JP4753242B2 - Operation part of clip device for endoscope - Google Patents

Description

  The present invention relates to an operation unit of an endoscopic clip device.

  Endoscopic clip devices generally have an operation line with a clip connecting member at the front end that is detachable from the rear end of the clip formed in a shape that opens forward, and the clip is kept closed. And a sheath that is disposed so as to come into contact with the clip closing ring from the rear and is loosely fitted to the operation line. An operation member for relatively advancing / retreating the proximal end portion of the operation line and the proximal end portion of the sheath is disposed in the operation portion of the endoscope clip apparatus.

In addition, since it is necessary to keep the clip constricted when inserting the clip device into the treatment instrument guide tube of the endoscope, the clip device for the endoscope is further constricted in the distal end portion. An outer tube made of a flexible tube or the like that can be stored in a loose state is loosely fitted to the sheath, and on the operation unit side, the outer tube can be moved forward and backward with respect to the sheath (for example, Patent Document 1).
JP 2002-224124 A

When using an endoscopic clip device to clip the affected mucosa with the clip, place the clip in front of the affected area and open it wide, then close the clip and pinch the affected mucosa Remote operation is performed from the operation unit.
Such a clip closing operation is performed by pushing the clip closing ring arranged on the rear end side of the clip forward with a sheath and covering the clip, so that the operation portion engages with the clip. An operation of pushing the sheath forward relative to the line is performed.

  However, the outer tube fitted to the sheath is in contact with the inner surface of the treatment instrument guide tube of the endoscope over the entire length, and the frictional resistance between the outer tube and the sheath is caused by the sheath and the inner operation line. When the clip closing operation is performed as described above, the sheath does not move at all with respect to the endoscope and the affected part, and the operation line is pulled to the operation part side. End up.

  Then, at the tip of the clip device, the clip is pulled back backward while being closed and is separated from the affected part, so that the affected part cannot be clipped properly. For this reason, conventionally, it has been necessary to perform the operation of closing the clip at the operation unit and breathing it together and pushing the sheath little by little into the treatment instrument guide tube of the endoscope. It was not uncommon for veterans to fail clipping operations.

  The present invention has been made to solve such a problem, and the clip for an endoscope that can be easily clipped by anyone without the clip being separated from the affected part when the clip is closed. An object is to provide an operation unit of the apparatus.

From the rear to the operation line having a clip connecting member detachably attached to the rear end of the clip formed in a shape that opens toward the front, and the clip closing ring for maintaining the clip in a closed state A sheath that is arranged so as to abut and is loosely fitted to the operation line, and an outer tube that is loosely fitted to the sheath so that the clip can be stored in the distal end portion are relatively advanced and retracted. In the operation portion of the endoscope clip device connected to the operation line, the sheath, and the proximal end portion of the outer tube to perform the operation, the proximal end of the operation line and the proximal end of the outer tube are arranged in the axial direction. A locking mechanism that locks so as not to move relatively is provided so that the distal end of the outer tube is proximal to the distal end of the sheath in the locked state of the locking mechanism . proximal and proximal end of the mantle tube of the proximal end operating line Are possible relatively advancing and retracting operation for, by solving the locked state, the proximal end of the mantle tube is made possible relatively advancing and retracting operation with respect to the base end and the proximal end of the sheath of the operating line, the mantle tube It is made possible to move to a position where the tip of the cover covers a clip removably attached to the clip connecting member .

Incidentally, the locking mechanism, and one of the advance and retreat restricting recess formed in the outer peripheral surface of the member of the linked member linked member and a proximal end of the mantle tube to the proximal end of the operating lines, forward and backward from the other member And a fitting member provided so as to be freely inserted into and removed from the restriction recess. Further, an urging member that urges the fitting member in a direction in which the fitting member is fitted in the recess for advance / retreat restriction may be provided. The fitting member may be disengaged from the restricting recess so that one member and the other member can be relatively moved forward and backward.

  Further, the fitting member may be provided at the tip of the pin-shaped member, and a knob for performing a pulling operation for moving the fitting member may be provided on the other end side of the pin-shaped member, or the fitting member may be The push part for the push-in operation for moving the fitting member is arranged at a position 180 ° symmetrical to the fitting member with respect to the center of the hole. It may be. Then, when the engagement between the fitting member and the recess for advance / retreat is disengaged and the one member and the other member can be relatively advanced / retracted, the advance / retreat range restricting means for restricting the range of the advance / retreat operation is provided. It may be provided. The advance / retreat range restricting means may be an advance / retreat range restricting recess formed in the outer peripheral surface of one member longer in the axial direction than the advance / retreat restricting recess.

Further, one of the members may be an operation portion main body formed in a cylindrical shape, and the other member may be a mantle tube base end cap loosely fitted on the operation portion main body, and the recess for advance / retreat restriction is the operation portion main body. The outer tube base end cap may be rotatable about the axis with respect to the operation portion main body in a state where the outer circumferential surface of the outer circumferential surface is formed in the circumferential direction and the fitting member is engaged with the groove. The forward / backward range regulating recess is a small-diameter portion formed on the outer peripheral surface of the operation portion main body , and the outer tube base end cap is rotated around the axis with respect to the operation portion main body with the fitting member engaged with the small-diameter portion. It may be freely rotatable.

  Also, a first finger hook for engaging the operator's first finger and a second finger hook for engaging the second finger and the third finger are provided, and the sheath of the sheath is attached to the first finger hook. The base end may be connected via the sheath connecting member, and the base end of the operation line may be connected to the second finger hook via the operation portion main body. The part main body may be fitted so as to be movable forward and backward in the axial direction and rotatable around the axis. The base end portion of the operation unit main body is connected to the base end of the operation line at the center axis position, and a passage hole through which the sheath connecting member passes loosely is formed in an arcuate groove shape around the base end portion. Well, the sheath connecting member is formed in a cross-sectional shape in which a part of the cross section of the cylindrical body is cut out in a region passing through the passage hole, and rotates around the base end of the operation line in the passage hole. You may be able to do that.

  According to the operation part of the clip device for an endoscope of the present invention, there is provided a locking mechanism that locks the proximal end of the operation line and the proximal end of the outer tube so as not to move relatively in the axial direction. The base end of the operation line can be moved back and forth relative to the base end of the operation line and the base end of the mantle tube, so that when the clip is closed, Since only the sheath moves in the axial direction, the clip does not leave the affected area, and anyone can easily perform the clipping operation.

Embodiments of the present invention will be specifically described below with reference to the drawings.
FIG. 5 is a plan sectional view of the distal end portion of the endoscope clip device, and FIG. 6 is a side sectional view thereof.
1 is a clip that is indwelled in a state where a living tissue is picked to perform hemostasis and the like, and is formed by bending a member having a spring property, such as a stainless steel plate for a spring, by pressing or the like, The rear end is bent back in parallel with a substantially U-shaped half-loop shape, and is formed in a shape that expands forward from the middle portion when no external force is applied. The clip 1 may have other shapes (for example, a shape in which the rear end portion is bent in a loop shape, etc.), and the clip 1 may be formed of a spring wire or the like.

Reference numeral 2 denotes a clip closing ring for closing the clip 1 and maintaining the closed state. The clip closing ring 2 is formed in a cylindrical shape by a rigid body such as a stainless pipe material or a hard plastic, and is formed from an intermediate portion of the clip 1. It is attached in a state that surrounds a little rear part.
Reference numeral 3 denotes a flexible sheath for pushing the clip closing ring 2 toward the distal end of the clip 1 in order to force the clip 1 into a closed state. A flexible operation line 4 made of, for example, a stainless steel wire or a coil, which is detachably connected, is loosely inserted over the entire length so as to be slidable in the axial direction.

  The flexible sheath 3 is formed of, for example, a coil pipe that is tightly wound with a stainless steel wire. However, it may be formed by a tube made of synthetic resin such as made of strong fluororesin, polyimide resin or PEEK (polyetheretherketone) resin. A cylindrical tip cap 3A formed of a rigid body such as a stainless pipe material or a hard plastic material is integrated with the distal end of the flexible sheath 3 by brazing or the like in series with the flexible sheath 3. The tip end face of the tip cap 3A is in contact with the rear end face of the clip closing ring 2 and pushes the clip closing ring 2 forward.

  A clip connecting member 4A that is detachable from the rear end of the clip 1 is connected to the tip of the operation line 4 by a connecting ring 4B. The clip connecting member 4A is formed of a material having a spring property, and in a state where no external force is applied, the clip connecting member 4A expands forward as shown in FIG. As shown in FIG. 3, the clip 1 is elastically deformed and engaged with the rear end portion of the clip 1, and expands when it protrudes forward from the distal end of the distal end cap 3 </ b> A of the flexible sheath 3. Is disengaged.

  Returning to FIG. 5, reference numeral 5 denotes an outer tube that comes into contact with the treatment instrument guide tube when being inserted into and removed from the endoscope treatment instrument guide tube, and is formed of, for example, a flexible fluororesin tube. Thus, the flexible sheath 3 is loosely fitted. Then, as shown in FIG. 7, when the outer tube 5 is pushed forward and covered with the clip 1, the clip 1 is elastically deformed to be closed, and when the outer tube 5 is retracted rearward, the clip 1 is restored. 5 is returned to the expanded state shown in FIG.

FIG. 1 shows the flexible sheath 3, the operation wire 4, and the outer end of the outer tube 5 connected to the flexible sheath 3, the operation wire 4, and the outer tube 5. FIG. 2 is a side cross-sectional view of the operation unit 10 arranged, and FIG. 2 is a cross-sectional view taken along the line AA.
The operation unit 10 is provided with a first finger hook 11 for engaging the operator's first finger and a second finger hook 12 for engaging the operator's second and third fingers. ing. The planar shape is shown in FIG. 8 and the following figures, but any shape may be used.

  Reference numeral 13 shown in FIGS. 1 and 2 denotes an elongated cylindrical operation unit main body with the distal end opened, and a cylindrical sheath operation cylinder 14 formed integrally with the first finger hook 11 is attached to the operation unit main body 13. On the other hand, it is fitted to the outer peripheral surface of the operation section main body 13 so as to be movable forward and backward in the axial direction and rotatable around the axis. However, a structure in which the sheath operation tube 14 is fitted to the inner peripheral surface of the operation unit main body 13 may be adopted.

  The second finger hook 12 is arranged so as to be slidable along the outer peripheral surface of the sheath operation tube 14 and to be rotatable around the axis. The second finger hook 12 is connected to the proximal end portion of the operation portion main body 13 by a connecting screw 15. It is designed to work as a unit. The sheath operating tube 14 is formed with an elongated slit 16 in the axial direction through which the connecting screw 15 passes loosely so that the connecting screw 15 can freely slide and rotate around the axis. Then, the base end of the operation line 4 is connected to the central axis position of the base end portion of the operation unit main body 13, and the base end of the operation line 4 is connected to the second finger hook 12 via the operation unit main body 13. It has become. The vicinity of the base end of the operation line 4 is reinforced by being fitted with a reinforcing pipe 4p in order to prevent hip folding.

  Reference numeral 17 denotes a sheath connecting member made of a rigid body that connects the base end of the flexible sheath 3 and the first finger hook 11, and has a cross-sectional shape (180 ° in this case) cut away leaving a part of the cross section of the cylindrical body. It is formed in a bowl shape with an arc of a degree remaining. As shown in FIG. 2, a passage hole 18 for allowing the sheath connecting member 17 to pass loosely is formed in an arcuate groove shape in the proximal end portion of the operation portion main body 13.

  Since the passage hole 18 is formed to have a larger arc angle than the sheath connecting member 17, the sheath connecting member 17 can be rotated around the axis in the passage hole 18. The sheath connecting member 17 rotates around the base end of the operation line 4 and is clipped inside the flexible sheath 3 with respect to the distal end thereof. The connecting member 4 </ b> A rotates and the clip 1 rotates with respect to the flexible sheath 3. Reference numeral 19 denotes a fixing pin that fixes the proximal end of the sheath connecting member 17 to the first finger hook 11.

  As shown in FIG. 1, a cylindrical outer tube base end cap 20 whose rear end is opened is disposed at the proximal end of the outer tube 5 so as to be fitted on the outer periphery of the operation unit main body 13. . The outer tube base end cap 20 is locked by a locking mechanism 21 so that it cannot move relative to the second finger hook 12 in the axial direction in a normal state. In other words, the proximal end of the operation line 4 and the proximal end of the outer tube 5 are locked by the locking mechanism 21 so as not to move relative to each other in the axial direction. When the finger hook 11 is slid, the proximal end of the flexible sheath 3 moves forward and backward with respect to the proximal end of the operation line 4 and the proximal end of the outer tube 5.

  The locking mechanism 21 can be freely fitted into and removed from the circumferential groove 22 (advanced / retracted recess) formed on the outer peripheral surface of the operation section main body 13 and the circumferential groove 22 from the outer tube base end cap 20 side. And a fitting member 23 provided in the housing. The circumferential groove 22 is provided at the tip of a pin-like member that protrudes sideways, and is biased by a coil spring 25 (biasing means) in a direction to be fitted into the circumferential groove 22. A knob 24 is provided on the protruding end side.

  Therefore, the outer tube base end cap 20 can rotate around the axis with respect to the operation portion main body 13 but cannot move in the axial direction. However, as shown by the arrow U in FIG. 3, if the knob 24 is picked with a fingertip and pulled against the urging force of the coil spring 25, the fitting member 23 is disengaged from the circumferential groove 22, and the outer tube base The end cap 20 can be moved forward and backward in the axial direction with respect to the operation portion main body 13, and the outer tube 5 moves in the axial direction with respect to the operation line 4.

  On the outer peripheral surface of the operation portion main body 13, a small-diameter portion 26 (advance / retraction range restricting recess) is formed longer than the circumferential groove 22 in the axial direction at a position adjacent to the circumferential groove 22 and closer to the front side. Therefore, if the mantle tube base end cap 20 is moved forward by releasing the finger from the knob 24, the mantle tube base end cap 20 is within the range in which the fitting member 23 can move within the small diameter portion 26, as shown in FIG. Can be moved in the axial direction with respect to the operation portion main body 13, and the outer tube 5 slides in the axial direction with respect to the operation line 4.

  The outer tube base end cap 20 can always be rotated around the axis with respect to the operation portion main body 13. Since the rear end portion of the small-diameter portion 26 is a slope 26a, if the outer tube base end cap 20 is slid rearward, the fitting member 23 is fitted into the circumferential groove 22 beyond the slope 26a, The outer tube base end cap 20 is locked to the operation portion main body 13, and the base end of the operation line 4 and the base end of the outer tube 5 return to a state where they do not move in the axial direction (normal state). Reference numeral 27 denotes a water injection cap to which a syringe barrel or the like can be connected, and 28 denotes an O-ring for sealing. Various other mechanisms can be employed as the locking mechanism 21.

  FIG. 8 schematically shows a state in which an operation of changing the clip 1 (or attaching a new clip 1) is performed in the endoscope clip apparatus configured as described above, and the first finger hook 11 is held at hand. By pulling the side of the flexible sheath 3 backward, the clip connecting member 4A provided at the tip of the operation line 4 is exposed, and the clip 1 is connected to the clip connecting member 4A. Can be engaged or disengaged. 8 and the subsequent drawings, illustration of some components such as the distal end cap 3A of the flexible sheath 3, the connecting screw 15, and the O-ring 28 is omitted.

  Next, as schematically shown in FIG. 9, when the clip device is passed through the endoscope treatment tool guide tube 40 shown schematically, the locking mechanism 21 is released and the outer tube base end cap 20 is moved forward. The outer tube 5 is pushed forward to the position where it covers the clip 1, and the clip 1 is elastically deformed in a closed state within the distal end of the outer tube 5, and the outer tube 5 is completely attached to the clip 1 and the flexible sheath 3. In the state where it is covered, it is pushed into the treatment instrument guide tube 40 of the endoscope.

  When the distal end of the clip device protrudes from the distal end of the treatment instrument guide tube 40 toward the inside of the body, the outer tube proximal end cap 20 is slid to the proximal side as shown schematically in FIG. By retracting, the clip 1 returns to its natural state due to its own elasticity, and is in a state of expanding toward the front at the distal end of the flexible sheath 3. Since the locking mechanism 21 returns to the locked state, the operation line 4 and the outer tube 5 are fixed integrally with respect to the axial operation thereafter.

  When the clip 1 in the expanded state is brought close to the affected part 50 by remote control so that the affected part 50 is positioned between the clips 1, as shown schematically in FIG. By pushing the flexible sheath 3 forward, the clip closing ring 2 is pushed forward so as to cover the clip 1, and the clip 1 is forcibly closed, such as a bleeding part of the mucous membrane. Can be clipped.

  In this operation, in the present invention, the operation line 4 is locked to the outer tube 5 which is in contact with the treatment instrument guide tube 40 of the endoscope over its entire length and is difficult to move due to its frictional resistance. Therefore, since only the flexible sheath 3 is pushed forward and the clip 1 is not separated from the affected area 50, the affected area 50 can be easily clipped by the clip 1 even if an inexperienced operator or the like operates. .

  Then, as shown in FIG. 12, if the operation of pulling the flexible sheath 3 backward again by the first finger hook 11 is performed, the distal end of the flexible sheath 3 is retracted backward to expose the clip connecting member 4A. Therefore, the clip 1 in a state in which it is disengaged from the clip 1 and forcibly closed by the clip closing ring 2 can be placed in the body.

It should be noted that the embodiment of the present invention is not limited to the above-described embodiment. For example, as shown in FIG. 13 and FIG. 14, which is a cross-sectional view cut along the line BB, is an advance / retreat regulating recess. You may employ | adopt the mechanism which can perform operation which disengages engagement member 23 'with respect to the circumferential groove 22 by pushing operation of push part 24'.
In this locking mechanism 21 ′, a push part 24 ′ that is pushed and operated by a fingertip is formed on a plate-like member having a hole H having a diameter slightly larger than the outer diameter of the operation part main body 13. A fitting member 23 ′ formed by the inner edge of the hole H and a coil spring 25 ′ in a compressed state are arranged at a position 180 ° symmetrical to the push portion 24 ′ with respect to the center of H.

Side surface sectional drawing of the operation part of the clip apparatus for endoscopes of the Example of this invention. Sectional drawing of the state cut | disconnected in the AA in FIG. 1 of the operation part of the clip apparatus for endoscopes of the Example of this invention. Side surface sectional drawing of the operation state of the operation part of the clip apparatus for endoscopes of the Example of this invention. Side surface sectional drawing of the operation state of the operation part of the clip apparatus for endoscopes of the Example of this invention. The plane sectional view of the tip part of the clip device for endoscopes of the example of the present invention. Side surface sectional drawing of the front-end | tip part of the clip apparatus for endoscopes of the Example of this invention. The plane sectional view of the operation state of the tip part of the clip device for endoscopes of the example of the present invention. The plane fragmentary sectional view which shows schematically operation | movement of the clip apparatus for endoscopes of the Example of this invention in order. The plane fragmentary sectional view which shows schematically operation | movement of the clip apparatus for endoscopes of the Example of this invention in order. The plane fragmentary sectional view which shows schematically operation | movement of the clip apparatus for endoscopes of the Example of this invention in order. The plane fragmentary sectional view which shows schematically operation | movement of the clip apparatus for endoscopes of the Example of this invention in order. The plane fragmentary sectional view which shows schematically operation | movement of the clip apparatus for endoscopes of the Example of this invention in order. Side surface sectional drawing of the latching mechanism of the clip apparatus for endoscopes of the 2nd Example of this invention. Sectional drawing of the state cut | disconnected in the BB line in FIG. 13 of the latching mechanism of the clip apparatus for endoscopes of the 2nd Example of this invention.

Explanation of symbols

DESCRIPTION OF SYMBOLS 1 ... Clip 2 ... Clip closing ring 3 ... Flexible sheath 4 ... Operation line 4A ... Clip connection member 5 ... Outer tube 10 ... Operation part 11 ... 1st finger hook 12 ... 2nd finger hook 13 ... Operation part main body 14 ... Sheath operation tube 17 ... sheath connecting member 20 ... outer tube base end caps 21 and 21 '... locking mechanism 22 ... circumferential groove (recessed / retracted recess)
23, 23 '... fitting member 24 ... knob 24' ... push portion 25, 25 '... coil spring 26 ... small diameter portion (recessed / retracted range regulating recess)
H ... hole

Claims (15)

An operation line having a clip connecting member detachably attached to a rear end portion of a clip formed in a shape opened toward the front at a front end portion, and a rear side with respect to a clip closing ring for maintaining the clip in a closed state A sheath that is disposed so as to abut against the operation line and is loosely fitted to the operation line, and an outer tube that is loosely fitted to the sheath so that the clip can be stored in a state where the clip is constricted in the distal end portion. In the operation portion of the endoscope clip device that is connected to the proximal end portion of the operation line, the sheath, and the outer tube in order to perform an operation of moving back and forth relatively,
A locking mechanism for locking the base end of the operation line and the base end of the outer tube so as not to move relatively in the axial direction is detachably provided, and in the locked state of the locking mechanism, the tip of the mantle tube is located proximal to the distal end of the sheath is movable relative reciprocating operation proximal end of the sheath against the proximal end and the proximal end of the mantle tube of the operating line, the By releasing the locking state, the proximal end of the outer tube can be moved forward and backward relative to the proximal end of the operation line and the proximal end of the sheath, and the distal end of the outer tube is moved to the clip connecting member. An operation portion of an endoscope clip device, wherein the operation portion is movable to a position covering the clip removably attached to the endoscope. The operation unit of the endoscope clip device according to claim 1, wherein the locking mechanism is one of a member connected to a proximal end of the operation line and a member connected to a proximal end of the outer tube. operating portion of the outer peripheral surface which is formed on advance and retreat limiting recess, the other relative to the advance and retreat restricting recess from member Hamada' freely provided the fitting member and the contain an that endoscopic clipping device member. The operation part of the endoscope clip apparatus according to claim 2, wherein an urging member that urges the fitting member in a direction in which the fitting member is fitted into the advance / retreat restricting recess is provided . Operation part. The operation portion of the endoscope clip device according to claim 3, wherein the fitting member with respect to the recess for advance / retreat is controlled by performing an operation of moving the fitting member in a direction against the urging force of the urging member. operating portion of the engagement is disengaged, the one member and the other member and the relatively reciprocating endoscopic clipping device ing ready for operation. The operation part of the clip apparatus for endoscopes according to claim 4, wherein the fitting member is provided at a tip of a pin-like member, and a knob for performing a pulling operation for moving the fitting member is the pin. operation of the endoscope clip device that provided on the other end of the Jo member. 5. An operation portion of the endoscope clip device according to claim 4 , wherein the fitting member is formed by an inner edge portion of a hole that is detachably engageable with the advance / retreat regulating recess, and the pushing member moves the fitting member. An operating portion of the endoscope clip device, wherein a push portion for performing the operation is disposed at a position 180 ° symmetrical to the fitting member with respect to the center of the hole . The operation part of the endoscope clip device according to any one of claims 2 to 6 , wherein the engagement between the fitting member and the recess for advance / retreat is disengaged, and the one member and the other member are when you are ready to relatively retreat operation, the operation portion of the endoscope clip device reciprocating range restricting means for restricting the range of the forward and backward movement are al provided. The operation part of the endoscope clip device according to claim 7 , wherein the advance / retreat range restricting means is formed on an outer peripheral surface of the one member longer in the axial direction than the advance / retreat restricting recess. operation of der Ru endoscope clip device. The operation part of the endoscope clip device according to any one of claims 2 to 8 , wherein the one member is an operation part main body formed in a cylindrical shape, and the other member is connected to the operation part main body. The operation part of the endoscope clip apparatus which is a shell tube base end cap loosely fitted . The operation portion of the endoscope clip device according to claim 9 , wherein the recess for advance / retreat is a groove formed in a circumferential direction on an outer peripheral surface of the operation portion main body, and the fitting member is engaged with the groove. An operation part of an endoscopic clip device in which the outer tube base end cap is rotatable about an axis with respect to the operation part main body in a combined state . The operation portion of the endoscope clip device according to claim 9 or 10 , wherein the recess for advance / retreat range restriction is a small diameter portion formed on an outer peripheral surface of the operation portion main body, and the fitting member is provided in the small diameter portion. An operating portion of an endoscopic clip device in which the outer tube base end cap is rotatable about an axis with respect to the operating portion main body in a state where is engaged . The operation part of the endoscope clip device according to any one of claims 9 to 11, wherein the first finger hook for engaging the operator's first finger and the second finger and the third finger are engaged. A second finger hook is provided, and a proximal end of the sheath is connected to the first finger hook via a sheath connecting member, and a proximal end of the operation line is connected to the second finger hook operation of the endoscope clip device parts through the body that are connected. The operation portion of the clip device for an endoscope according to claim 12 , wherein a sheath operation tube that advances and retreats integrally with the first finger hook is movable in and out of the operation portion main body in an axial direction and around the axis. An operation unit of an endoscope clip device that is rotatably fitted . The operation portion of the endoscope clip device according to claim 12 or 13, wherein a proximal end portion of the operation line is coupled to a proximal end portion of the operation portion main body at a central axis position, The operation part of the clip apparatus for endoscopes in which the passage hole which a sheath connection member passes loosely is formed in circular arc-shaped groove shape . The operation part of the clip device for an endoscope according to claim 14 , wherein the sheath connecting member is formed in a cross-sectional shape in which a part of a cross section of the cylindrical body is left in a region passing through the passage hole. have been, the operation portion of the endoscope clip device that can be rotated around the proximal end of the operation wire in the passage hole.

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