JP2004275785A - High frequency incision instrument - Google Patents

Abstract

<P>PROBLEM TO BE SOLVED: To provide a high frequency incision instrument, improved in safety and operability of EST (duodenal papilla sphincter muscle resection). <P>SOLUTION: This high frequency incision instrument is composed of: a flexible insert part 3 inserted into the body through an endoscope 2; two slits (opening parts) 7a, 7b provided on the insert part 3; a knife wire (an operating wire) 6 disposed to freely move forward and backward to the inside of the insert part 3; an incision part (a knife part) 9 provided on the distal end of the knife wire 6 and extended to the outside of the insert part 3 through the slits 7a, 7b; and a coating (an insulating coating) 11 covering a part of the incision part 9 and the knife wire 6 and made of fluorine resin. <P>COPYRIGHT: (C)2005,JPO&NCIPI

Description

  The present invention relates to a high-frequency incision device that is inserted into a body through an endoscope and performs high-frequency incision of an affected part.

  In general, a conductive knife wire is exposed at a distal end of an insertion portion such as an elongated flexible tube as a kind of an endoscope treatment tool to be inserted into a body through an endoscope, and high-frequency current is applied to the knife wire. There is known a configuration in which an incision is made in the affected area. For example, Patent Literature 1 and Patent Literature 2 disclose such endoscope treatment tools.

  Here, Patent Literature 1 includes an outer sheath through which the treatment tool main body is inserted so as to be able to advance and retreat. Then, the length of the knife wire exposed to the outside of the outer sheath is changed by moving the outer sheath forward and backward with respect to the treatment instrument body in the axial direction.

Patent Literature 2 discloses a configuration in which conductive Teflon (registered trademark) is coated on the surface of a conductive knife wire exposed at a distal end portion of an insertion portion.
JP-A-5-176940 JP-A-4-307055

  By the way, for example, when performing EST (duodenal papillary sphincter resection) using a knife wire, the following operation is performed. After setting the distal end of the insertion portion of the endoscope inserted in advance in the patient's body close to the nipple, the insertion portion of the treatment tool for the endoscope is inserted into the body through the treatment tool insertion channel of the endoscope. Inserted. Then, the distal end of the insertion portion of the treatment instrument protruding to the outside of the endoscope through the forceps port of the endoscope is inserted into the bile duct transpapillarily. In this state, a high-frequency current is applied to the knife wire to cut off the papillary sphincter.

  Also, when performing the above-mentioned EST using the treatment tool of Patent Document 1, if the body of the endoscope or the tissue around the nipple is in contact with the knife wire, while watching the image of the endoscope to prevent this, Then, an operation of moving the mantle sheath is required. However, since the operation of moving the mantle sheath is performed in a state in which the distal end of the tube of the treatment tool body is inserted into the bile duct transpapillarily, the tube of the treatment tool body is moved when the operation of moving the mantle sheath is performed. In addition, there is a problem of increasing the possibility of falling out of the nipple.

  Further, in the shape near the nipple, for example, in a diverticulum case, the nipple is located at a position deeper than the surrounding tissue, so that the main body of the endoscope may not be able to approach the nipple. In such a case, a long knife length may be advantageous in order to match the direction of travel of the bile duct with the direction of the tube and the knife of the treatment instrument main body. There is a risk of damaging the tissue around the nipple that is not the target on the side. Further, in this state, since the knife wire is in contact with many living tissues, the current density at the target site is low, and it is difficult to make a papilla incision.

  Further, in the treatment tool of Patent Document 1, a means for operating the direction and shape of the distal end of the tube of the treatment tool body using an operation wire is introduced. However, it is very difficult to simultaneously operate the operation wire for changing the direction of the distal end of the tube of the treatment instrument main body in addition to the operation of the mantle sheath and the operation of the knife wire.

  Further, although the treatment instrument of Patent Document 2 can prevent the knife wire from adhering to the contact tissue, it cannot prevent the knife wire from contacting a living tissue other than the target site.

  The present invention has been made in view of the above circumstances, and an object of the present invention is to provide a high-frequency incision tool capable of improving safety and operability of EST (duodenal papillary sphincter resection).

  The invention according to claim 1 includes a flexible insertion portion inserted into a body through an endoscope, an opening provided in the insertion portion, an operation wire disposed in the insertion portion so as to be able to advance and retreat, and the operation device. A knife portion provided at the distal end of the wire and extending from the opening to the outside of the insertion portion; and an insulating coating made of a fluororesin covering a part of the knife portion and the operation wire. It is a high-frequency incision tool.

  The invention according to claim 2, wherein a flexible insertion portion having a first lumen and a second lumen and inserted into a body through an endoscope; an opening provided in the first lumen; An operation wire disposed in the first lumen so as to be able to advance and retreat, a knife portion provided at a distal end of the operation wire and extending from the opening to the outside of the insertion portion; And a high-frequency incision tool comprising: an insulating coating covering the portion.

  According to a third aspect of the present invention, there is provided a flexible insertion portion to be inserted into a body through an endoscope, an opening provided in the insertion portion, an operation wire arranged to be able to advance and retreat in the insertion portion, and A knife portion provided at a distal end of a wire and extending from the opening to the outside of the insertion portion; and an insulating coating covering a part of the knife portion and having a different color from the knife portion. This is a high-frequency incision tool.

  According to the present invention, the safety and operability of EST (duodenal papillary sphincterectomy) can be improved.

  Hereinafter, a first embodiment of the present invention will be described with reference to FIGS. An endoscopic treatment tool 1 according to the present embodiment has an elongated insertion portion 3 inserted into a body through an endoscope 2 (see FIG. 5), and a proximal side connected to a proximal end portion of the insertion portion 3. An operation unit 4 is provided.

  Further, as shown in FIG. 2, the main body 3a of the insertion portion 3 of the treatment instrument 1 is formed by a three-lumen tube having three lumens 5a, 5b, 5c in one tube. Here, three lumens in the three-lumen tube, that is, the first lumen 5a, the second lumen 5b, and the third lumen 5c are formed to have different lumen diameters (inner diameter dimensions).

  In this embodiment, the lumen diameter d1 of the first lumen 5a, the lumen diameter d2 of the second lumen 5b, and the lumen diameter d3 of the third lumen 5c are set to have a relationship of d1 <d3 <d2. ing. A conductive knife wire (operation wire) 6 to be described later is inserted through the first lumen 5a having the smallest lumen diameter. However, the insertion portion main body 3a is not limited to the above-described three-lumen tube, and may be any tube having one or more lumens 5.

  As shown in FIG. 1A, a small diameter portion 3a2 having an outer diameter smaller than that of the large diameter portion 3a1 on the base end side is formed at the distal end of the insertion portion main body 3a. The outer diameter of the insertion portion main body 3a may have the same diameter over the entire length, or may have a gentle taper.

  Further, a part of the knife wire 6 is exposed at the distal end of the small diameter portion 3a2 in the insertion portion main body 3a. Here, as shown in FIG. 3, two slits (openings) 7a and 7b are provided at the distal end of the small diameter portion 3a2 so as to be separated from each other. The distal end of the knife wire 6 inserted into the first lumen 5a is exposed to the outside through the front and rear slits 7a and 7b, and is exposed to the outside of the insertion portion main body 3a between the front and rear slits 7a and 7b. ing.

  The tip of the knife wire 6 is connected to a knife tip 8 as a locking tool. The distal end of the knife wire 6 has a knife tip 8 press-fitted into the first lumen 5a through a front slit 7a and fixed. The fixing position of the knife tip 8 is not limited to this.

  In addition, as shown in FIG. 1A, the exposed portion of the entire length Y of the knife wire 6 exposed at the distal end portion of the insertion portion 3 has an incision portion (knife portion) that is not insulated within a range X of 5 to 15 mm from the distal end. 9) are formed. Further, an insulating portion 10 that is insulated is provided in the exposed portion of the knife wire 6 except for the cutout portion 9.

  The insulating portion 10 is formed by applying a coating (insulating coating) 11 of PFA fluororesin for insulation on the outer peripheral surface of the wire element wire of the knife wire 6. Note that the coating 11 is not limited to the above-mentioned fluororesin. For example, polytetrafluoroethylene (PTFE), tetrafluoroethylene hexafluoropropylene resin (FEP), polyethylene, polyolefin, polyamide, vinyl chloride, latex, natural rubber, polysulfone, polyphenylsulfone, polyetherimide, POM , PEEK, polycarbonate, ABS and the like, and synthetic resin materials thereof.

  Then, a high frequency is applied to the incision 9 in the exposed portion of the knife wire 6, so that the incision of the living tissue of the affected part is performed. The coating 11 may be colored in blue, white, green, or the like so that the cutout 9 in the exposed portion of the knife wire 6 can be distinguished from the coating 11 on the insulating portion 10.

  The base end of the knife wire 6 extends through the first lumen 5 a in the insertion section 3 and extends to the operation section 4 side. FIG. 1B shows an operation unit 4 of the treatment tool 1 for an endoscope according to the present embodiment.

  As shown in FIG. 1B, the operation unit 4 includes a substantially rod-shaped main body 12 and a slider 13 slidable along the main body 12 in the axial direction. Further, a scale 14 is displayed on the main body 12 of the operation unit 4 as an index for confirming the amount of movement of the slider 13.

  The proximal end of the knife wire 6 is connected to the slider 13. The knife wire 6 can be pulled by pulling the slider 13 to the rear end side.

  FIG. 4 shows an example of a connection method between the base end of the insertion section 3 and the operation section 4. Here, a fly member 15 is provided at a connection end of the operation section 4 with the insertion section 3. A connecting tube 16 composed of a single lumen is connected to the fly member 15.

  Further, a heat-shrinkable tube 17 is provided at a connection portion between the insertion portion 3 and the operation portion 4. Then, the base end of the main body 3a (three lumen tube) of the insertion portion 3 and the distal end of the connecting tube 16 are inserted into the heat shrinkable tube 17 and abutted against each other. Both are connected by contraction. The heat-shrinkable tube 17 may be provided with an adhesive.

  In addition, a guide wire cock 18 and a liquid feeding cock 19 are provided near the connecting portion of the insertion portion 3 with the operating portion 4 at the base end. Here, the guide wire cock 18 is connected to the second lumen 5b, and the liquid feed cock 19 is connected to the third lumen 5c. The guide wire cock 18 and the liquid feed cock 19 are connected to the base end of the insertion section 3 by the heat shrinkable tubes 17, respectively.

  Note that characters or illustrations may be written on the outer peripheral surface of the guide wire cock 18 and the outer peripheral surface of the liquid feed cock 19 so that each type can be distinguished.

  Next, the operation of the above configuration will be described. FIG. 5 shows a state in which, for example, EST (duodenal sphincter resection) is performed using the endoscope treatment tool 1 according to the present embodiment. In FIG. 5, H1 is a bile duct, and H2 is a pancreatic duct.

  The following operation is performed when performing the EST procedure. After the distal end of the insertion portion of the endoscope 2 previously inserted into the patient's body is set close to the nipple H3, the treatment instrument 1 for the endoscope is passed through the treatment instrument insertion channel of the endoscope 2. The insertion section 3 is inserted into the body. Then, the distal end of the insertion portion 3 of the treatment tool 1 protruding to the outside of the endoscope 2 through the forceps port of the endoscope 2 is inserted into the bile duct H1 transpapillarily. In this state, a high-frequency current is applied only to the incision 9 of the knife wire 6, and the papillary sphincter is excised.

  Therefore, the above configuration has the following effects. That is, in the present embodiment, a non-insulated incision 9 is provided within a range of 5 to 15 mm from the distal end of the exposed portion of the knife wire 6 exposed at the distal end of the insertion section 3 of the endoscope treatment tool 1. Since the insulated portion 10 is provided in a portion other than the incision 9, the knife exposed at the distal end of the insertion portion 3 when performing EST treatment using the endoscope treatment tool 1. The high-frequency current flows only in the incision 9 in a range X of 5 to 15 mm from the tip of the exposed portion of the entire length Y of the wire 6, and the high-frequency current flows in the insulating portion 10 of the exposed portion of the knife wire 6 excluding the incision 9. It is kept in a state where no current flows. Therefore, on the exposed portion of the knife wire 6, it is possible to have a function of a knife capable of partially incising only in a range X of 5 to 15 mm from the tip of the exposed portion of the knife wire 6. Only the thickness of H3 can be incised, and damage to other papillary tissues and the endoscope 2 can be prevented to the utmost. Therefore, the EST can be performed safely and reliably even in the conventional difficult EST case, and the transpapillary bile duct insertion performance of the insertion portion 3 of the endoscope treatment tool 1 can be improved.

  Further, the knife function portion of the incision 9 at the exposed portion of the knife wire 6 is short in length, and the portion in contact with the living tissue is small, so that the current density of the high-frequency current is high and the incision can be performed reliably. It becomes possible.

  In addition, by using the end surface of the coating 11 on the exposed portion of the knife wire 6 as an index, it is possible to easily measure the insertion depth of the knife wire 6 into the papilla H3 of the treatment tool 1 for an endoscope. .

  In addition, the thickness of the human nipple sphincter is usually about 10 mm, and in consideration of the incision method of carefully opening (cutting the nipple largely in the hole diameter direction) and small incision (cutting the nipple small in the hole diameter direction). However, the function of the knife only needs to be about 5 to 15 mm at the tip of the exposed portion of the knife wire 6. However, when performing the EST, the length of the exposed portion of the knife wire 6 exposed to the outside of the insertion portion main body 3a of the treatment instrument 1 is 20 mm in order to match the traveling direction of the bile duct H1 with the position of the knife wire 6. About 35 mm is required.

  Here, when the length of the exposed portion of the knife wire 6 is short, the insertion portion when the distal end portion of the insertion portion main body 3a is curved in an arc shape as shown in FIG. The bending of the distal end of the main body 3a becomes tight (large), and the main body 3a has a shape that does not match the running direction with the bile duct H1. However, as the exposure length of the knife wire 6 is longer, there is a danger that the living tissue other than the target site is damaged on the hand side of the knife wire 6 or the endoscope 2 is damaged by contact with the endoscope 2. There is a problem that increases. Further, in a state in which the proximal portion of the knife wire 6 is in contact with a living tissue other than the target site, the current density of the high-frequency current at the target site is reduced, so that the incision may not be performed well.

  Therefore, according to the endoscope treatment tool 1 having the configuration of the present embodiment, the above-described danger can be prevented, so that the EST can be performed safely and securely, and especially for a doctor with little experience. You can do EST with care.

  FIGS. 6 to 8A to 8C show a second embodiment of the present invention. This embodiment is a substantially wire-shaped pre-curve stylet used in combination with the endoscope treatment tool 1 of the first embodiment (see FIGS. 1 (A), 1 (B) to 5). (A metal core) 21 is provided. As shown in FIG. 7, the pre-curve stylet 21 is provided with two curved (R) portions 22, 23 having different radii of curvature.

  Here, a first curved portion 22 is arranged on the front end side of the pre-curve stylet 21 and a second curved portion 23 is arranged on the rear end side. The first curved portion 22 has a radius r1 of, for example, 20 ± 5 mm and an opening angle θ1 of approximately 210 ± 20 °. Further, the radius r2 of the second curved portion 23 is set to, for example, 60 ± 10 mm, and the opening angle θ2 is set to about 120 ± 20 °.

  Further, in the pre-curve stylet 21 of the present embodiment, a bent portion 24 that is bent at a substantially right angle toward the inside of the curve is formed at the distal end of the first curved portion 22. The length L of the bent portion 24 is set to, for example, about 5 ± 1 mm. The difference (gap) between the outer diameter of the pre-curve stylet 21 and the inner diameter of the lumen 5 of the insertion portion main body 3a of the endoscope treatment tool 1 into which the pre-curve stylet 21 is inserted is 0. It is set to about 3 mm or less. The pre-curve stylet 21 of the present embodiment is formed of a metal material such as stainless steel or a resin material.

  Next, the operation of the above configuration will be described. When the endoscope treatment tool 1 of the present embodiment is used, the pre-curve stylet 21 is inserted into the lumen 5 of the insertion portion main body 3a for a certain period of time, as shown in FIG. At this time, the pre-curve stylet 21 is inserted into the lumen 5 of the insertion section main body 3a of the endoscope treatment tool 1 for a predetermined time, so that the pre-curve stylet is inserted into the insertion section main body 3a of the endoscope treatment tool 1. 21; that is, two curved shapes adapted to the respective shapes of the first curved portion 22 on the front end side and the second curved portion 23 on the rear end side of the pre-curve stylet 21. 22a and 23a can be attached.

  As described above, in the present embodiment, the bending habits 22a and 23a having two different curved shapes can be formed in the insertion portion main body 3a of the treatment tool 1 for an endoscope. By adjusting the length by which the insertion portion main body 3a of the treatment tool for endoscope 1 protrudes from the front end of the endoscope 2 as shown in FIG. The facing direction and the shape of the insertion portion main body 3a of the endoscope treatment tool 1 can be variously adjusted. For this reason, it is easy to match the shape to a papillary opening having various shapes or a shape suitable for a bile duct shape.

  FIGS. 8A to 8C show a state in which the pre-curve stylet 5 is removed from the insertion section 3 and the EST is performed using the endoscope treatment tool 1 of the present embodiment. It is shown. Here, FIG. 8A shows a method of approaching the insertion portion main body 3a of the endoscope treatment tool 1 to the nipple H3 in a general nipple-shaped case.

  FIG. 8 (B) shows a method of approaching the insertion portion main body 3a of the endoscopic treatment tool 1 to the nipple H3 in a case where the upper part of the nipple H3 is hanging down. FIG. 8C shows a method of approaching the insertion portion main body 3a of the endoscopic treatment tool 1 to the nipple H3 in a case where the endoscope 2 cannot approach the nipple H3, such as a diverticulum case.

  Therefore, in the above configuration, the first curved portion 22 and the rear end side of the pre-curve stylet 21 can be easily attached to the insertion portion main body 3a of the endoscope treatment tool 1 without requiring any heat treatment or the like. It is possible to form two curved shapes 22a and 23a according to the respective shapes of the second curved portion 23. In addition, the angle and shape of the insertion section main body 3a of the treatment tool 1 for an endoscope when the insertion section main body 3a protrudes from the endoscope 2 can be adjusted by the two different curving bends 22a and 23a. And a case where it is difficult to approach the insertion portion main body 3a of the treatment instrument 1 for an endoscope, for example, a case in which the upper part of the nipple hangs down, and a case in which the endoscope 2 cannot approach the nipple H3 such as a case of parapapillary diverticulum For many cases, for example, the insertion performance of the insertion portion main body 3a of the endoscope treatment tool 1 into the nipple H3 and the bile duct H1 can be improved.

Furthermore, the present invention is not limited to the above-described embodiment, and it goes without saying that various modifications can be made without departing from the spirit of the present invention.
Next, other characteristic technical matters of the present application will be additionally described as follows.
Record
(Additional Item 1) In an endoscopic treatment tool having a knife wire for incision of an affected part by high frequency, a part of an exposed part from a tube of the knife wire is exposed to a knife wire by an insulating member for the purpose of insulation. An endoscope treatment tool that is insulated except for a range of 5 to 15 mm from the tip.

  (Additional Item 2) The endoscope treatment tool according to Additional Item 1, wherein the insulating member is made of a coating, tubing, or the like made of a material having high insulation performance.

  (Additional Item 3) The endoscope treatment tool according to Additional Item 1, wherein a fluorine-based resin such as PTFE, PFA, FEP, or polyimide or other resin is used for the insulating member.

  (Additional Item 4) The endoscope treatment tool according to Additional Item 1, wherein the color of the insulating member is easily distinguishable from the knife wire.

  (Additional Item 5) The endoscope treatment tool according to Additional Item 1, wherein the color of the insulating member is a color that is easily distinguishable from a body cavity color.

  (Additional Item 6) The endoscope treatment tool according to Additional Items 4 and 5, wherein the color of the insulating member is blue, white, green, or the like.

  (Additional Item 7) The endoscope treatment tool according to Additional Item 1, wherein a heat-shrinkable tube structure is used for the insulating member.

  (Additional Item 8) The treatment tool for an endoscope according to Additional Item 1, wherein the outer diameter of the insulating portion is equal to or close to the outer diameter of the knife wire.

  (Additional Item 9) In the treatment field for an endoscope having a tube that is used by being inserted into a bile duct by transpapillary in the field of pancreatobiliary disease, two R curves (first R / radius: 20 ± 5 mm, angle : 210 ± 20 °, 2nd R / radius: 60 ± 10 mm, angle: 120 ± 20 °), a treatment for an endoscope providing a bending habit to a tube by a pre-curve stylet (core bar). Utensils.

  (Additional Item 10) The endoscope treatment tool according to Additional Item 9, wherein a metal such as stainless steel or steel is used as a material of the pre-curve stylet.

  (Additional Item 11) The endoscope treatment tool according to Additional Item 9, wherein a shape memory alloy such as nitinol is used for the pre-curve stylet.

  (Additional Item 12) The endoscope treatment tool according to Additional Item 9, wherein a hard or soft plastic is used for the pre-curve stylet.

  (Additional Item 13) The endoscope treatment tool according to Additional Item 9, wherein the difference (gap) between the outer diameter of the pre-curve stylet and the inner diameter of the pre-curve stylet insertion lumen of the tube is 0.3 mm or less.

  (Prior Art of Supplementary Items 1 to 13) Patent Literature 1 is a conventional technology for Supplementary Items 1 to 13, and Patent Document 2 is a conventional technology of Supplementary Items 1 to 8.

  (Problems to be Solved by Additional Items 1 to 13) The problem of Patent Document 1 is that when the scope body or the tissue around the nipple is in contact with the knife wire, while watching the image of the endoscope in order to prevent this, Then, an operation of moving the mantle sheath is required. When performing this operation, the distal end of the tube is inserted into the bile duct transpapillarily, and moving the mantle sheath in this state increases the possibility that the tube may fall out of the bile duct and nipple. . Further, in the shape near the nipple, for example, in a diverticulum case, the nipple is located at a position deeper than the surrounding tissue, and the scope body may not be able to approach the nipple. In such a case, a long knife length may be advantageous in order to align the running of the bile duct with the directions of the tube and the knife. More likely to be damaged. In this state, since the knife wire is in contact with many tissues, the current density at the target site is low, and it is difficult to make a papilla incision.

  In the above invention, means for operating the direction and shape of the tube tip using an operation wire is introduced. In addition to the operation of the sheath sheath and the operation of the knife wire, the operation wire for changing the direction is simultaneously operated. It is very difficult to do.

  The problem of Patent Literature 2 is that it is possible to prevent the knife wire from adhering to the contact tissue, but it is impossible to prevent the knife wire from contacting other than the target site.

  (Object of Additional Items 1 to 8) The purpose of additional items 1 to 8 is to improve the safety and operability of the EST.

  (Purpose of Supplementary Items 9 to 13) The purpose of Supplementary Items 9 to 13 is to improve the transcutaneous insertion property of the sheath into the bile duct by means of inexpensive and easy means.

  (Effects of Additional Items 1 to 8) The operation according to additional items 1 to 8 is that only the tip 5 to 15 mm of the knife wire exposed portion can have a knife function (can be incised). Only the thickness of the part can be incised, and damage to other tissues around the nipple and the scope can be prevented to the utmost. In addition, since the knife function portion is short and the portion in contact with the tissue is small, the current density is high, and the incision can be reliably performed.

  (Operation of Additional Items 9 to 13) The operation according to additional items 9 to 13 can easily give a tube a pre-curve stylet-like shape, and the two different R shapes of the tube allow the tube to be moved from the distal end of the scope. By adjusting the length of extending the tube, the direction and shape of the tube tip can be easily adjusted according to the opening of the nipple and running of the bile duct, and the tube can be easily inserted into the bile duct. .

  (Effects of Supplementary Items 1 to 13) According to the present invention, EST can be performed safely and reliably even in the case of the conventional difficult EST, and the transpapillary bile duct insertion performance of the tube can be improved. is there.

BRIEF DESCRIPTION OF THE DRAWINGS FIG. 1 shows a first embodiment of the present invention, in which (A) is a side view showing a distal end portion of an insertion portion of an endoscope treatment instrument, and (B) is an operation section of the endoscope treatment instrument. Side view. FIG. 2 is a cross-sectional view of a tube of an insertion portion in the treatment tool for an endoscope according to the first embodiment. The longitudinal section of the important section showing the tip part of the tube of the insertion section in the treatment tool for endoscopes of a 1st embodiment. FIG. 2 is an explanatory diagram for explaining a connection portion between a tube of an insertion portion and an operation portion in the endoscope treatment tool according to the first embodiment. FIG. 2 is an explanatory diagram for explaining a state in which EST is performed using the endoscope treatment tool according to the first embodiment; The side view which shows the external appearance of the front-end | tip part of the insertion part in the treatment tool for endoscopes of 2nd Embodiment of this invention. The side view which shows the pre-curve stylet in the treatment tool for endoscopes of 2nd Embodiment. FIG. 8A shows a state in which EST is performed using the endoscope treatment tool according to the second embodiment, wherein FIG. 10A shows an endoscope treatment tool for a nipple in a general nipple-shaped case; (B) is an explanatory view showing an approach method of an endoscopic treatment tool to a nipple in a case where the upper part of the nipple is hanging down, and (C) is a nipple having a scope such as a diverticulum case. Explanatory drawing which shows the approach method of the treatment tool for an endoscope with respect to a nipple in the case where it cannot approach.

Explanation of reference numerals

    2 endoscope, 3 insertion section, 6 knife wire (operation wire), 7a, 7b slit (opening), 9 cutout section (knife section), 10 insulating section, 11 coating (insulating coating) ).

Claims (3)

A flexible insertion portion inserted into the body through the endoscope,
An opening provided in the insertion portion,
An operation wire arranged to be able to advance and retreat within the insertion portion,
A knife portion provided at a distal end of the operation wire and extending from the opening to the outside of the insertion portion;
An insulating coating made of a fluororesin covering a part of the knife portion and the operation wire,
High-frequency incision tool consisting of A flexible insertion portion having a first lumen and a second lumen and inserted into a body through an endoscope;
An opening provided in the first lumen;
An operation wire arranged to be able to advance and retreat within the first lumen;
A knife portion provided at a distal end of the operation wire and extending from the opening to the outside of the insertion portion;
An insulating coating covering a part of the knife portion;
High-frequency incision tool consisting of A flexible insertion portion inserted into the body through the endoscope,
An opening provided in the insertion portion,
An operation wire arranged to be able to advance and retreat within the insertion portion,
A knife portion provided at a distal end of the operation wire and extending from the opening to the outside of the insertion portion;
An insulating coating covering a part of the knife portion and having a different color from the knife portion;
High-frequency incision tool consisting of

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