the mucous membrane 23. The submucosal layer 22 is punctured. In this state, (c)
When the gel 17 is pressurized by the syringe 14, the gel 17 is locally injected into the submucosal layer 22 from the distal end opening of the injection needle 13 through the tube 12 as shown in FIG. Since the gel 17 injected into the submucosal layer 22 is heated by body temperature, the viscosity of the gel 17 increases and the submucosal layer 22 of the lesion 24 is separated from the muscular layer 21 by the gel 17, and the submucosal layer 22 and the mucous membrane An bulge portion 25 is formed at 23. Next, as shown in (d), the transparent cap 67 attached to the distal end component 7 of the endoscope 1 is moved to the bulging portion 2.
5 and the snare ring 63 is projected. In this state, on the operation unit 2 side of the endoscope 1, the tube 1
2 is pulled out, the tube 12 having the injection needle 13 is pulled out from the first channel 61, and the inside of the transparent cap 67 becomes negative pressure when sucked from the suction line 66. Accordingly, as shown in (e), the bulge portion 25 passes through the snare ring 63 and is drawn into the transparent cap 67. After confirming that the bulging portion 25 has been drawn into the transparent cap 67, as shown in FIG. 3F, the snare ring 63 is squeezed and a high-frequency current is applied to the snare ring 63. It is cut off in parts. Therefore, as shown in (g), the incised mucous membrane 23, that is, the mucous membrane 23 having the lesion 24, is housed in the transparent cap 67, and the mucous membrane 23 is completely peeled off from normal living tissue. Along with the endoscope 1, the mucous membrane 23 having the lesion 24 can be taken out of the body. Finally, similarly to the fourth embodiment, the cooling water supply tube 65 is inserted into the first channel 61, and the gel 17 remaining with the cooling water such as physiological saline cooled to a temperature lower than the body temperature. Is washed and removed. According to each of the above embodiments, the following configuration is obtained. (Supplementary Note 1) A gel having a viscosity-temperature characteristic in which the viscosity is high at body temperature and low at below body temperature, an endoscope having a channel at an insertion portion, and inserted through a channel of the endoscope. A gel injection tube having an injection needle at the distal end, a gel pressurizing means connected to the base end of the tube, pressurizing the gel, and injecting the gel with the injection needle through the tube, and controlling the temperature of the gel And an endoscope system. (Supplementary Note 2) The means for controlling the temperature of the gel is configured to cool the gel by flowing cooling water between a channel of the endoscope and a tube inserted through the channel. An endoscope system according to claim 1, wherein the endoscope system is characterized in that: (Supplementary note 3) The endoscope system according to supplementary note 1, wherein the means for controlling the temperature of the gel is a Peltier element provided in the gel pressurizing means. (Supplementary Note 4) The endoscope system according to supplementary note 1, wherein the gel pressurizing means is a syringe. (Supplementary Note 5) A gel exhibiting a viscosity-temperature characteristic having a high viscosity at body temperature and a low viscosity at or below body temperature, wherein a gel containing a hemostatic agent such as epinephrine is mixed. (Supplementary Note 6) A gel having a viscosity-temperature characteristic having a high viscosity at a body temperature and a low viscosity at a body temperature or lower, wherein a dye such as indigo carmine is mixed therein. (Supplementary Note 7) Outside the body, the gel is cooled to a temperature lower than the body temperature to lower the viscosity, and the gel is injected under the mucous membrane with a syringe needle with a tube inserted into the channel of the endoscope, whereby the gel is cooled at the body temperature. Endoscopic mucosal resection characterized by increasing viscosity and forming a bulge on the mucous membrane. (Supplementary Note 8) In endoscopic mucosal resection in which the injection needle with a tube inserted into the channel of the endoscope is injected several times under the mucous membrane, the temperature of the gel remaining in the injection needle with the tube An endoscopic mucosal resection, wherein when the water level rises, cooling water flows through the channel to cool the gel and reduce the viscosity. (Supplementary Note 9) In an endoscopic mucosal resection in which a gel is locally injected under the mucosa of a lesion, after the lesion is excised, the remaining gel is washed with cooling water cooled to a temperature lower than the body temperature. -Endoscopic mucosal resection characterized by removal. As described above, according to the present invention, a gel having a viscosity-temperature characteristic in which the viscosity is high at body temperature and low at below body temperature is temperature-controlled. When topically injected, the viscosity of the gel is low, and the viscosity of the gel locally injected under the mucous membrane increases, and a sufficiently high bulge can be formed on the mucous membrane. Once formed, the bulge maintains its shape longer due to the viscosity of the gel, so that resection can be easily performed.

BRIEF DESCRIPTION OF THE DRAWINGS FIG. 1 shows a first embodiment of the present invention, in which (a) is a perspective view of the entire endoscope, and (b) is an enlarged perspective view of a portion A. FIG. 2 is a vertical side view of the syringe of the embodiment. FIG. 3 is an explanatory diagram of an endoscopic mucosal resection of the embodiment. FIG. 4 is a vertical sectional side view of a syringe showing a second embodiment of the present invention. 5A and 5B show a third embodiment of the present invention, wherein FIG. 5A is a longitudinal sectional side view of an operation unit, and FIG. 5B is a cross-sectional view taken along line BB. FIG. 6 is an explanatory diagram of an endoscopic mucosal resection according to a fourth embodiment of the present invention. FIG. 7 is an explanatory view of an endoscopic mucosal resection according to a fifth embodiment of the present invention. [Description of Signs] 1 ... Endoscope 3 ... Insertion portion 12 ... Tube 13 ... Injection needle 14 ... Syringe

Claims (1)

Claims: 1. A gel having a viscosity-temperature characteristic in which viscosity is high at body temperature and low at below body temperature, an endoscope having a channel at an insertion portion, and a channel of the endoscope. A gel injecting tube having an injection needle at the distal end inserted into the tube, gel pressurizing means connected to the proximal end of the tube, pressurizing the gel, and injecting the gel with the injection needle through the tube; Means for controlling the temperature of the endoscope.