JP2021108798A - Aid for endoscope insertion - Google Patents

Abstract

To provide an aid for endoscope insertion capable of reliably and easily arranging the opening so as to be directed to the duodenal papilla with a simple configuration.SOLUTION: An overtube 1 for a small diameter endoscope insertion is used for covering an insertion part 21 of a small diameter endoscope 20, and guiding the insertion part 21 into the common bile duct of a subject through the duodenal papilla of the subject, and includes: a flexible curved cylindrical body 10 that holds a predetermined curvature in a state of being placed on a horizontal surface; and a side wall opening 12 formed on a side wall on a center C side that defines the curved shape on an axial tip side of the cylindrical body 10 for deriving the tip of the insertion part 21. The side wall opening 12 is provided at a position with a predetermined inclination angle in a circumferential direction with respect to the horizontal surface of the peripheral surface of the cylindrical body 10.SELECTED DRAWING: Figure 3

Description

The present invention relates to an endoscope insertion assisting tool used to guide the insertion portion of a small-diameter endoscope into the lumen of a subject.

In recent years, with increasing interest in minimally invasive medical care, endoscopy and treatment for bile and pancreatic diseases have become widespread.

However, the bile duct and pancreatic duct run in the direction of intersection with the duodenum at a steep angle, and the outer diameter of the insertion part of an endoscope with a general inner diameter (such as a duodenum endoscope or an endoscope for the upper gastrointestinal tract is around 10 mm). Since it is thinner than an endoscope), a normal endoscope cannot be inserted into the bile duct or pancreatic duct, and there is a problem that the inside of the bile duct or pancreatic duct cannot be directly visually recognized.

For such problems, for example, a tubular body through which the insertion portion of the endoscope is inserted, an opening provided on the tip side of the tubular body and opening to the side wall thereof, and an opening of the tubular body It has been proposed to insert an endoscope into the bile duct, which is said to have an outer diameter of about 6 mm at the insertion site, using an endoscope insertion aid equipped with an inflatable balloon on the tip side. (See Patent Document 1). According to this endoscope insertion assisting tool, after inserting the insertion portion covered with the tubular body to a desired position in the body cavity, the balloon is inflated and brought into close contact with the inner wall in the body cavity to bring the side wall opening. Can be held in a desired position (eg, a position facing the duodenal papilla).

Japanese Unexamined Patent Publication No. 62-22623

However, in the endoscope insertion assisting tool described in Patent Document 1, the opening of the tubular body may not be positioned toward the duodenal papilla. This type of common auxiliary tool is made of a flexible material, and the torque applied to the base end side of the auxiliary tool is difficult to be transmitted to the tip side, and by twisting the base end side, the opening located on the tip end side is opened. It is difficult to adjust for the duodenal papilla. Therefore, once the assistive device is inserted, it is difficult to adjust the position of the opening. If the opening does not face the duodenal papilla, once the endoscope and assistive device are removed from the body, the orientation of the opening is adjusted. The act of adjusting and then reinserting into the body had to be repeated until the opening was facing the duodenal papilla.

If the opening of the tubular body is not located toward the papilla of Vater, there is a problem that the endoscope cannot be inserted into the bile duct and endoscopy / treatment cannot be performed.

Further, in recent endoscopy, for example, as shown in FIG. 13A, the outer diameter of the insertion portion is about 3.5 mm through a predetermined channel of a general endoscope 30 (side endoscope). A method of observing the inside of the bile duct by inserting a specially reduced diameter endoscope (bile duct endoscope) 31 for inserting the bile duct into the bile duct like a catheter has also come to be used. In this method, the structure of the endoscope 31 is complicated and the cost is high, and the general-purpose small-diameter endoscope 20 having an insertion portion outer diameter of about 6 mm as shown in FIG. 13 (b) is obtained. The field of view was narrower than that, and high resolution could not be expected for the image. For this reason, in recent years, an auxiliary tool capable of supporting the direct insertion of a general-purpose small-diameter endoscope 20 into the bile duct, which has a wider field of view and superior image resolution than the specially reduced-diameter biliary tract mirror 31, has been waiting. It was.

Therefore, an object of the present invention is to provide an endoscope insertion assisting tool having a simple structure and capable of reliably and easily arranging the opening so as to face the duodenal papilla.

In order to achieve the above object, the endoscope insertion aid according to the present invention is an endoscope insertion aid for guiding the insertion portion of the endoscope into the lumen of the subject, and is flexible. A curved tubular body having a tubular shape in which a hole through which the insertion portion can be inserted extends in the axial direction and maintaining a predetermined curvature when placed on a predetermined plane, and the tubular body of the tubular body. The configuration is formed on the side wall on the central side that defines the curved shape on the tip side in the axial direction, and has an opening for leading out the tip portion of the insertion portion.

The endoscope insertion assisting tool according to the present invention is a simple one in which the tubular body is formed into a curved shape by a flexible material and an opening is provided in the side wall on the central side that defines the curved shape. It can be realized by a simple structure. In addition, in this endoscope insertion aid, the curved shape of the tubular body is shaped so that it fits well in the stomach of a person (human) and the fitting posture is close to a certain posture. By setting the placement position of the opening in consideration of the position (fitting position) of the papilla of Vater with respect to the tubular body in the above-mentioned fitting posture of a human, when covering the insertion part of the endoscope and guiding it to the back of the duodenal. In addition, the opening of the tubular body can be easily arranged at a position facing the papilla of Vater.

In the endoscope insertion assisting tool according to the present invention, the opening has an inclination angle of 0 ° to 90 ° in the circumferential direction of the tubular body with respect to the specified plane of the surface of the tubular body. It may be configured to be provided at a position.

In the endoscope insertion assisting tool according to the present invention, the inclination angle of the opening in the circumferential direction of the tubular body is set according to the position of the duodenal papilla starting from the fitting position of the tubular body in the stomach. Then, in the process of covering the insertion portion of the endoscope and guiding it to the depth of the duodenum of the subject, the opening of the tubular body can be arranged at a position where it naturally faces the duodenal papilla. After that, the tip of the insertion portion can be pulled out from the opening and easily inserted into the duodenal papilla, and the insertion portion can be easily guided into the common bile duct from there.

In the endoscope insertion assisting tool according to the present invention, the opening is 1.0a to 2 in the axial direction of the tubular body, where a is the outer diameter (outer diameter) of the outer circumference of the tubular body. It may have a length of 0.0a and a depth of 0.3a to 0.7a from the outer circumference.

With this configuration, the endoscope insertion assisting tool according to the present invention has an opening that opens with a size larger than the size of the tubular body. The pushing operation can be performed reliably and easily.

The endoscope insertion assisting tool according to the present invention may be provided along the peripheral surface on the distal end side of the opening of the tubular body and may have an inflatable balloon.

With this configuration, the endoscope insertion assisting tool according to the present invention abuts the tip of the insertion portion of the endoscope derived from the opening against the inflated balloon and changes its direction, thereby changing the direction of the tip of the insertion portion. The part can be easily guided to the papilla of Vater.

The endoscope insertion assisting tool according to the present invention has a configuration in which the balloon is restricted from expanding on the peripheral surface of the tubular body opposite to the side on which the opening is formed. You may.

With this configuration, the endoscope insertion aid according to the present invention has an endoscope insertion portion between the opening and the duodenal papilla by inflating the balloon with the opening facing the duodenal papilla. It is easier to take the space required to bend the tip towards the papilla of Vater and more easily guide the insertion part of the endoscope to the papilla of Vater.

The endoscope insertion assisting tool according to the present invention is formed on the surface of the tubular body along the axial direction, and has a medium flow path for sending a medium for expanding and contracting the balloon, and a medium flow path of the medium flow path. It may further have an on-off valve.

With this configuration, the endoscope insertion assisting tool according to the present invention allows the practitioner to operate the on-off valve at hand and easily inflate the balloon at the timing when the insertion portion of the endoscope is pulled out from the opening. be able to.

The endoscope insertion assisting tool according to the present invention is used to cover the insertion portion of the endoscope and guide the insertion portion to the bile duct via the duodenal papilla of the subject, and the tubular body is the same. The curved shape is formed so as to easily fit in the main part of the inner wall of the human stomach, and the opening is formed when the duodenum of the subject is changed in posture and the tubular body is fitted in the stomach of the subject. The inclination angle of the tubular body in the circumferential direction may be set so that the opening faces the duodenal papilla.

With this configuration, in the endoscope insertion assisting tool according to the present invention, the curved shape of the tubular body is made into a shape that fits well in the human stomach, and the tube is aligned with the position of the duodenal papilla starting from the fitting position. By setting the position of the opening inside the curved shape of the shape, the duodenum is postureed by using the force of the endoscope in the process of covering the insertion part of the endoscope and guiding it to the depth of the duodenum of the subject. It can be varied and placed in a position where the opening naturally faces the duodenal papilla.

According to the present invention, it is possible to provide an endoscope insertion assisting tool capable of reliably and easily arranging the opening so as to face the duodenal papilla with a simple configuration.

It is a perspective view of the overtube for inserting a small-diameter endoscope which concerns on one Embodiment of this invention. FIG. 3 is a perspective view showing a state in which the overtube for inserting a small-diameter endoscope of FIG. 1 is placed inside out. It is a top view which shows the state in which the overtube for inserting a small-diameter endoscope which concerns on one Embodiment of this invention is placed horizontally. FIG. 3 is a cross-sectional view taken along the line AA of the overtube for inserting a small-diameter endoscope in FIG. FIG. 3 is a cross-sectional view taken along the line BB of the overtube for inserting a small-diameter endoscope in FIG. It is a side view of the overtube for inserting a small-diameter endoscope according to one embodiment of the present invention, (a) shows a view seen from the arrow C direction of FIG. 5, and (b) is the arrow D direction. The figure seen from is shown. It is a front view of the overtube for inserting a small-diameter endoscope in FIG. 3 as viewed from the arrow E direction, (a) shows a state when the balloon is contracted, and (b) shows a state when the balloon is expanded. .. It is a side view which shows the structure of the grip of the overtube for inserting a small diameter endoscope which concerns on one Embodiment of this invention. FIG. 5 is a conceptual diagram showing a procedure for inserting a small-diameter endoscope into the lumen of a subject using an overtube for inserting a small-diameter endoscope according to an embodiment of the present invention. It is a conceptual diagram which shows the insertion procedure from the duodenum of the subject of the small-diameter endoscope using the overtube for insertion of the small-diameter endoscope which concerns on one Embodiment of this invention, and (a) is to the back of the duodenum. (B) shows the procedure for inserting the duodenal papilla into the bile duct. FIG. 5 is a conceptual diagram showing a cross section taken along line FF in FIG. 10 (a). FIG. 10 (b) is an enlarged side view showing a balloon inflated state of the overtube for inserting a small-diameter endoscope in FIG. 10 (b). It is a perspective view which shows the structure of the endoscope of a different type, (a) shows the endoscope which inserted the specially reduced diameter biliary tract mirror, (b) shows the small diameter endoscope. There is.

Hereinafter, embodiments for carrying out the present invention will be described with reference to the drawings.

1 to 8 show an overtube 1 for inserting a small-diameter endoscope according to an embodiment of the present invention.

The small-diameter endoscope insertion overtube (hereinafter, simply referred to as an overtube) 1 corresponds to the endoscope insertion auxiliary tool in the present invention, and the small-diameter endoscope 20 (see FIG. 13B). ) Is used to guide the insertion portion 21 into the cavity of the subject.

In the present embodiment, the overtube 1 has a lateral hole (side wall opening 12: see FIG. 3) provided on the side wall, and covers the insertion portion 21 of the small-diameter endoscope 20 to cover the subject, for example, the oral cavity to the duodenum 51. By inserting it into the back of the tube, the lateral hole of the overtube 1 is naturally positioned so as to face the duodenal papilla 51a (see FIGS. 9 and 10).

In order to realize this, in the present embodiment, it is assumed that the tube body of the overtube 1 (cylindrical body 10: see FIG. 3) has flexibility, and the shape of the tube body is changed to the human stomach 50 (cylindrical body 10: see FIG. 3). (See FIGS. 9 and 10) The curved shape is formed so that the body fits well in the posture and the posture is close to a certain posture, and the position where the tube body fits in the human stomach 50 in the above posture is the starting point. The position of the lateral hole and the inclination angle θ1 with respect to the curved portion of the tube body are set according to the position of the duodenal papilla 51a.

First, the configuration of the overtube 1 will be described.

As shown in FIGS. 1 to 3, the overtube 1 according to the present embodiment includes a tubular body 10 through which the small-diameter endoscope 20 can be inserted, and a grip 11 for operating the tubular body 10. , Is equipped.

The tubular body 10 is formed by, for example, forming a flexible material into a tubular shape (tubular) in which a hole through which a small-diameter endoscope 20 can be inserted extends in the axial direction. A lubricating coat is coated on the outer peripheral surface and the inner peripheral surface of the hole. As shown in FIG. 4, the tubular body 10 has an outer diameter OD1 of, for example, 10 mm, and an inner diameter ID1 of, for example, 8 mm. The inner diameter ID1 is preferably 5 mm or more, and more preferably 7 mm or more in order to allow the small-diameter endoscope 20 to be inserted through the tubular body 10. Further, the outer diameter OD1 is preferably 20 mm or less, and more preferably 15 mm or less in order to insert the tubular body 10 into the duodenum. Examples of the material of the tubular body 10 include polymer materials such as polyamide resin, polyamide-based elastomer, polyurethane, silicone, polyetheretherketone, polyetherimide, polyethylene, and polyvinyl chloride (PVC). The material of the tubular body 10 is preferably transparent, but is not limited to this.

The tubular body 10 is placed in a natural state in which the force of the user (practitioner) does not act, for example, a horizontal plane defined as the XY plane in FIG. 3 (corresponding to the plane defined in the present invention). It holds a curved shape that curves (draws a curve) with a predetermined curvature in the state. In particular, FIG. 3 illustrates a tubular body 10 in which the curved shape is curved with a constant curvature and has a shape (arc shape) corresponding to a substantially circular arc having a diameter D1. Here, the diameter D1 of the tubular body 10 is not particularly limited, but is preferably set in the range of 250 mm to 450 mm, for example, 400 mm. Further, the total length of the tubular body 10 when the diameter D1 = 400 mm is preferably shorter than, for example, 1256 (π × D1 = 1256) mm, and may be, for example, about 1000 mm. As described above, the tubular body 10 has a flexible shape and has a curved shape that maintains a predetermined curvature when placed on a horizontal plane. In the example of FIG. 3, the curved shape of the tubular body 10 is defined as a shape that draws an arc having a radius of curvature of (D1) / 2 from the center C of the substantially circular circle described above.

When the side on which the grip 11 is provided is the rear end side and the opposite side is the front end side, the tubular body 10 opens at both ends, and the rear end opening 10a and the tip opening 10b (FIGS. 1 to 3), respectively. See). The rear end opening 10a functions as an insertion port into which the insertion portion 21 of the small-diameter endoscope 20 is inserted, and the front end opening 10b is a window for securing an imaging region of the small-diameter endoscope 20 and a small diameter. The insertion portion 21 of the endoscope 20 functions as a protruding port.

The grip 11 is, for example, formed by molding a resin material into a cylindrical shape as shown in FIG. 8, and is configured by inserting a tubular body 10 in a fixed state in the direction of the central axis of the cylindrical shape. The grip 11 shown in FIG. 8 has a drum shape whose outer circumference gradually decreases as it approaches the center from both ends in the axial direction, but it may have a shape other than this. In the grip 11 illustrated in FIG. 8, the length L1 between both ends is, for example, 40 mm, and the diameter D2 of the end faces on both ends is, for example, 32 mm. Further, the side surface of the grip 11 connecting both ends forms a surface along an arc having a radius of curvature R1 in the axial direction. As an example, the radius of curvature R1 is, for example, a length of 40 mm, and the length L2 of the side surface in this case is determined by the radius of curvature R1.

In the overtube 1, the side wall on the tip end side of the tubular body 10 is provided with a side wall opening 12 for leading out the tip end 22 of the insertion portion 21 of the small-diameter endoscope 20 to be inserted. The side wall opening 12 corresponds to the opening in the present invention.

As shown in FIGS. 1 to 3, 5 and 6, the side wall opening 12 is formed on the inner side surface of the above-mentioned curved shape on the axially tip side of the tubular body 10. More specifically, the side wall opening 12 is formed on the side wall on the side of the center C (see FIG. 3) that defines the curved shape of the tubular body 10 along the axial direction of the tubular body 10. Further, as shown in FIG. 5, the side wall opening 12 is inclined from 0 ° (degree) to 90 ° with respect to the plane (XY plane: horizontal plane) on which the overtube 1 is placed in FIG. 3, for example. It is open to.

In particular, in FIG. 5, the side wall opening 12 is provided at a position having a predetermined inclination angle θ1 in the circumferential direction of the tubular body 10 with respect to the horizontal plane of the surface of the tubular body 10. In the tubular body 10 illustrated in FIG. 5, the side wall opening 12 has a structure that opens diagonally downward at an inclination angle θ1 = 50 ° with respect to the horizontal plane. When the overtube 1 having the tubular body 10 having the side wall opening 12 formed so as to face diagonally downward with respect to the horizontal plane is used upside down (see, for example, FIG. 2), the side wall opening 12 is the horizontal plane. Needless to say, it faces diagonally upward.

As shown in FIGS. 6A and 6B, the side wall opening 12 of the tubular body 10 has, for example, an axial length L5 of the tubular body 10 of 15 mm, and is the outer periphery of the tubular body 10. The depth L6 from the surface is set to, for example, 5 mm, and the width L7 (the length in the direction orthogonal to the axial direction of the tubular body 10) is set to, for example, 8 mm. As described above, the side wall opening 12 of the overtube 1 has a diameter OD1 (= 10 mm) of the outer circumference of the tubular body 10 which is 1.5 times the diameter a in the axial direction of the tubular body 10. It has a length and a depth of 1/2 times the diameter a from the outer circumference. The shape of the side wall opening 12 shown in FIGS. 6A and 6B is merely an example, and the side wall opening 12 in the overtube 1 according to the present embodiment is 1. It is desirable to have a length of 0a to 2.0a and a depth of 0.3a to 0.7a from the outer circumference of the tubular body 10.

The shape of the side wall opening 12 shown in FIGS. 5 and 6 is based on the premise that the curved shape of the tubular body 10 is formed so as to easily fit the shape of the inner wall main part of the human stomach 50. The inclination angle θ1 with respect to the plane in the circumferential direction of the tubular body 10 was set according to the position of the duodenal papilla 51a (see FIGS. 9 and 10) starting from the position where the body 10 fits in the human stomach 50. It is a thing.

As shown in FIGS. 1 to 3, 6 and 7, the tubular body 10 is provided with a balloon 13 on the peripheral surface of the side wall opening 12 on the distal end side. The balloon 13 is wound and fixed in the circumferential direction of the tubular body 10 leaving a part of the section, and can be selectively expanded and contracted outward in the circumferential direction on the peripheral surface on the opposite side of the part of the section. It has become. That is, the balloon 13 constitutes an eccentric expansion balloon in which expansion is restricted on the peripheral surface of the peripheral surface of the tubular body 10 on the side opposite to the side on which the side wall opening 12 is formed. Regarding such an eccentric expansion balloon, for example, among the balloons 13 provided over the entire peripheral surface of the tubular body 10, a structure for suppressing the region corresponding to the above-mentioned partial section so as not to expand, or the balloon 13 It may have a structure in which the film thickness is thicker than the other regions in the region corresponding to the above-mentioned partial section so that it cannot be expanded.

For the balloon 13, the angle θ2 corresponding to the circumference of the region where expansion is restricted in the tubular body 10 can be set to θ2 = 50 °, for example, as shown in FIG. The balloon 13 is restricted from expanding at the peripheral surface position at an angle θ2 in the tubular body 10, and as shown in FIG. 7 (b), only on the peripheral surface side on the opposite side thereof, for example, with respect to the horizontal plane described above. The tubular body 10 expands outward at an angle of 25 ° ((θ2) / 2) diagonally downward. Here, the balloon 13 that expands diagonally downward at an angle of 25 ° is the entire region in the width direction of the side wall opening 12 provided at the inclination angle θ1 with respect to the horizontal plane with respect to the region in the circumferential direction of the tubular body 10. Will be covered.

The material of the balloon 13 is not particularly limited, but is preferably a material having a certain degree of flexibility. For example, ethylene such as polyethylene, polyethylene terephthalate, polypropylene, or an ethylene-propylene copolymer and other α-olefins are used. Copolymers, ethylene-vinyl acetate copolymers, polyvinyl chloride (PVC), crosslinked ethylene-vinyl acetate copolymers, polyurethanes, polyamides, polyamide elastomers, polyimides, polyimide elastomers, silicone rubbers, natural rubbers, isoprene rubbers, etc. Can be used.

The balloon 13 can be manufactured by applying various conventionally known molding methods as a balloon molding method, for example, a blow molding method, using the material of the above-mentioned material. The wall thickness of the balloon 13 can be, for example, about 0.01 to 0.50 mm, but is not particularly limited. As an example of the size of the balloon 13, as shown in FIG. 6, the outer diameter D3 at the time of contraction can be set to, for example, 14 mm, and the axial length L3 can be set to, for example, 20 mm.

The overtube 1 is also formed on the surface of the tubular body 10 along the axial direction and has a fluid passage 14 for sending a medium (for example, a liquid or a gas) for expanding and contracting the balloon 13. As shown in FIG. 4, the fluid passage 14 is formed with an outer diameter OD2 of, for example, 2 mm and an inner diameter ID2 of, for example, 1 mm.

As shown in FIGS. 1 to 3, a stopcock 15 for opening and closing the fluid passage 14 is provided on the rear end side of the tubular body 10. The stopcock 15 is connected to a fluid storage device (neither shown) via a fluid supply / suction device. By opening / closing the stopcock 15, the overtube 1 supplies fluid from the fluid storage device through the fluid passage 14 by the fluid supply / suction device to inflate the balloon 13 (see FIG. 7B). Alternatively, the fluid supply / suction device can return the fluid in the fluid passage 14 to the fluid storage device to contract the balloon 13 (fold it into a state without bulging as shown in FIG. 7A). There is. When the balloon 13 is inflated by the supply of the fluid, it has a function of receiving the tip portion 22 of the insertion portion 21 of the small-diameter endoscope 20 led out from the side wall opening 12 and changing the direction thereof (see FIG. 12). ) Is fulfilled. The fluid passage 14 and the stopcock 15 correspond to the medium flow path and the on-off valve of the present invention, respectively.

Next, an endoscope using the overtube 1 as an insertion aid will be described. The overtube 1 is used, for example, to guide the small-diameter endoscope 20 shown in FIG. 13 (b) into the lumen (common bile duct 53) of the subject. The small-diameter endoscope 20 is an endoscope having a smaller outer diameter at the insertion portion than the most common endoscope such as the endoscope 30 (see FIG. 13 (a)), and is preferably 4 to 8 mm. A small-diameter endoscope 20 having an insertion portion outer diameter in the range of 5 to 7 mm is provided for use.

As shown in FIG. 13B, the small-diameter endoscope 20 has an observation optical system 23, an illumination optical system 24, an air supply / water supply nozzle 25, and forceps on the tip surface 22a of the tip portion 22 of the insertion portion 21. A mouth 26 is provided. In the small-diameter endoscope 20, the insertion portion 21 has a required length suitable for endoscopy / treatment, and the rear end side (the side opposite to the tip portion 22) has a hand operation portion (FIG. Not shown) is provided. The insertion unit 21 has a mechanism for acquiring a front image through the observation optical system 23 by operating various operation buttons or the like between the tip surface 22a and the hand operation unit, and an illumination optical system 24. A mechanism for driving and illuminating the front, a mechanism for sending and sending water via an air supply / water supply nozzle 25, a forceps opening 26 for inserting a treatment tool such as forceps, and the like are housed.

Next, the operation method of the overtube 1 according to the present embodiment will be described with reference to FIGS. 9 to 12. Here, an endoscope commercially available as a transnasal endoscope is used as the small-diameter endoscope 20, and the overtube 1 covered with the insertion portion 21, that is, the inside of the hole extending in the axial direction of the tubular body 10. The operation method in the case of guiding the overtube 1 in the state where the insertion portion 21 is inserted into the bile duct (common bile duct 53) of the subject will be described.

In endoscopy / treatment for the bile duct using the small-diameter endoscope 20, the practitioner (medical doctor) first covers the insertion portion 21 of the small-diameter endoscope 20 with the overtube 1 and then covers the insertion portion 21 of the small-diameter endoscope 20. In this state, the overtube 1 is inserted together with the insertion portion 21 from the oral cavity of the subject. The posture of the subject at this time may be either the prone position or the left lateral decubitus position. The operation of covering the insertion portion 21 with the overtube 1 is to insert the insertion portion 21 through the rear end opening 10a of the tubular body 10 until the tip reaches a position near the tip opening 10b, or the tip of the insertion portion 21. Is pushed forward to the point where it protrudes from the tip opening 10b.

Subsequently, the practitioner pushes the overtube 1 to the position immediately before the entrance of the duodenum 51 in the subject's stomach 50 as shown in FIG. 9. This operation can be performed while confirming the traveling position while displaying the captured image obtained from the tip opening 10b of the overtube 1 via the observation optical system 23 on the monitor. At this time, the balloon 13 provided on the tip end side of the tubular body 10 of the overtube 1 is in a contracted state (see FIG. 7A).

Further, the practitioner operates the overtube 1 so as to push it toward the back of the duodenum 51. In this operation, the practitioner displays the captured image obtained by the observation optical system 23 on the monitor and pushes forward while confirming the insertion position, while checking the X-ray fluoroscopic image and opening the side wall opening 12 of the overtube 1. Push the duodenal papilla 51a deeper than the duodenal papilla 51a, and then return the small-diameter endoscope 20 to the position of the side wall opening 12 of the overtube 1 or further to the posterior end side, and from the image obtained there, the duodenal papilla Check the position of 51a.

The practitioner changes the duodenum 51 from the posture shown in FIG. 9 to the posture shown in FIG. 10 (a) by performing an operation such as twisting the small-diameter endoscope 20 and / or the overtube 1.

By changing the posture of the duodenum 51 in this way, when the small-diameter endoscope 20 is inserted into the bile duct (liver 52 side), the pushing force when the hand portion of the small-diameter endoscope 20 is pushed is increased. It becomes easier to transmit to the tip side.

The overtube 1 according to the present embodiment is pushed into the duodenum 51 of the subject, and in a state where the duodenum 51 is in the posture shown in FIG. 10 (a), the side wall opening 12 of the tubular body 10 is the duodenal papilla 51a. Will be placed at a position facing the. That is, in the present embodiment, the tubular body 10 is formed in a curved shape (see FIG. 9) that fits well with respect to the shape of the inner wall of the stomach 50 of the subject, and the duodenal papilla is determined by the posture change of the duodenum 51. The inclination angle θ1 (see FIG. 5) of the side wall opening 12 inside the curved shape of the tubular body 10 is set so that the side wall opening 12 faces the position of 51a.

FIG. 11 conceptually shows the state of the cross section taken along the line FF in FIG. 10A, in which the side wall opening 12 of the tubular body 10 of the overtube 1 is the duodenal papilla of the duodenum 51 of the subject. It is arranged at a position facing 51a.

With the overtube 1 inserted until the side wall opening 12 of the tubular body 10 faces the duodenal papilla 51a (see FIG. 10A), the practitioner inserts the small-diameter endoscope 20. 21 is led out forward from the side wall opening 12 of the tubular body 10 and further inserted from the duodenal papilla 51a into the back of the common bile duct 53.

Prior to this operation, the practitioner inserts the insertion portion 21 of the small-diameter endoscope 20 from the inserted state of the overtube 1 shown in FIG. 10A, and the tip surface 22a is the side wall opening 12 of the tubular body 10. Pull it back until it reaches the position.

Next, the practitioner monitors the captured image obtained by the observation optical system 23 at that position, confirms that the side wall opening 12 is at a position facing the duodenal papilla 51a, and then performs the small-diameter endoscope 20. The tip portion 22 of the insertion portion 21 is led out. The tip 22 of the insertion portion 21 is derived by, for example, the practitioner operating the hand operation portion (not shown) of the small-diameter endoscope 20 to bend the tip 22 of the insertion portion 21. be able to.

Subsequently, as shown in FIG. 10B, the practitioner performs an operation of inflating the balloon 13 provided at the tip of the tubular body 10 of the overtube 1. At that time, the practitioner opens the stopcock 15 to supply fluid from the fluid storage device through the fluid passage 14 by the fluid supply / suction device to inflate the balloon 13.

FIG. 12 is an enlarged side view showing an inflated state of the balloon 13 of the overtube 1 in FIG. 10B. As shown in FIG. 12, the practitioner further draws the tip 22 of the insertion portion 21 of the small-diameter endoscope 20 from the side wall opening 12 of the tubular body 10 and inflates the balloon 13. , The operation of pushing the small-diameter endoscope 20 toward the front (in the direction of the arrow) is performed.

At that time, the insertion portion 21 of the small-diameter endoscope 20 is pushed back so that the tip portion 22 abuts on the inflated balloon 13 and faces the duodenal papilla 51a. As a result, the practitioner continues the operation of further pushing the insertion portion 21 in the direction of the arrow, thereby inserting the tip portion 22 of the insertion portion 21 into the duodenal papilla 51a and further totaling as shown in FIG. 10 (b). It is possible to push it deeper into the bile duct 53.

With the tip 22 of the insertion portion 21 inserted into the common bile duct 53, the practitioner irradiates the inside of the common bile duct 53 with the illumination optical system 24 and monitors the captured image obtained by the observation optical system 23. By checking the internal condition of the common bile duct 53, endoscopy of the bile duct can be performed. In addition, endoscopic treatment of the common bile duct 53 can be performed by feeding gas or liquid from the air supply / water supply nozzle 25 as needed and pulling out a treatment tool such as forceps from the forceps opening 26.

Next, the action will be described.

In the overtube 1 according to the present embodiment, the shape of the tubular body 10 is formed, for example, into a curved shape that fits well with respect to the curve of the inner wall of the human stomach 50. The fact that the overtube 1 fits well in the stomach 50 of the subject means that the overtube 1 is inserted into the stomach 50 and has a curved shape along the inner wall of the stomach 50 regardless of the posture at the start of insertion. It means that it is easy to maintain, that is, it is easy to maintain a constant posture or a posture close to it in the stomach 50.

In the overtube 1 according to the present embodiment, the position and inclination angle θ1 of the side wall opening 12 provided inside the curved shape of the tubular body 10 are the above-mentioned constant postures in the human stomach 50 of the tubular body 10. It is set according to the position of the duodenal papilla 51a starting from the fitting position in (or a posture close to it). As a result, in the overtube 1 according to the present embodiment, when the small-diameter endoscope 20 is used as an auxiliary tool for inserting into the lumen of the subject, the curved shape of the tubular body 10 causes the stomach 50 of the subject. It fits well on the inner wall, and when it is pushed further into the duodenum 51, the side wall opening 12 naturally faces the duodenal papilla 51a. Therefore, after that, the insertion portion 21 of the small-diameter endoscope 20 can be easily inserted into the common bile duct 53 from the duodenal papilla 51a.

In the above-described embodiment, an example of endoscopy / treatment in which the insertion portion 21 of the small-diameter endoscope 20 is inserted into the common bile duct 53 of the subject is given. The overtube 1 can be similarly handled when it is inserted into the common hepatic duct or the pancreatic duct. This overtube 1 is generally applicable to a small-diameter endoscope 20 such as one that can be inserted through the mouth of a subject, in addition to the above-mentioned nasal endoscope.

Further, in the above-described embodiment, the shapes and dimensions of the tubular body 10, the grip 11, the side wall opening 12, the balloon 13, and the like in the overtube 1 are specified, but this is merely an example. It goes without saying that various other shapes and dimensions can be adopted.

As described above, the overtube 1 according to the present embodiment is an endoscope insertion assisting tool for guiding the insertion portion 21 of the small diameter endoscope 20 into the cavity of the subject, and is flexible. A curved tubular body 10 having a property and having a predetermined curvature when placed on a predetermined plane, and having a tubular shape in which a hole through which an insertion portion 21 can be inserted extends in the axial direction, and a tubular body. The configuration is formed on the side wall on the center C side that defines the curved shape on the tip side in the axial direction of 10, and has a side wall opening 12 that leads out the tip 22 of the insertion portion 21.

In the overtube 1 according to the present embodiment, the tubular body 10 is formed into a curved shape by a flexible material, and the side wall opening 12 is provided on the side wall on the center C side that defines the curved shape. It can be realized by a simple structure.

Further, in the overtube 1, the curved shape of the tubular body 10 is shaped so that it fits well in the human stomach 50 and the fitting posture is close to a constant posture, and the side wall opening 12 has a curved shape. By setting the arrangement position in consideration of the position (fitting position) of the papilla of Vater 51a with respect to the tubular body 10 in the above-mentioned fitting posture of a human, the back of the duodenal 51 can be placed over the insertion portion 21 of the small-diameter endoscope 20. When guiding to, the side wall opening 12 of the tubular body 10 can be easily arranged at a position facing the duodenal papilla 51a.

Further, in the overtube 1 according to the present embodiment, the side wall opening 12 is a position having a predetermined inclination angle θ1 in the circumferential direction of the tubular body 10 with respect to the above-described specified plane of the surface of the tubular body 10. It is a configuration provided in.

With this configuration, the overtube 1 according to the present embodiment has a side wall opening in the circumferential direction of the tubular body 10 in accordance with the position of the duodenal papilla 51a starting from the fitting position of the tubular body 10 in the stomach 50. By setting the inclination angle θ1 of 12, the side wall opening 12 of the tubular body 10 naturally becomes the duodenal papilla in the process of covering the insertion portion 21 of the small-diameter endoscope 20 and guiding it to the depth of the duodenum 51 of the subject. It can be arranged at a position that surely faces 51a. After that, the tip 22 of the insertion portion 21 can be easily inserted into the duodenal papilla 51a by being led out from the side wall opening 12, and the insertion portion 21 can be easily guided into the common bile duct 53 from there.

Further, in the overtube 1 according to the present embodiment, the side wall opening 12 has a diameter of 1.0a to 2.0a in the axial direction of the tubular body 10 when the diameter of the outer circumference of the tubular body 10 is a. It has a length and a depth of 0.3a to 0.7a from the outer circumference of the tubular body 10.

With this configuration, the overtube 1 according to the present embodiment has a side wall opening 12 that opens with a size larger than the size of the tubular body 10, so that the insertion portion 21 of the small-diameter endoscope 20 is derived. The operation and the operation of pushing forward can be performed reliably and easily.

Further, the overtube 1 according to the present embodiment is provided along the peripheral surface on the distal end side of the side wall opening 12 of the tubular body 10 and has an inflatable balloon 13.

With this configuration, the overtube 1 according to the present embodiment is oriented by abutting the tip portion 22 of the insertion portion 21 of the small-diameter endoscope 20 led out from the side wall opening 12 against the inflated balloon 13. Therefore, the tip portion 22 of the insertion portion 21 can be easily guided to the duodenal papilla 51a.

Further, in the overtube 1 according to the present embodiment, the balloon 13 has a configuration in which expansion is restricted on the peripheral surface of the peripheral surface of the tubular body 10 opposite to the side on which the side wall opening 12 is formed. have.

The overtube 1 according to the present embodiment has an eccentric expansion balloon structure in which the balloon 13 expands only with respect to the side where the side wall opening 12 of the tubular body 10 is formed, whereby the side wall opening 12 is expanded. By inflating the balloon 13 toward the duodenal papilla 51a, the tip 22 of the insertion portion 21 of the small-diameter endoscope 20 is curved toward the duodenal papilla 51a between the side wall opening 12 and the duodenal papilla 51a. It becomes easy to take the necessary interval for the operation, and the insertion portion 21 of the small-diameter endoscope 20 can be more easily guided to the duodenal papilla 51a.

Further, the overtube 1 according to the present embodiment is formed on the surface of the tubular body 10 along the axial direction, and has a fluid passage 14 for sending a fluid for expanding and contracting the balloon 13 and a stopcock connected to the fluid passage 14. 15 and the like.

With this configuration, the overtube 1 according to the present embodiment can be easily arranged at the timing when the practitioner operates the stopcock 15 at hand and pulls out the insertion portion 21 of the small-diameter endoscope 20 from the side wall opening 12. The balloon 13 can be inflated.

Further, the overtube 1 according to the present embodiment is used to cover the insertion portion 21 of the small-diameter endoscope 20 and guide the insertion portion 21 to the common bile duct 53 via the duodenal papilla 51a of the subject, and has a tubular shape. The body 10 has a curved shape that easily fits in the main part of the inner wall of the human stomach 50, and the side wall opening 12 has the duodenum 51 of the subject changed in posture, and the tubular body 10 fits in the stomach 50 of the subject. In this state, the inclination angle θ1 in the circumferential direction of the tubular body 10 is set so that the side wall opening 12 faces the duodenal papilla 51a.

With this configuration, the overtube 1 according to the present embodiment has a curved shape of the tubular body 10 that fits well in the human stomach 50, and is aligned with the position of the duodenal papilla 51a starting from the fitting position. By setting the position of the side wall opening 12 inside the curved shape of the tubular body 10, the small-diameter endoscope is placed on the insertion portion 21 of the small-diameter endoscope 20 and guided to the depth of the duodenum 51 of the subject. The duodenum 51 can be changed in posture by utilizing the force of the mirror 20, and the side wall opening 12 can be arranged at a position where it naturally faces the duodenal papilla 51a.

In addition, the overtube 1 according to the present embodiment can be arranged so that the side wall opening 12 surely faces the duodenal papilla 51a while being easy to operate by the practitioner, and the difficulty of the treatment is kept low. be able to.

Further, the overtube 1 makes it easy to repeatedly insert and remove the small-diameter endoscope 20 into and from the common bile duct 53, and is excellent in the ability to insert and remove the bile duct a plurality of times.

Further, this overtube 1 has a side wall having a relatively large inner diameter of the tubular body 10 as compared with the case of using a specially reduced biliary tract mirror 31 having an insertion portion outer diameter of about 3.5 mm. The size of the opening 12 can also be set large. This makes it suitable for guiding the small-diameter endoscope 20 having a relatively large-diameter forceps opening 26.

Further, since the overtube 1 can easily guide the small diameter endoscope 20 equipped with a camera having a higher resolution than the specially reduced diameter biliary tract mirror 31 to the common bile duct 53, it is an observation optical system. The image resolution of the captured image obtained via the 23 can be increased.

Further, since the overtube 1 enables guidance to the common bile duct 53 of the widely used small-diameter endoscope 20, the cost is lower than the case of using the specially reduced-diameter biliary tract mirror 31. Can be achieved.

As described above, the endoscope insertion assisting tool of the present invention has an effect of being able to reliably and easily arrange the opening so as to face the duodenal papilla with a simple configuration, and has a small diameter. It is useful for all endoscope insertion aids used to guide the endoscope.

1 Overtube for inserting a small-diameter endoscope (auxiliary tool for inserting an endoscope)
10 Cylindrical body 12 Side wall opening (opening)
13 Balloon 14 Fluid passage (medium passage)
15 Stopcock (on-off valve)
20 Small-diameter endoscope (endoscope)
21 Insertion part 22 Tip of insertion part 50 Gastric 51 Duodenal 51a Duodenal papilla 52 Liver 53 Common bile duct (bile duct, lumen)

Claims (7)

It is an endoscope insertion aid for guiding the insertion part of the endoscope into the lumen of the subject.
A curved tubular body that is flexible and retains a predetermined curvature when placed on a predetermined plane, and has a tubular shape in which a hole through which the insertion portion can be inserted extends in the axial direction.
An opening formed on the side wall on the central side that defines the curved shape on the axially tip side of the tubular body and from which the tip end portion of the insertion portion is led out.
Auxiliary tool for inserting an endoscope, which is characterized by having. The first aspect of the present invention is characterized in that the opening is provided at a position having an inclination angle of 0 ° to 90 ° in the circumferential direction of the tubular body with respect to the specified plane of the surface of the tubular body. The described endoscope insertion aid. The opening has a length of 1.0a to 2.0a in the axial direction of the tubular body, and 0.3a to 0 from the outer circumference, where a is the diameter of the outer circumference of the tubular body. .. The endoscope insertion assisting tool according to claim 1 or 2, which has a depth of 7a. The endoscope insertion according to any one of claims 1 to 3, which is provided along the peripheral surface on the distal end side of the tubular body with respect to the opening and has an inflatable balloon. Auxiliary tool. The endoscopy according to claim 4, wherein the balloon has a configuration in which expansion is restricted on the peripheral surface of the tubular body opposite to the peripheral surface on which the opening is formed. Auxiliary tool for inserting a mirror. A claim characterized by further having a medium flow path formed on the surface of the tubular body along the axial direction and sending a medium for expanding and contracting the balloon, and an on-off valve of the medium flow path. Item 4. The endoscope insertion assisting tool according to Item 4. It is used to cover the insertion part of the endoscope and guide the insertion part to the bile duct via the duodenal papilla of the subject.
The tubular body is formed so that the curved shape easily fits in the main part of the inner wall of the human stomach.
The opening is such that when the subject's duodenum is displaced and the tubular body is contained in the subject's stomach, the opening is positioned to face the duodenal papilla. The endoscope insertion assisting tool according to any one of claims 1 to 6, wherein an inclination angle in the circumferential direction is set.

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