JP2017060579A - Clip device for endoscope and operation method of clip device for endoscope - Google Patents

Abstract

PROBLEM TO BE SOLVED: To provide a clip device for an endoscope capable of efficiently gripping a lesion, and an operation method thereof.SOLUTION: A clip device for an endoscope includes an outer cylindrical body 10, an inner cylindrical body 20 arranged in the outer cylindrical body 10, a linear material 40 arranged in the inner cylindrical body 20, a clip 30 arranged on a distal side of the inner cylindrical body 20 and connected to the linear material 40, and a handle 50 connected to a proximal side of the inner cylindrical body 20. The distal side of the handle 50 can be inserted into the outer cylindrical body 10.SELECTED DRAWING: Figure 1

Description

  The present invention relates to an endoscopic clip device for gripping an object and an operating method of the endoscopic clip device.

  Traditionally, endoscopic submucosal dissection (ESD) or endoscopy is used in the treatment of early cancer using an endoscope, especially cancer of the esophagus and stomach such as the stomach where it is difficult to secure a space for performing a procedure. Endoscopic mucosal resection (EMR) has been used. In ESD or EMR, in order to reliably remove the lower layer of a lesioned part, saline or hyaluronic acid or the like is injected between the muscle layer and the submucosal layer of the lesioned part to raise the lesioned part. Then, using the clip attached with the linear object (thread) as an auxiliary, grabbed and grasped the lesioned part, pulled the linear object of the clip to the proximal side and pulled it, and when the lesioned part was peeled off, The lower layer of the lesion is excised with a treatment tool for incision such as an electric knife, and the lesion is taken out of the body.

  As a treatment tool for gripping a lesioned part, for example, Patent Document 1 discloses an auxiliary tool for an endoscope apparatus. An outer cylinder, an inner cylinder in the outer cylinder, a linear object in the inner cylinder, a clip connected to a distal side of the linear object, and a proximal side of the inner cylinder 2. Description of the Related Art A clip device having a handle connected to is known. A method of gripping an object with a clip using such a clip device is as follows. The clip includes a clip body including one gripping base material, another gripping base material facing the one gripping base material, and a cylindrical fastener movable in the axial direction. By moving the fastener in the axial direction to the distal side, the gripping base material is closed. First, the clip device is inserted into the forceps channel of the endoscope in a state where the clip is disposed outside the inner cylinder body and outside the inner cylinder body, and when reaching the object, the outer cylinder body is pulled proximally, or the inner cylinder body Is pushed distally to expose the clip from the outer cylinder. Next, the clip is pulled into the inner cylinder by moving the linear object proximally with respect to the inner cylinder. At this time, the proximal end of the fastener provided on the clip abuts on the distal end of the inner cylinder, so that the clip body pulled by the linear object is relative to the fastener and the inner cylinder. To the proximal side and the clip is closed to grip the lesion.

JP 2014-171629 A

Endoscopic clip devices are required to be simplified and more efficient in how they are used, but conventional endoscopic clip devices still have room for improvement in terms of grasping lesions. .
The present invention has been made in view of the above circumstances, and an object of the present invention is to provide an endoscopic clip device capable of efficiently grasping a lesion and an operating method thereof.

  The present inventors have found that the following problems occur when a clip is closed to hold a lesion, which is an object. When the linear object is moved proximally with respect to the inner cylinder and the clip is closed, the inner cylinder also moves proximally with the movement of the linear object due to the contact resistance between the linear object and the inner cylinder. The distal end of the inner cylinder and the clip may be pulled into the outer cylinder. When all or part of the clip is pulled into the outer cylinder as described above without gripping the target object, when performing an operation to expose the clip from the outer cylinder, the proximity of the outer cylinder The upper end and the distal end of the handle are brought into contact with each other. Then, the clip cannot be exposed from the outer cylinder even if the outer cylinder is pulled proximally or the inner cylinder is pushed distally, except for the clip being pulled proximally via a linear object Is in a state where it cannot be operated. In such a case, it is necessary to operate the position of the endoscope and perform gripping again, or to take out the clip device from the endoscope and insert a new clip device again. Usually, the inner cylinder is set longer than the outer cylinder so that such a situation does not occur. However, because there is a difference between the inner diameter of the outer cylinder and the outer diameter of the inner cylinder, the clip device bends along the curvature of the forceps channel of the endoscope. As a result, the inner cylinder snakes in the outer cylinder. The path of the inner cylinder becomes larger, the distal end of the inner cylinder moves relatively to the proximal side of the distal end of the outer cylinder, and the distal end of the inner cylinder is moved into the outer cylinder as described above. A situation may occur in which the end and the clip are received.

  In order for the clip to grip the object, the clip is located at the distal end of the clip, the distal end of the inner cylinder, the distal end of the outer cylinder, and then the tip of the inner cylinder is located distally. And the clip needs to be open enough to grip the object. However, when all or part of the distal end of the inner cylinder and the clip are present in the outer cylinder as described above, the clip cannot contact the lesioned portion in a grippable manner or a part of the clip may Since it is located in the outer cylinder, the grip base material of the clip is not sufficiently opened, and the lesioned part may not be gripped.

  The endoscopic clip device of the present invention that has achieved the above object includes an outer cylinder, an inner cylinder disposed in the outer cylinder, a linear object disposed in the inner cylinder, A clip disposed on the distal side of the inner cylinder and connected to the linear object, and a handle connected to the proximal side of the inner cylinder, the handle in the outer cylinder It has a gist in that the distal side can be inserted. Since the clip device for an endoscope of the present invention can insert the distal side of the handle into the outer cylinder even after the proximal end of the outer cylinder and the distal end of the handle come into contact with each other, Even if the distal end of the inner cylinder is pulled into the outer cylinder before the object grips the object, the outer cylinder can be further moved proximally to expose the clip from the outer cylinder. it can. For this reason, even when the clip is pulled into the outer cylinder when the linear object is moved proximally with respect to the inner cylinder and the clip is closed, the outer cylinder is pulled proximally, Insert the distal end of the handle into the outer cylinder by pushing the inner cylinder distally, and place the clip and the distal end of the inner cylinder more distally than the distal end of the outer cylinder be able to. Thus, even after the entire length of the inner cylinder has been accommodated in the outer cylinder, the distal end of the inner cylinder and the clip can be exposed again from the outer cylinder, and the clip can be closed. Thus, it is not necessary to manipulate the position of the clip or to replace the clip device, so that the lesion can be efficiently grasped.

  In the endoscope clip device of the present invention, it is preferable that a slit is provided at the proximal end portion of the outer cylinder. Since the portion provided with the slit of the outer cylindrical body expands in the radial direction, the distal side of the handle can be inserted into the portion provided with the slit.

  The slit is preferably provided along the axial direction of the outer cylinder. Thereby, it becomes easy to expand the part in which the slit of the outer cylinder was provided in the radial direction.

  It is preferable that the number of slits is 1 or more and 4 or less. This is because if the number of slits is too large, the portion provided with the slits naturally expands in the radial direction even when it is not necessary to insert the distal side of the handle into the outer cylinder.

  In the endoscope clip device of the present invention, it is preferable that a diameter-enlarged portion having a larger inner diameter than the distal side is provided at the proximal end portion of the outer cylinder. This is because the distal side of the handle can be inserted into the enlarged diameter portion of the outer cylinder.

  It is preferable that the diameter-enlarged portion of the outer cylinder has a conical shape whose inner diameter increases toward the proximal side. This is because the shape of the enlarged diameter portion is preferably formed in accordance with the preferred shape on the distal side of the handle.

  The endoscope clip device of the present invention may be capable of reducing the outer diameter of the distal end portion of the handle. The distal side of the handle can be inserted into the outer cylinder also by changing the outer diameter of the handle.

  In addition, another endoscopic clip device of the present invention that has achieved the above object includes an outer cylinder, an inner cylinder arranged in the outer cylinder, and a line arranged in the inner cylinder. And a clip disposed on the distal side of the inner cylinder and connected to the linear object, and a handle connected to the proximal side of the inner cylinder. It has a gist in that a part of the proximal side of the cylinder is removable. In another endoscopic clip device of the present invention, a part of the proximal side of the outer cylinder is removable, so that in the state where the part of the proximal side of the outer cylinder is not removed, The distal end and the clip are difficult to be exposed from the distal side of the outer cylinder, and the distal end and the clip of the inner cylinder from the distal side of the outer cylinder when part of the proximal side of the outer cylinder is removed Is easily exposed. Therefore, when closing the clip by moving the linear object to the proximal side relative to the inner cylinder, remove the proximal side of the outer cylinder and remove the clip and the distal end of the inner cylinder. It can arrange | position to the distal side rather than the distal end of a cylinder. If the linear object is moved to the proximal side in this state, the clip and the distal end of the inner cylinder abut against each other without the clip of the distal end of the inner cylinder and the clip being pulled into the outer cylinder. Since it can be closed, the lesioned part can be efficiently grasped.

  The operation method of the clip device for an endoscope of the present invention that can achieve the above object includes an outer cylinder, an inner cylinder disposed in the outer cylinder, and a linear shape disposed in the inner cylinder. A clip device for an endoscope having an object, a clip disposed on a distal side of the inner cylinder, and connected to a linear object; and a handle connected to a proximal side of the inner cylinder , Moving the outer cylinder proximally with respect to the inner cylinder, inserting the distal side of the handle into the outer cylinder, and moving the linear object proximally with respect to the inner cylinder And a step of closing the clip. Since the operation method of the clip device for an endoscope of the present invention includes the step of inserting the distal side of the handle into the outer cylinder, the clip and the distal end of the inner cylinder are placed more than the distal end of the outer cylinder. Can be placed distally. If the linear object is moved to the proximal side in this state, the clip and the distal end of the inner cylinder abut against each other without the clip of the distal end of the inner cylinder and the clip being pulled into the outer cylinder. Since it can be closed, the lesioned part can be efficiently grasped.

  Further, another operating method of the endoscope clip device of the present invention that can achieve the above object is an outer cylinder, an inner cylinder disposed in the outer cylinder, and an inner cylinder. An endoscope having a linear object, a clip disposed on a distal side of the inner cylinder, connected to the linear object, and a handle connected to a proximal side of the inner cylinder In the mirror clip device, a step of removing a portion of the outer cylinder on the proximal side, a step of moving the outer cylinder to the proximal side with respect to the inner cylinder, and a linear object with respect to the inner cylinder And moving the proximal side to close the clip. Another operation method of the clip device for an endoscope of the present invention includes the step of removing a portion of the proximal side of the outer cylinder, so that the distal end of the clip and the inner cylinder is connected to the distal end of the outer cylinder. It can arrange | position to a more distal side. If the linear object is moved to the proximal side in this state, the clip and the distal end of the inner cylinder abut against each other without the clip of the distal end of the inner cylinder and the clip being pulled into the outer cylinder. Since it can be closed, the lesioned part can be efficiently grasped.

  The endoscope clip device and the operating method thereof according to the present invention can be obtained by moving the linear object without moving the distal end of the inner cylinder and the clip into the outer cylinder even if the linear object is moved proximally. Since the distal end of the cylindrical body abuts and the clip can be closed, the lesioned part can be efficiently grasped.

The top view of the clip apparatus for endoscopes of this invention is represented. The sectional view of the clip device for endoscopes of the present invention is expressed. The perspective view of the clip concerning the present invention is represented. The side view of the clip concerning the present invention is expressed. The side view of the clip apparatus for endoscopes of this invention is represented. The side view of the clip apparatus for endoscopes of this invention is represented. The side view of the clip apparatus for endoscopes of this invention is represented. The side view of the clip apparatus for endoscopes of this invention is represented. The side view of the clip apparatus for endoscopes of this invention is represented. The side view of the clip apparatus for endoscopes of this invention is represented. The side view of the clip apparatus for endoscopes of this invention is represented. The side view of the outer cylinder which concerns on this invention is represented. The side view of the outer cylinder which concerns on this invention is represented. The side view which shows the operating method of the clip apparatus for endoscopes of this invention (partial sectional view) is represented. The side view which shows the operating method of the clip apparatus for endoscopes of this invention (partial sectional view) is represented. The side view which shows the operating method of the clip apparatus for endoscopes of this invention (partial sectional view) is represented. The side view which shows the operating method of the clip apparatus for endoscopes of this invention (partial sectional view) is represented. The side view which shows the operating method of the clip apparatus for endoscopes of this invention is represented.

  Hereinafter, the present invention will be described in more detail based on the following embodiments, but the present invention is not limited by the following embodiments as a matter of course, and appropriate modifications are made within a range that can meet the purpose described above and below. In addition, it is of course possible to carry out them, all of which are included in the technical scope of the present invention. In addition, in each drawing, although hatching, a member code | symbol, etc. may be abbreviate | omitted for convenience, in this case, a description and another drawing shall be referred. In addition, the dimensions of the various members in the drawings are given priority to contribute to the understanding of the features of the present invention, and may be different from the actual dimensions.

1. Endoscopic clip device In the present invention, an endoscopic clip is used to seal or grip an object (a lesioned part of an organ) during countersurgery (counter traction) during treatment under an endoscope. An instrument that picks objects for hemostasis, suturing, and marking. In this specification, it may be described simply as “clip”. The clip in the endoscope clip device of the present invention is mainly used for grasping a lesioned part. In addition, after holding a lesioned part with a clip, it is also possible to pull the lesioned part by pulling a linear object proximally.

  In the present invention, an endoscopic clip device is a device that is inserted into a forceps channel of an endoscope and holds an object by controlling opening and closing of the clip. In the present specification, an endoscopic clip device may be simply referred to as “device” or “clip device”.

  In the present invention, the axial direction refers to the major axis direction of the outer cylinder or the inner cylinder, the proximal side in the axial direction refers to the direction on the hand side of the device user, and the distal side refers to the proximal side. Point in the opposite direction. In the present invention, the radial direction refers to the radial direction of the outer cylindrical body or the inner cylindrical body, the inner direction refers to the direction toward the center of the outer cylindrical body or the inner cylindrical body, and the outer direction refers to the outer side. It refers to the radial direction of the cylinder or inner cylinder.

  FIG. 1 shows a plan view of an endoscopic clip device of the present invention, and FIG. 2 shows a cross-sectional view of the endoscopic clip device of the present invention. The endoscope clip device 1 of the present invention includes an outer cylinder body 10, an inner cylinder body 20, a linear object 40, a clip 30, and a handle 50.

  The outer cylinder 10 is a cylindrical member that arranges the inner cylinder 20 in the inner cavity. The outer cylinder 10 has the clip 30 disposed in the inner cavity so that the clip 30 passes from the forceps opening of the endoscope through the forceps channel and is transported to the vicinity of the object until the clip 30 is moved into the endoscope. Injuries to the internal forceps, the forceps channel, and the body tissue other than the lesioned part are prevented.

  It is desirable that the outer cylinder 10 has both a flexibility that bends along the shape in the body cavity and a rigidity that reliably reaches the tissue to be treated in a well-balanced manner. For this reason, the outer cylinder 10 is formed by, for example, connecting a plurality of cylinders formed of synthetic resin, cylinders formed of coiled metal or synthetic resin, or short cylindrical joint pieces in the axial direction. A movable cylinder is used, and among these, a cylinder formed of a synthetic resin is preferably used. Moreover, it is preferable that the outer cylinder 10 is formed from a transparent or translucent material so that the operator can visually confirm the positional relationship between the outer cylinder 10 and the inner cylinder 20.

  Although the thickness of the outer cylinder 10 is not particularly limited, in order to achieve both flexibility and rigidity of the outer cylinder 10, for example, it is preferably 100 μm or more, more preferably 150 μm or more, and 200 μm or more. More preferably, it is 400 μm or less, more preferably 300 μm or less, and further preferably 250 μm or less.

  The inner cylinder 20 is disposed in the outer cylinder 10 and the linear object 40 is disposed in the lumen. The opening / closing degree of the clip 30 can be adjusted by moving the inner cylinder 20 in the axial direction with respect to the clip 30. Similar to the outer cylinder 10, the inner cylinder 20 desirably has both the flexibility of bending along the shape of the body cavity and the rigidity of reliably reaching the treatment target tissue in a well-balanced manner.

  The inner cylinder 20 is formed from, for example, a cylinder formed of a coiled metal or a synthetic resin, a cylinder formed by connecting a plurality of short cylindrical joint pieces in the axial direction, and a synthetic resin. A cylindrical body is used.

  Although the thickness of the inner cylinder 20 is not particularly limited, in order to achieve both flexibility and strength of the inner cylinder 20, for example, it is preferably 100 μm or more, more preferably 150 μm or more, and 200 μm or more. More preferably, it is 400 μm or less, more preferably 300 μm or less, and further preferably 250 μm or less.

  The difference between the inner diameter of the outer cylinder 10 and the outer diameter of the inner cylinder 20 is preferably 50 μm or more and 300 μm or less. The clip device 1 of the present invention has a case where the difference between the inner diameter of the outer cylinder 10 and the outer diameter of the inner cylinder 20 is large, and the entire length of the inner cylinder 20 is accommodated in the outer cylinder 10 by bending. Can also be suitably used.

  The difference in length between the outer cylinder 10 and the inner cylinder 20 is preferably 35 mm or less, more preferably 30 mm or less, and even more preferably 25 mm or less. The clip device 1 of the present invention is also suitable for a case where the difference in length between the outer cylinder body 10 and the inner cylinder body 20 is small, and the entire length of the inner cylinder body 20 is accommodated in the outer cylinder body 10 by bending. Can be used.

  Examples of the synthetic resin forming the outer cylinder 10 and the inner cylinder 20 include polyamide resins such as nylon, polyolefin resins such as polypropylene (PP) and polyethylene (PE), polyester resins such as polyethylene terephthalate (PET), poly Aromatic polyetherketone resin such as ether ether ketone (PEEK), polyimide resin, polytetrafluoroethylene (PTFE), tetrafluoroethylene-perfluoroalkyl vinyl ether copolymer (PFA), ethylene-tetrafluoroethylene copolymer ( A synthetic resin such as a fluororesin such as ETFE) can be used. From the viewpoint of slipperiness, the synthetic resins forming the outer cylinder body 10 and the inner cylinder body 20 are preferably made of different materials.

  The clip 30 grips an object (lesioned part), is disposed on the distal side of the inner cylinder 20, and is connected to the linear object 40. 3 represents a perspective view of the clip 30 according to the present invention, and FIG. 4 represents a side view of the clip 30 according to the present invention. As shown in FIGS. 3 and 4, the clip 30 is movable in the axial direction with a clip body 31 including one gripping base material 32 and another gripping base material 33 facing the one gripping base material 32. And a cylindrical fastener 35.

  The closing operation of the clip 30 is performed as follows. First, the fastener 35 is arrange | positioned so that the outer side of the proximal side of the V-shaped clip main body 31 of an open state may be enclosed. Next, the fastener 35 is moved to the distal side of the gripping base materials 32 and 33. Then, as the fastener 35 moves distally, the gripping base materials 32 and 33 are loaded with a pressing force directed radially inward by the fastener 35, and the gripping base materials 32 and 33 approach each other. Therefore, the clip 30 is closed.

  The clip main body 31 and the fastener 35 including the gripping base materials 32 and 33 are preferably formed from a material having high elasticity and biocompatibility, for example, stainless steel such as SUS304 or SUS631, a Ni—Ti alloy, or the like. Preferably formed.

  The clip main body 31 can be formed by joining one gripping base material 32 and another gripping base material 33 that are individually manufactured by a method such as mechanical fixing by screws, caulking, welding, adhesion, or the like. .

  On the other hand, as shown in FIGS. 3 and 4, a clip body 31 having one gripping base material 32 and another gripping base material 33 facing each other by bending one metal plate into a V shape or a U shape. May be formed.

  As shown in FIGS. 3 and 4, the two gripping base materials 32 and 33 can be shaped symmetrically with respect to the axial direction of the inner cylindrical body 20. As a result, the two gripping base materials 32 and 33 are easily stretched and contracted in the radial direction, so that the lesioned part can be easily gripped.

  An opening (not shown) may be formed on the distal side of the gripping base materials 32 and 33 so that the gripping base materials 32 and 33 of the clip 30 can be easily deformed. In order to reinforce the gripping base materials 32 and 33, the gripping base materials 32 and 33 may be formed with ridges or recesses (both not shown). The ridges and ridges may be formed integrally with the gripping base materials 32 and 33, or separate members may be added. When formed integrally, the protrusions viewed from one surface of the gripping base materials 32 and 33 may be formed to be concave when viewed from the back surface. The ridges and ridges are preferably provided along the axial direction of the gripping base materials 32 and 33.

  As shown in FIG. 3, it is preferable that the width | variety of the distal side of the holding | grip base materials 32 and 33 of the clip main body 31 is formed wider than the width | variety of a proximal side. When the clip 30 is in the open state, the fastener 35 is disposed on the proximal side of the gripping base materials 32 and 33, and when the clip 30 is in the closed state, the fastener 35 is preferably disposed on the distal side of the gripping base materials 32 and 33. Can do.

  Although not shown, the length of one grip base 32 of the clip body 31 may be formed larger than the length of the other grip base 33. This is because the lesion can be reliably grasped by the clip 30.

  As shown in FIG. 4, at least a part of the gripping base materials 32 and 33 may have a curved portion 34 that curves so as to protrude radially inward. In addition to the gripping base materials 32 and 33 being easily bent, the distal side of the clip main body 31 is easily expanded in the radial direction, so that the gripping position of the clip 30 is easily aligned with the lesioned part.

  As shown in FIG. 4, a part of one gripping base material 32 may be in contact with another gripping base material 33. The gripping base materials 32 and 33 include a proximal base end portion where the pair of gripping base materials 32 and 33 are arranged substantially in parallel, a gripping portion for gripping a lesioned portion, and between the base end portion and the gripping portion. It can be divided into the central part. A location where a part of one gripping base material 32 and another gripping base material 33 are in contact with each other is not particularly limited, but is preferably provided at the central portion and more preferably at the distal end portion of the base end portion. Here, the base end portion, the grip portion, and the center portion of the grip base materials 32 and 33 may be portions divided by dividing the grip base materials 32 and 33 into three equal parts in the axial direction. Further, when the gripping base materials 32 and 33 are provided with the bending portion 34 as shown in FIGS. 3 and 4, one gripping base material 32 and another gripping base material 33 are in contact with each other at the proximal end of the bending portion 34. It is preferable. By providing a location where a part of one gripping base 32 is in contact with another gripping base 33, the opening angle between the gripping bases 32 and 33 at the distal end of the clip 30 can be adjusted in designing the clip 30. The opening angle can be maintained even during use. Moreover, since the opening angle can be increased by providing the contact portion as compared with the case where the contact portion is not in contact, the lesioned portion can be reliably grasped by the clip 30.

  As shown in FIG. 3, an uneven claw portion may be provided at the distal end of the clip body 31. When the lesioned part is gripped by the clip 30, the nail part at the distal end of the clip main body 31 bites into the lesioned part, so that the lesioned part is prevented from dropping from the clip 30.

  The fastener 35 is formed in a cylindrical body or a rectangular tube body, for example. The outer diameter of the fastener 35 is preferably larger than the inner diameter of the inner cylinder 20. Thereby, when the linear object 40 is pulled to the proximal side, the proximal end of the fastener 35 and the distal end of the inner cylinder 20 abut, and only the clip body 31 is drawn into the inner cylinder 20. As a result, the fastener 35 moves to the distal side of the clip body 31, and the clip 30 can be closed.

  The linear object 40 is a member that pulls the clip 30 that holds the object. The linear object 40 is disposed in the inner cylinder 20.

  The linear object 40 is preferably connected to the proximal side of the clip 30, and the axial position of the linear object 40 connected to the clip 30 is not particularly limited.

  For the connection between the linear object 40 and the clip 30, welding or adhesion can be used in addition to mechanical fixation by a connection member such as a screw or caulking. Moreover, the linear object 40 and the clip 30 can also be connected by connecting the linear object 40 to the proximal end of the clip 30 formed in V shape or U shape. The method for tying the linear object 40 to the clip 30 is not particularly limited, and for example, it can be a figure eight knot.

  Further, in the linear object 40 having one end, the other end, and a midway between the one end and the other end, the midway part of the linear object 40 is hung on the proximal side of the clip 30. Thus, the linear object 40 and the clip 30 may be connected. Here, one end of the linear object 40 indicates a range of 30% of the entire length of the linear object 40, and the other end of the linear object 40 is 30% of the total length of the linear object 40. The midway part refers to the remaining 40% length range other than the one end part and the other end part of the linear object 40.

  The linear object 40 is preferably formed from a material having biocompatibility and strength. For example, a metal wire such as stainless steel or carbon steel, a polyamide resin such as nylon, or a polyolefin resin such as PP or PE. , Synthetic resin fibers such as polyester resins such as PET, aromatic polyether ketone resins such as PEEK, polyimide resins, fluororesins such as PTFE, PFA, and ETFE. In addition, the linear object 40 can select a highly rigid wire material and a highly flexible thread material suitably according to the use of a clip apparatus.

  In order to improve the slidability of the linear object 40 and reduce the frictional force between the linear object 40 and the clip 30, the linear object 40 is preferably made of a fluororesin. Moreover, when using the linear object 40 which is not formed from a fluororesin, it is preferable that the outer surface of the linear object 40 is coat | covered with the fluororesin. As the fluororesin covering the surface of the linear object 40, for example, PTFE, PFA, ETFE, tetrafluoroethylene / hexafluoropropylene copolymer (FEP), or the like can be used.

  A known method may be employed for coating the linear material 40 with the fluororesin, and for example, an immersion method, a spray method, a fluidized bed method, a kneader coater method, or the like can be used.

  It is preferable that the inner edge of the clip 30 in contact with the linear object 40 is chamfered. Since the inner edge of the clip 30 is the part that most rubs against the linear object 40 when the linear object 40 is pulled out, damage to the linear object 40 can be suppressed by chamfering the inner edge of the clip 30. Can do. Especially, it is preferable that the inner edge of the clip 30 on the proximal side is chamfered. The inner edge on the proximal side of the clip 30 can be, for example, the inner edge of the section located on the most proximal side by dividing the longitudinal direction of the clip 30 into three when the clip 30 is viewed from above. In addition, as a method of chamfering the inner edge of the clip 30, for example, a known method such as performing R-surface machining with a chamfering machine or the like can be used.

  Since the linear object 40 is disposed in the inner cylinder 20, the thickness (outer diameter) of the linear object 40 is smaller than the inner diameter of the inner cylinder 20.

  The linear object 40 may be disposed in the inner cylinder 20 and the handle 50, and a part of the linear object 40 may be exposed from the proximal side of the handle 50. The user can move the linear object 40 proximally to close the clip 30 by pulling a portion of the linear object 40 exposed from the proximal side of the handle 50. it can. The user can open and close the clip 30 by operating the handle 50.

  In order to smoothly move the linear object 40, the length of the linear object 40 is preferably 1.1 times or more, for example, 1.3 times or more the length of the inner cylinder 20. More preferably, it is more preferably 1.5 times or more.

  Moreover, although there is no restriction | limiting in particular about the upper limit of the length of the linear object 40, For example, it is 3.4 times or less of the length of the inner cylinder 20 so that operation of the linear object 40 may not be prevented. Preferably, it is 3.2 times or less, more preferably 3.0 times or less.

  Since the linear object 40 is preferably formed from a fluororesin, there is a possibility that the linear object 40 slides from the hand when the user grips the linear object 40 and prevents the linear object 40 from moving smoothly. . For this reason, a fixing device for fixing the linear object 40 may be connected to a part of the linear object 40 exposed from the proximal side of the handle 50.

  The handle 50 is a member that is gripped by the user when the device 1 is operated, and is connected to the proximal side of the inner cylinder 20. Since the linear object 40 is disposed in the handle 50, the handle 50 is preferably formed in a cylindrical shape. The handle 50 may be composed of two or more members.

  It is preferable that the distal side of the handle 50 has a conical shape whose outer diameter decreases toward the distal end. By relaxing the shape of the distal side of the handle 50 connected to the inner cylinder 20, stress concentration on the connecting portion between the inner cylinder 20 and the handle 50 is alleviated, and the inner cylinder 20 and the handle 50 are deformed. And prevent damage.

  As shown in FIG. 1, a protective part 51 is preferably provided on the distal side of the handle 50. More specifically, the protective part 51 is preferably a protective cap that covers the distal end of the handle 50. By providing the protection part 51, when the inner cylinder 20 is bent, the elasticity of the inner cylinder 20 material and the handle 50 material is suppressed from changing suddenly. Similarly to the handle 50, the protection part 51 is preferably formed in a cylindrical shape.

  Connection between the handle 50 and the inner cylinder 20 is press-fitting, press-contact, fitting, mechanical fixing by screws, caulking, etc., adhesion using an adhesive such as polyurethane, epoxy, cyano, or silicone, welding, etc. Can be used. Further, when a groove narrower than the outer diameter of the inner cylinder 20 is formed along the axial direction outside the handle 50, the handle 50 can be fixed by pressing the inner cylinder 20 into the groove. And the inner cylinder 20 may be connected.

  The protection part 51 is preferably formed of an elastic member. The protection part 51 can be formed from a polyamide elastomer, for example. Thereby, it can suppress that the elasticity of the inner cylinder 20 material and the handle | steering-wheel 50 material changes rapidly.

  As shown in FIGS. 1 and 2, an auxiliary handle 52 may be provided on the outer surface of the outer cylinder 10 to facilitate the operation of moving the outer cylinder 10.

  The auxiliary handle 52 and the outer cylinder 10 are connected by mechanical fixing by fitting, screws, caulking, etc., adhesion using an adhesive such as polyurethane, epoxy, cyano, silicone, or welding. Can do. When a groove is formed along the axial direction outside the auxiliary handle 52, the outer cylinder 10 is accommodated in the groove of the auxiliary handle 52 or in the lumen of the auxiliary handle 52 through the groove. Thus, the auxiliary handle 52 and the outer cylinder 10 may be connected. The auxiliary handle 52 and the outer cylinder 10 may be removable.

  As a material of the handle 50 and the auxiliary handle 52, for example, a synthetic resin such as silicone rubber, or foamed plastic such as polyurethane foam can be used.

  The outer cylinder 10 is inserted into the body from the distal side together with the inner cylinder 20 via the forceps channel of the endoscope. Therefore, the outer diameter of the handle 50 connected to the proximal side of the inner cylinder 20 and located on the proximal side of the outer cylinder 10 prevents the handle 50 from entering the forceps channel. It is preferably larger than the inner diameter of the channel. Similarly, the outer diameter of the auxiliary handle 52 is preferably larger than the inner diameter of the forceps channel of the endoscope.

  When the clip device 1 is inserted into the forceps channel of the endoscope, the outer surface of the outer cylinder 10 and the inner wall of the forceps channel come into contact with each other, so that the position of the outer cylinder 10 is shifted in the axial direction, and the forceps channel is moved. The clip 30 may be exposed from the outer cylinder 10. Further, when the clip is transported, the position of the outer cylinder 10 may be shifted in the axial direction due to vibration or the like, and the clip 30 may be exposed from the outer cylinder 10 in the package. Therefore, as shown in FIG. 2, the clip device 1 is preferably provided with a spacer 60 on the outer side of the inner cylinder 20, proximal to the outer cylinder 10 and distal to the handle 50. . Since the proximal end of the spacer 60 and the distal end of the handle 50, and the distal end of the spacer 60 and the proximal end of the outer cylinder 10 are in contact, the position of the outer cylinder 10 in the axial direction during use, transportation, etc. It is possible to prevent the clip 30 from being exposed from the outer cylindrical body 10 by shifting.

  As the spacer 60, for example, a cylindrical member having a lumen or a cylindrical member having a rectangular tube shape can be used.

  In order to prevent the spacer 60 from being housed in the outer cylinder body 10, the outer diameter of the distal end of the spacer 60 is preferably larger than the inner diameter of the proximal end of the outer cylinder body 10. Since the distal end of the spacer 60 and the proximal end of the outer cylinder 10 are in contact, the inner diameter of the distal end of the spacer 60 is smaller than the outer diameter of the proximal end of the outer cylinder 10. Further, in order to prevent the handle 50 from being housed inside the spacer 60 and to prevent the axial position of the outer cylinder 10 from shifting, the inner diameter of the proximal end of the spacer 60 is set outside the distal end of the handle 50. Smaller than the diameter.

  Further, the spacer 60 is provided with an opening, a slit, a hook-and-loop fastener, a snap, etc. that communicate with the lumen along the axial direction so that the spacer 60 can be easily attached to and removed from the outer side of the inner cylinder 20. An engaging member such as a fastener may be provided. As a material of the spacer 60, for example, a synthetic resin such as polypropylene or a foamed plastic such as polyurethane foam can be used.

  The clip device 1 of the present invention can insert the distal side of the handle 50 into the outer cylinder 10. Since there is a difference between the inner diameter of the outer cylinder 10 and the outer diameter of the inner cylinder 20 of the clip device 1, the clip device 1 is bent along the curve of the forceps channel of the endoscope. The inner cylinder 20 meanders and the path of the inner cylinder 20 increases, and the distal end of the inner cylinder 20 moves relatively closer to the proximal side than the distal end of the outer cylinder 10, and the outer cylinder A state in which the distal end of the inner cylinder 20 and the clip 30 are accommodated in 10 can occur. In this case, in a state where the distal side of the handle 50 is not inserted into the outer cylinder 10, the opening / closing operation of the clip 30 cannot be performed. Therefore, by inserting the distal side of the handle 50 into the outer cylinder 10, the outer cylinder 10 moves more proximally, and the distal end of the clip 30 and the inner cylinder 20 is moved to the outer cylinder 10. It can arrange | position to the distal side rather than the distal end. If the linear object 40 is moved proximally in this state, the distal end of the inner cylinder 20 and the clip 30 are not drawn into the outer cylinder 10, and the distal end of the clip 30 and the inner cylinder 20 is moved. Since the end can contact and the clip 30 can be closed, the lesioned part can be efficiently grasped.

  Aspects 1 to 4 that allow the distal side of the handle 50 to be inserted into the outer cylinder 10 will be described.

(Embodiment 1)
5 and 6 are side views showing a configuration example in which the slit 11 is provided in the outer cylindrical body 10 of the clip device 1. FIG. 5 shows a state before the distal side of the handle 50 is inserted into the outer cylinder 10, and FIG. 6 shows a state after the distal side of the handle 50 is inserted into the outer cylinder 10. Yes.

  As shown in FIG. 5, it is preferable that a slit 11 is provided at the proximal end portion of the outer cylindrical body 10. Since the portion provided with the slit 11 of the outer cylinder 10 expands radially outward, the distal side of the handle 50 can be inserted into the portion provided with the slit 11 as shown in FIG. . Here, the slit 11 is a cut that penetrates or does not penetrate inside and outside of the outer cylindrical body 10, and includes a perforation and a groove.

  The slit 11 preferably extends to the proximal end of the outer cylinder 10. Thereby, since the outer cylinder 10 can be expanded radially outward at the proximal end of the outer cylinder 10, the distal side of the handle 50 can be easily inserted. In order to make the outer cylindrical body 10 easily expand radially outward, it is preferable that the slit 11 penetrates into and out of the outer cylindrical body 10.

  The slit 11 is preferably provided along the axial direction of the outer cylindrical body 10. Thereby, it becomes easy to expand the part in which the slit 11 was provided to radial direction outward.

  The method of providing the slit 11 is not particularly limited, and for example, cutting with a rotary blade, a tube cutter, or a laser can be used.

  The number of slits 11 is preferably 1 or more, and more preferably 2 or more. On the other hand, the number of slits 11 is preferably 5 or less, and more preferably 4 or less. This is because if the number of the slits 11 is too large, even if it is not necessary to insert the distal side of the handle 50 into the outer cylindrical body 10, the portion provided with the slits 11 naturally expands in the radial direction. From the standpoint of manufacturing efficiency, the number of slits 11 is preferably an even number.

  The length of the slit 11 in the axial direction is preferably longer than the length of the closed clip 30 in the axial direction. In this case, when the distal side of the handle 50 is inserted into the outer cylinder 10, the distal side of the inner cylinder 20 and the clip 30 are exposed from the outer cylinder 10 on the distal side of the outer cylinder 10. The clip 30 can be easily closed.

  The length of the slit 11 can be 0.9 times or more the axial length of the closed clip 30, and is preferably longer than the axial length of the closed clip 30. For example, when the axial length of the clip 30 in the closed state is about 5.7 mm, the axial length of the slit 11 is preferably 6 mm or more, for example.

(Embodiment 2)
7 and 8 are side views showing a configuration example in which the enlarged diameter portion 12 is provided in the outer cylindrical body 10 of the clip device 1. 7 shows a state before the distal side of the handle 50 is inserted into the outer cylinder 10, and FIG. 8 shows a state after the distal side of the handle 50 is inserted into the outer cylinder 10. Yes.

  As shown in FIG. 7, it is preferable that a diameter-enlarged portion 12 having a larger inner diameter than the distal side is provided at the proximal end portion of the outer cylindrical body 10. This is because the distal side of the handle 50 can be inserted into the outer cylinder 10 in the enlarged diameter portion 12 as shown in FIG.

  The inner diameter of the enlarged diameter portion 12 only needs to be formed larger than the inner diameter on the distal side of the outer cylindrical body 10, and the inner diameter of the enlarged diameter portion 12 is 1.5 of the inner diameter on the distal side of the outer cylindrical body 10. It is preferable that it is twice or more.

  It is preferable that the shape of the enlarged diameter portion 12 is formed in accordance with the shape on the distal side of the handle 50. Therefore, it is preferable that the enlarged diameter portion 12 has a conical shape whose inner diameter increases toward the proximal side.

  Similarly to the slit 11 shown in the first embodiment, the length in the axial direction of the enlarged diameter portion 12 is preferably longer than the length in the axial direction of the clip 30 in the closed state, specifically, 6 mm or more. It is preferable.

(Embodiment 3)
9 to 11 are side views showing a configuration example in which the inflatable portion 21 is provided in the inner cylinder 20 of the clip device 1. FIG. 9 shows a state before the distal side of the handle 50 is inserted into the outer cylindrical body 10, and FIG. 10 shows a state where the outer diameter of the inner cylindrical body 20 is reduced by contracting the inflating portion 21. FIG. 11 shows a state after the distal side of the handle 50 is inserted into the outer cylindrical body 10.

  As shown in FIG. 9, an inflatable portion 21 that can change the outer diameter of the inner cylinder 20 may be provided at the proximal end of the inner cylinder 20. In the present embodiment, it is preferable that the proximal inner diameter of the outer cylinder 10 is larger than the distal outer diameter of the handle 50. The expansion part 21 provided in the inner cylinder 20 plays the same role as the spacer 60 described above. That is, when the clip device 1 is inserted into the forceps channel of the endoscope, the expansion portion 21 is expanded, so that the position of the outer cylinder 10 is shifted in the axial direction, and the clip 30 from the outer cylinder 10 in the forceps channel. Is prevented from being exposed.

  The expansion part 21 of the inner cylinder 20 has a multiple tube structure. By enclosing a gas between the inner tube and the outer tube of the expanding portion 21, the expanding portion 21 can be expanded, and by discharging the gas outside the inner cylinder, the expanding portion 21 can be contracted.

  In the inflated state of the inflating part 21, it is preferable that the outermost diameter of the inflating part 21 of the inner cylinder 20 is larger than the inner diameter of the outer cylinder 10. Since the expansion part 21 of the inner cylinder 20 is not inserted into the outer cylinder 10, the distal end of the inner cylinder 20 and the clip 30 can be hardly exposed from the outer cylinder 10.

  In the contracted state of the expansion part 21, the outermost diameter of the expansion part 21 of the inner cylinder 20 is preferably smaller than the inner diameter of the outer cylinder 10. Since the expanding portion 21 of the inner cylinder 20 is inserted into the outer cylinder 10, the distal end of the clip 30 and the inner cylinder 20 can be disposed more distally than the distal end of the outer cylinder 10. it can. If the linear object 40 is moved proximally in this state, the distal end of the inner cylinder 20 and the clip 30 are not drawn into the outer cylinder 10, and the distal end of the clip 30 and the inner cylinder 20 is moved. Since the end can contact and the clip 30 can be closed, the lesioned part can be efficiently grasped.

(Embodiment 4)
In the first and second embodiments, the example in which the distal side of the handle 50 can be inserted into the outer cylinder 10 by increasing the inner diameter of the proximal side of the outer cylinder 10 has been described. The inner diameter of the distal side of the handle 50 can also be changed. That is, the endoscope clip device 1 of the present invention may be capable of reducing the outer diameter of the distal end portion of the handle 50. By changing the outer diameter of the handle 50, the distal side of the handle 50 can be inserted into the outer cylinder 10.

  As a method for reducing the outer diameter of the distal end portion of the handle 50, for example, an aspect in which an inflating portion as described in the third embodiment is provided at the distal end portion of the handle 50, or the distal end of the handle 50 is provided. There is an aspect in which a protrusion that can be accommodated in the handle 50 is provided in the portion.

(Other embodiments)
Another endoscopic clip device 1 according to the present invention includes an outer cylindrical body 10, an inner cylindrical body 20 disposed in the outer cylindrical body 10, and a linear object 40 disposed in the inner cylindrical body 20. And a clip 30 disposed on the distal side of the inner cylinder 20 and connected to the linear object 40, and a handle 50 connected to the proximal side of the inner cylinder 20. And a part of the proximal side of the outer cylinder 10 is removable. Another endoscopic clip device 1 of the present invention is removable in a part of the proximal side of the outer cylindrical body 10, so that in a state where a part of the proximal side of the outer cylindrical body 10 is not removed, The distal end of the cylindrical body 20 and the clip 30 are difficult to be exposed from the distal side of the outer cylindrical body 10, and in a state in which a part of the proximal side of the outer cylindrical body 10 is removed, the distal end of the outer cylindrical body 10 is inward from the distal side. The distal end of the cylinder 20 and the clip 30 are easily exposed. For this reason, when the linear object 40 is moved to the proximal side with respect to the inner cylinder 20 and the clip 30 is closed, a part of the proximal side of the outer cylinder 10 is removed, and the clip 30 and the inner cylinder 20 are removed. The distal end of the outer cylindrical body 10 can be disposed more distally than the distal end of the outer cylinder 10. If the linear object 40 is moved proximally in this state, the distal end of the inner cylinder 20 and the clip 30 are not drawn into the outer cylinder 10, and the distal end of the clip 30 and the inner cylinder 20 is moved. Since the end can contact and the clip 30 can be closed, the lesioned part can be efficiently grasped.

  In the present invention, removing the proximal part of the outer cylinder 10 means that the proximal part is separated from the outer cylinder 10 or that the proximal part is completely outer cylinder. 10 means that it is still connected to the outer cylinder 10 without being separated.

  The configurations of the outer cylindrical body 10, the inner cylindrical body 20, the clip 30, the linear object 40, and the handle 50 are as already described.

  As shown in FIG. 12, in order to be able to remove a part of the proximal side of the outer cylindrical body 10, for example, a cut line 15 can be formed in the outer cylindrical body 10. The cut line 15 is a line that penetrates or does not penetrate inside and outside the outer cylinder 10 that guides the removal position, and is, for example, a perforation or a groove.

  As shown in FIG. 12, the cut line 15 is preferably formed in a spiral shape from the proximal end of the outer cylinder 10 toward the distal side. If such a cut line 15 is followed, a part of the proximal side of the outer cylindrical body 10 can be easily removed.

  Although not shown in the figure, the cut line 15 is preferably formed along the circumferential direction of the outer cylinder 10. In this case, the outer cylinder 10 can be removed along the cut line 15 in the circumferential direction.

  Further, as shown in FIG. 13, it is preferable that the slit 11 is provided along the axial direction of the outer cylindrical body 10, and the cut line 15 is formed along the circumferential direction of the outer cylindrical body 10. That is, the slit 11 and the cut line 15 are preferably orthogonal. In this case, the outer cylinder 10 can be removed in the circumferential direction along the cut line 15 with the slit 11 as a trigger.

2. Operation method of clip device for endoscope (first operation method)
The operation method of the endoscope clip device 1 according to the present invention includes an outer cylinder 10, an inner cylinder 20 arranged in the outer cylinder 10, and a linear object arranged in the inner cylinder 20. 40, a clip 30 disposed on the distal side of the inner cylinder 20 and connected to the linear object 40, and a handle 50 connected to the proximal side of the inner cylinder 20 In the endoscope clip device 1, the step of moving the outer cylinder 10 proximally with respect to the inner cylinder 20 and inserting the distal side of the handle 50 into the outer cylinder 10, and the linear object 40 Moving the proximal side of the inner cylinder 20 and closing the clip 30.

  An operation method of the endoscope clip device 1 of the present invention will be described in detail with reference to FIGS. 14 to 18. 14 to 17 are side views (partially sectional views) showing an operation method of the endoscope clip device 1 according to the embodiment of the present invention, and FIG. 18 is a clip device 1 according to the embodiment of the present invention. The side view which shows the operating method of is represented. The members constituting the endoscope clip device 1 are as described in “1. Endoscope clip device” in this specification. Below, the slit 11 is provided in the proximal end part of the outer cylinder 10, and it demonstrates using the example in which the auxiliary handle 52 is provided in the outer side of the proximal side of the outer cylinder 10. FIG.

  In order to make it easy to specify the position of the lesioned part, a pigment is applied to the lesioned part or marking is performed around the lesioned part. The marking is performed, for example, by cauterizing around the lesion using a high-frequency instrument.

  Further, in order to facilitate excision of the lesion, physiological saline or hyaluronic acid is injected between the muscle layer and the submucosa of the lesion to raise the lesion.

  As shown in FIG. 2, the outer cylindrical body 10 is more proximal than the outer cylindrical body 10 so that the axial position of the outer cylindrical body 10 does not shift when the clip device 1 is inserted into the forceps channel. A spacer 60 may be attached to the side and distal to the handle 50.

  The inner cylinder 20 and the clip 30 are housed in the outer cylinder 10 so as not to damage the forceps channel when the clip device 1 is inserted into the forceps channel of the endoscope (step S21). Specifically, the auxiliary handle 52 connected to the outer cylinder 10 is moved little by little to the distal side with respect to the inner cylinder 20 and the handle 50, and the clip 30 is exposed from the outer cylinder 10 as shown in FIG. Move to the position where you do not. At this time, since the clip 30 is gradually housed in the outer cylinder 10, the opening degree of the grip base materials 32 and 33 of the clip body 31 decreases.

  The distal side of the clip device 1 is inserted into the forceps channel from the forceps port of the endoscope, and the distal side of the clip device 1 is reached to the lesioned part of the patient as the object (step S22). The surgeon moves the clip device 1 while observing the position of the lesion, the situation of the lesion, and the like using the video acquired from the endoscope. When the spacer 60 is provided, the spacer 60 attached to the outside of the inner cylinder 20 is removed from the outer cylinder 10.

  The outer cylinder 10 is moved proximally with respect to the inner cylinder 20 (step S23). Specifically, the auxiliary handle 52 connected to the outer cylinder 10 is moved little by little to the proximal side with respect to the inner cylinder 20 and the handle 50, and the clip 30 is removed from the outer cylinder 10 as shown in FIG. Expose. As the grip base materials 32 and 33 of the clip body 31 constrained by the shape of the lumen of the outer cylinder 10 are exposed from the outer cylinder 10, the opening degree of the clip 30 gradually increases. However, in this case, since there is a difference between the inner diameter of the outer cylinder 10 and the outer diameter of the inner cylinder 20, the clip device 1 is bent along the curve of the forceps channel of the endoscope. Is moved to the proximal side, the inner cylindrical body 20 meanders in the outer cylindrical body 10 to increase the path of the inner cylindrical body 20, and the distal end of the inner cylindrical body 20 is relatively positioned at the outer cylindrical body 10. The clip 30 may not be exposed from the outer cylinder 10.

  In such a case, the portion provided with the slit 11 at the proximal end of the outer cylindrical body 10 is expanded radially outward (step S24). Thereby, since the internal diameter of the proximal end part of the outer cylinder 10 expands, it becomes easy to insert the distal side of the handle 50 into the outer cylinder 10.

  As shown in FIG. 6, the outer cylinder 10 is moved proximally with respect to the inner cylinder 20, and the distal side of the handle 50 is inserted into the outer cylinder 10 (step S25). Specifically, the distal side of the handle 50 is inserted into the proximal side of the outer cylinder 10 whose inner diameter is expanded by the slit 11 provided at the proximal end portion of the outer cylinder 10. For this reason, in the present invention, the distal end of the clip 30 and the inner cylinder 20 can be exposed from the distal end of the outer cylinder 10. If the linear object 40 is moved proximally in this state, the distal end of the inner cylinder 20 and the clip 30 are not drawn into the outer cylinder 10, and the distal end of the clip 30 and the inner cylinder 20 is moved. Since the end can contact and the clip 30 can be closed, the lesioned part can be efficiently grasped.

  The clip 30 exposed from the distal side of the outer cylinder 10 and the lesioned part are aligned (step S26).

  The linear object 40 exposed from the proximal side of the handle 50 is gripped, the linear object 40 is moved proximally with respect to the inner cylinder 20, and the clip 30 is closed (step S27). When the linear object 40 is moved proximally with respect to the inner cylinder 20, the clip 30 is housed in the inner cylinder 20 from the proximal side, so that the opening degree of the clip 30 is gradually reduced. Eventually, the clip 30 is closed. Since the outer diameter of the fastener 35 provided on the clip body 31 is larger than the inner diameter of the inner cylinder 20, the proximal end of the fastener 35 and the distal end of the inner cylinder 20 abut, and the fastener 35 It is not drawn into the cylinder 20. As a result, the lesioned part 100 is grasped by the grasping base materials 32 and 33 of the clip 30 as shown in FIG. When a fixing device for fixing the linear object 40 exposed from the proximal side of the handle 50 is provided, the clip 30 is closed by moving the fixing device to the proximal side instead of the linear object 40. The lesioned part 100 may be gripped.

  By moving the linear object 40 to the proximal side, an electrocautery or the like is inserted between the lesioned part 100 and the submucosal layer 101 in a state where the lesioned part 100 is gripped by the clip 30 (the lesioned part 100 is excised). Step S28). At this time, when the linear object 40 is pulled toward the proximal end side and the lesioned part 100 is pulled by the clip 30, the lesioned part 100 can be easily excised. When the lesioned part 100 is excised, the lesioned part 100 may be raised by injecting physiological saline or hyaluronic acid between the muscle layer and the submucosal layer 101 of the lesioned part 100.

  When the lesioned part 100 can be excised as shown in FIG. 17, the handle 50 and the auxiliary handle 52 are moved proximally, and the outer cylinder 10 and the inner cylinder 20 are pulled out of the body (step S29). When using the clip device 1 in which the fixing device is attached to the linear object 40, if the outermost diameter of the fixing device is larger than the inner diameter of the inner cylinder 20, the outer cylinder 10 and the inner cylinder 20 are removed from the body. Before pulling out, the fixing device is removed from the linear object 40 in advance.

  As shown in FIG. 18, the proximal side of the linear object 40 is grasped, and the linear object 40 is moved to the proximal side (step S30). Thereby, operation which takes out clip 30 which grasped lesioned part 100 with linear thing 40 out of the body can be performed easily.

  When the lesioned part 100 is large enough to be accommodated in the outer cylindrical body 10, the outer cylindrical body 10, the inner cylindrical body 20, and the linear object 40 are moved to the proximal side instead of steps S29 and S30. (Step S40). Specifically, the handle 50, the auxiliary handle 52, and the linear object 40 are grasped, and the handle 50, the auxiliary handle 52, and the linear object 40 are moved to the proximal side. Thereby, the clip 30 and the linear object 40 are pulled out of the body together with the outer cylinder 10 and the inner cylinder 20.

  In addition, when not the slit but the enlarged diameter part 12 as shown in FIG. 7 is provided in the proximal end part of the outer cylinder 10, it replaces with step S24 and S25, and implements following step S50.

  As shown in FIG. 8, the outer cylinder 10 is moved proximally with respect to the inner cylinder 20, and the distal side of the handle 50 is inserted into the outer cylinder 10 (step S50). Specifically, the distal side of the handle 50 is inserted into the enlarged diameter portion 12 provided at the proximal end portion of the outer cylindrical body 10.

  Further, when the expansion portion 21 is provided at the proximal end portion of the inner cylindrical body 20 as shown in FIG. 9 instead of the slit at the proximal end portion of the outer cylindrical body 10, step S51 is performed before step S21. Step S52 is performed between Step S22 and Step S23, and Step S53 is performed instead of Steps S24 and S25.

  In order to prevent the axial position of the outer cylinder body 10 from shifting when the clip device 1 is inserted into the forceps channel, it is provided at the proximal end of the inner cylinder body 20 as shown in FIG. The expanded portion 21 is expanded (step S51). Specifically, the expanding portion 21 is expanded by enclosing a gas between the inner tube and the outer tube of the expanding portion 21.

  As shown in FIG. 10, the expansion part 21 of the inner cylinder 20 is contracted (step S52). Specifically, the expanding portion 21 is contracted by discharging the gas sealed between the inner tube and the outer tube of the expanding portion 21 to the outside of the inner cylindrical body.

  As shown in FIG. 11, the outer cylinder 10 is moved proximally with respect to the inner cylinder 20, and the distal side of the handle 50 is inserted into the outer cylinder 10 (step S53). Since the expansion part 21 of the inner cylinder 20 is contracted, the distal side of the handle 50 can be inserted into the outer cylinder 10.

(Second operation method)
Another operating method (second operating method) of the endoscope clip device 1 according to the present invention includes an outer cylinder 10, an inner cylinder 20 disposed in the outer cylinder 10, and an inner cylinder 20. The linear object 40 disposed inside and the clip 30 disposed on the distal side of the inner cylinder 20 and connected to the proximal side of the inner cylinder 20 are connected to the clip 30 connected to the linear object 40. In the endoscopic clip device 1 having the handle 50, the step of removing a part of the proximal side of the outer cylinder 10 and the movement of the outer cylinder 10 to the proximal side with respect to the inner cylinder 20 And a step of moving the linear object 40 proximally with respect to the inner cylindrical body 20 to close the clip 30.

  Another operating method of the endoscope clip device 1 of the present invention performs the following steps S60 and S61 instead of steps S24 and S25 of the above-described operating method. Here, description will be made using an example in which a cut line 15 as shown in FIG. 12 is provided at the proximal end portion of the outer cylindrical body 10. The cut line 15 is formed in a spiral shape from the proximal end of the outer cylindrical body 10 toward the distal side.

  A part of the proximal side of the outer cylinder 10 is removed (step S60). Specifically, a part of the proximal side of the outer cylinder 10 is removed in accordance with a cut line 15 provided at the proximal end portion of the outer cylinder 10. For this reason, in the present invention, the distal end of the clip 30 and the inner cylinder 20 can be exposed from the distal end of the outer cylinder 10.

  Next, the outer cylinder 10 is moved proximally with respect to the inner cylinder 20 (step S61). Since the clip 30 and the distal end of the inner cylinder 20 can abut and close the clip 30 without the distal end of the inner cylinder 20 and the clip 30 being pulled into the outer cylinder 10, It becomes possible to grip efficiently.

1: Endoscopic clip device 10: Outer cylindrical body 11: Slit 12: Expanded diameter portion 15: Cut line 20: Inner cylindrical body 21: Expansion portion 30: Clip 31: Clip body 32, 33: Holding base material 34: Curved portion 35: Fastener 40: Linear object 50: Handle 51: Protection portion 60: Spacer 100: Lesion portion 101: Submucosal layer

Claims (10)

An outer cylinder,
An inner cylinder disposed in the outer cylinder;
A linear object disposed in the inner cylinder;
A clip disposed on the distal side of the inner cylinder and connected to the linear object;
A handle connected to the proximal side of the inner cylinder,
A clip device for an endoscope, wherein a distal side of the handle can be inserted into the outer cylinder.   The endoscope clip device according to claim 1, wherein a slit is provided at a proximal end portion of the outer cylinder.   The endoscope clip device according to claim 2, wherein the slit is provided along an axial direction of the outer cylindrical body.   The endoscopic clip device according to claim 2 or 3, wherein the number of the slits is 1 or more and 4 or less.   The endoscope clip device according to claim 1, wherein a diameter-enlarged portion having an inner diameter larger than that of a distal side is provided at a proximal end portion of the outer cylindrical body.   6. The endoscope clip device according to claim 5, wherein the enlarged diameter portion of the outer cylindrical body has a conical shape with an inner diameter increasing toward the proximal side.   The endoscope clip device according to claim 1, wherein an outer diameter of a distal end portion of the handle can be reduced. An outer cylinder,
An inner cylinder disposed in the outer cylinder;
A linear object disposed in the inner cylinder;
A clip disposed on the distal side of the inner cylinder and connected to the linear object;
A handle connected to the proximal side of the inner cylinder,
An endoscopic clip device characterized in that a part of a proximal side of the outer cylinder is removable. An outer cylinder,
An inner cylinder disposed in the outer cylinder;
A linear object disposed in the inner cylinder;
A clip disposed on the distal side of the inner cylinder and connected to the linear object;
An endoscope clip device having a handle connected to a proximal side of the inner cylinder,
Moving the outer cylinder proximally relative to the inner cylinder and inserting the distal side of the handle into the outer cylinder;
A step of moving the linear object proximally with respect to the inner cylindrical body and closing the clip. An outer cylinder,
An inner cylinder disposed in the outer cylinder;
A linear object disposed in the inner cylinder;
A clip disposed on the distal side of the inner cylinder and connected to the linear object;
An endoscope clip device having a handle connected to a proximal side of the inner cylinder,
Removing a portion of the outer cylinder on the proximal side;
Moving the outer cylinder proximally relative to the inner cylinder;
A step of moving the linear object proximally with respect to the inner cylindrical body and closing the clip.