JP6200627B2 - Capsule endoscope guidance instrument - Google Patents

Description

  The present invention relates to a treatment instrument used for guiding a capsule endoscope to an affected area. The present invention is a method of obtaining a detailed image from an image obtained by inserting the wireless capsule endoscope into a bile duct or pancreatic duct using a normal endoscope.

  Endoscopic retrograde cholangiopancreatography is widely used as an inspection of the bile duct or pancreatic duct connected to the duodenum. In this examination, after the endoscope is orally reached to the duodenal papilla, which is the outlet for bile or pancreatic juice, a contrast tube is inserted into the bile duct or pancreatic duct from the distal end of the endoscope, and a contrast agent is injected from the contrast tube. By injecting, the thickness, shape, property, etc. of the bile duct or pancreatic duct are observed. That is, the above method does not directly observe the bile duct or pancreatic duct, but is diagnosed and treated by an image projected with a contrast agent.

  On the other hand, in order to directly observe the bile duct or pancreatic duct, it is necessary to insert an endoscopic device directly into the bile duct or pancreatic duct. Currently, a total of two endoscopes are required: an endoscope that inserts up to the duodenal papilla and a second endoscope that is guided to the bile duct or pancreatic duct via the treatment instrument insertion passage of the endoscope. It is said that. The former endoscope is called a “parent” and the latter endoscope is called a “child”, and is also called a parent-child endoscope. However, such a parent-child endoscope requires a high level of skill from the practitioner (doctor), and two endoscopes are simultaneously inserted for the subject. In other words, this parent-child cholangioscope / pancreatoscope is burdensome for both the practitioner and the patient, and it is often extremely difficult to conduct a highly accurate examination.

  Further, in a biopsy method in which a biological tissue is collected and microscopically diagnoses benign / malignant cells, it is often difficult to directly view the collection portion, and thus is often performed under fluoroscopy. For this reason, there is a case where a biological tissue cannot be collected accurately depending on a target site. In such a case, although the lesion actually exists, the presence of the lesion cannot be grasped, and the diagnosis result may be false negative. For example, even if there is a stone, diagnosis or treatment is performed under fluoroscopy, so it may not be detected because it is small, or even if it can be found, the stone may not be completely discharged and may partially remain in the body In addition, even if treatment is required in the bile duct or pancreatic duct, satisfactory treatment may not be performed under fluoroscopy. Even if the above-mentioned parent-child endoscope is adopted, in order to accurately obtain the tissue from the lesion under direct vision, the technical difficulty is extremely high and the burden on both the operator and the subject is excessive. Often, satisfactory results are not obtained.

In this way, especially when diagnosing or treating the bile duct or pancreatic duct region with an endoscope, it is difficult or impossible to visually recognize these regions as they are, so that both satisfactory diagnosis and treatment are difficult. There are many things.
On the other hand, wireless capsule endoscopes (hereinafter referred to as “capsule endoscopes”) have recently been developed and applied clinically to observation and diagnosis of the small or large intestine, and hence the esophagus or stomach. In the capsule endoscope, the inside of the digestive tract is swallowed from the mouth, moved by the peristaltic movement of the digestive tract, and the inside of the digestive tract can be photographed with a small camera built in the capsule endoscope (Patent Document 1, etc.) . For this reason, a method of guiding the capsule endoscope to a desired target site by holding the capsule endoscope with a normal endoscope has been proposed (Patent Document 2).

JP 2010-207451 JP2004-65971

  However, since the guiding method of Patent Document 2 is gripped by forceps provided in an endoscope, a target site can be observed, but a procedure such as tissue sampling (biopsy) or excision is performed. I can't. In order to perform such treatment, it is necessary to prepare an endoscope for treatment separately and perform the treatment, so that the burden on the practitioner or the subject is also increased.

  Accordingly, a main object of the present invention is to provide a treatment instrument that can guide the capsule endoscope more reliably and easily in order to observe and treat a site that is difficult to observe and treat with an endoscope. There is.

  As a result of intensive studies in view of the problems of the prior art, the present inventor has found that a member having a specific structure can achieve the above object, and has completed the present invention.

That is, the present invention relates to the following capsule endoscope guiding treatment tool.
1. A treatment tool for guiding a capsule endoscope to a target site,
(1) The treatment instrument has a handle, a tube body, and a wire-shaped guide for guiding the tube body to a target site,
(2) The wire-shaped guide is inserted inside the tube body,
(3) The tube body includes: a) an introduction port for introducing the wire-shaped guide member into the tube body; b) a lead-out port for leading the distal end portion of the wire-shaped guide member to the outside from the tube body; and c) a capsule endoscope. Including a fixing part for fixing,
(4) The outlet is provided at the tip of the tube body ,
(5) In the fixing portion, the capsule endoscope is fixed by a loop wire derived from an opening formed in the distal end region of the tube body.
A treatment device for guiding a capsule endoscope.
2. The treatment device for guiding a capsule endoscope according to Item 1 , wherein the capsule endoscope is fixed by attaching an adapter to which the loop wire can be attached to the capsule endoscope and interposing the adapter.
3. The treatment device for guiding a capsule endoscope according to Item 1 or 2 , wherein the tube main body has a size and a shape that can penetrate the insertion passage of the non-capsule endoscope.

  According to the capsule endoscope guiding member of the present invention, the capsule endoscope can be guided to a target place relatively easily and reliably, and further observation and treatment can be performed. In other words, since a guide wire is mounted and can be guided to the target bile duct, pancreatic duct, etc. using this guide wire, it has been difficult to introduce an endoscope in the bile duct, pancreatic duct, etc. It is possible to easily and surely guide the capsule endoscope to the local area and perform a reliable sniper biopsy. In other words, since the bile duct, pancreatic duct, etc. can be directly observed with an endoscope, it can contribute to diagnosis or treatment that requires such observation.

  As described above, the capsule endoscope guiding treatment instrument of the present invention makes it easy and reliable for the diagnosis, inspection and treatment of the bile duct or pancreatic duct region, which has been difficult in the prior art, and shortens the treatment time. Since there is an advantage of being able to plan, the burden on not only the practitioner but also the patient / subject is reduced. Thereby, the problem regarding the difficulty and reliability of the conventional so-called parent-child oral bile duct or pancreatoscope can be solved.

It is a schematic diagram which shows the outline | summary of this invention treatment tool. In the tube main body of this invention treatment tool, it is a schematic diagram which shows the state with which the capsule endoscope was mounted | worn at the front-end | tip area | region. It is a schematic diagram which shows the structure of the capsule endoscope for fixing to the treatment tool of this invention, or the adapter for it. It is a schematic diagram which shows the state which took out the loop wire from the through-hole. It is a schematic diagram which shows the state which penetrated this invention treatment tool through the endoscope, and also attached the capsule endoscope. It is a schematic diagram showing how the treatment tool of the present invention is inserted into an endoscope and introduced into the body orally in a state where a capsule endoscope is further attached. It is a schematic diagram which shows the state which inserted this invention treatment tool to the duodenal papilla. It is a schematic diagram which shows the state which made the guide wire reach | attain the target site | part from the front-end | tip of this invention treatment tool. It is a schematic diagram which shows the state which made this invention treatment tool reach | attain the target site | part. It is a schematic diagram which shows the state which inserted the endoscope in the overtube. It is a schematic diagram which shows the state which temporarily fixed the overtube to the esophagus.

1. Capsule endoscope guidance treatment tool The capsule endoscope guidance treatment tool of the present invention is a treatment tool for guiding a capsule endoscope to a target site,
(1) The treatment instrument has a handle, a tube body, and a wire-shaped guide for guiding the tube body to a target site,
(2) The wire-shaped guide is inserted inside the tube body,
(3) The tube body includes: a) an introduction port for introducing the wire-shaped guide member into the tube body; b) a lead-out port for leading the distal end portion of the wire-shaped guide member to the outside from the tube body; and c) a capsule endoscope. Including a fixing part for fixing,
(4) The outlet is provided at the tip of the tube body.
It is characterized by that.

  Hereinafter, a capsule endoscope guiding treatment tool of the present invention (the present treatment tool) will be described with reference to the drawings. FIG. 1 shows an overall view of the member of the present invention. The member 10 of the present invention includes a handle portion 11, a tube main body 12, and a wire-shaped guide member 13. The tube main body 12 has an introduction port 14 for introducing a wire-shaped guide member into the tube main body, a lead-out port 15 for leading the distal end portion of the wire-shaped guide member to the outside from the tube main body, and a fixing for fixing the capsule endoscope. A portion 16 is provided. The outlet 15 is provided at the distal end of the tube body 12 as shown. That is, one end opening of the tube body can be used as the outlet 15. 1 employs a system in which a capsule endoscope (not shown) is fixed by a loop wire 17.

  An enlarged view of the fixing portion 16 (installed in the distal end region of the tube body 12) in FIG. 1 is shown in FIG. As shown in FIG. 2, a through hole 18 penetrating from the inside of the tube main body 12 to the outside is formed in the distal end region of the tube main body 12, and a loop wire 17 is inserted therethrough, and the loop portion is the tube main body 12. It is in the state where it went out of. The capsule endoscope 20 is fixed to the fixing portion 16 on the surface of the tube main body 12 by tightening the loop wire 17 while the capsule endoscope 20 is passed through the loop portion of the loop wire 17. Hereinafter, each structure of this invention treatment tool is demonstrated.

  First, the handle part 11 is provided to hold and fix the treatment tool of the present invention with the fingers of the practitioner (doctor). As shown in FIG. 1, the handle portion 11 is provided so that a practitioner's finger can be inserted, whereby the treatment tool of the present invention can be controlled. Moreover, as an installation location of a handle part, as shown in FIG. 1, it can provide in one edge part of this invention member, for example. For example, 1) a loop wire for supporting the capsule endoscope, 2) a wire-shaped guide member for guiding the tube body to the target site, and 3) a forceps for treating the target site. Each operation part for operating (for example, biopsy forceps) etc. may be provided. The configuration / mechanism of the operation unit can be the same as the configuration / system employed in known or commercially available endoscopes. In FIG. 1, a second handle portion 19 for inserting and removing the loop wire 17 is provided in the vicinity of the handle portion 11. For example, the loop wire 17 can be taken in and out by sliding the second handle part up and down with the fingers of the practitioner along the tube body.

  The tube body 12 literally has a tube shape, and an introduction port for introducing a wire-shaped guide member into the tube body, b) a lead-out port for leading the distal end portion of the wire-shaped guide member to the outside, and c) A fixing unit 16 for fixing the capsule endoscope is included.

  As shown in FIG. 1, the introduction port 14 can suitably use one opening of the tube body as the introduction port. Moreover, it can also form in the side part of a tube main body as needed. The number of introduction ports is not limited, and one or two or more can be provided. As shown in FIG. 1, the outlet 15 can suitably use the other opening of the tube body as the outlet. Moreover, it can also form in the side part of a tube main body as needed. The number of outlets installed is not limited, and one or two or more outlets can be provided.

  The fixing part 16 is a part for fixing the capsule endoscope, and the fixing method is not particularly limited. For example, in addition to the method of fastening with the loop wire 17 as shown in FIG. 1, any fixing method such as a method using an adhesive / adhesive, a method using screws / screws, and a method using a magnet can be employed. In particular, in the present invention, a method of tightening with a loop wire can be suitably employed from the standpoint of ease of replacement, ease of attachment, and the like. When tightening with a loop wire, as shown in FIG. 2, the loop wire protrudes from the through hole 18 formed in the side surface of the tube body so as to draw a ring, and after passing the capsule endoscope through the loop, By tightening the loop wire, the capsule endoscope can be fixed to the fixing portion 16 on the side surface of the tube body. In this case, as shown in FIG. 3A, the capsule endoscope can be more reliably fixed to the tube body by forming the groove portion 31 through which the loop wire passes in the capsule endoscope body. Furthermore, as shown in FIG. 3 (b), the capsule endoscope can be more securely fixed to the tube body even by a method in which the adapter 33 having the same groove portion 32 is used and the adapter 33 is attached to the capsule endoscope. it can. In this case, there is an advantage that a commercially available capsule endoscope can be used as it is. Note that the adapter shown in FIG. 3B is cylindrical, but other shapes can be adopted that closely adhere to the shape of the capsule endoscope. Further, as the material of the adapter, a material (for example, rubber) that can follow the shape of the capsule endoscope can be preferably used.

  In the present invention, the recovery lead wire can be coupled to the capsule endoscope as necessary. When the capsule endoscope is detached from the fixed part, if one of the recovery leads is connected to the capsule endoscope and the other is set to go out of the oral cavity, the capsule endoscope It can be easily and safely collected without causing stray. As the recovery lead wire, for example, a synthetic resin fiber, a natural fiber, or the like can be used.

  In addition to the number of loop wires, the positions of the through holes, the number of arrangements, and the like can take various variations. For example, as shown in FIG. 4A, one capsule endoscope can be tightened by taking out two or more loop wires 17 and 17 ′ from one through hole 18. As shown in FIG. 4B, a plurality of through-holes 18 and 18 'are formed at two or more different positions, and a plurality of loop wires 17 and 17' are separately taken out from the plurality of through-holes 18 and 18 '. An endoscope can be attached.

  The wire-shaped guide member has a function of guiding a tube body (catheter) to which a capsule endoscope is attached to a target site (for example, bile duct, pancreatic duct, etc.). Therefore, it is used in a state in which the wire-shaped guide member is inserted into the tube body (insertion passage). As the wire-shaped guide member, for example, a guide wire, an endoscope forceps, or the like can be used. These may be known or commercially available. Moreover, these can be used by 1 type (s) or 2 or more types. For example, when both a guide wire and an endoscopic forceps are used in combination, the insertion path of the tube body can be used for biopsy under direct viewing of the capsule endoscope after the guide is guided to the target site by the guide wire. Therefore, it can be used as an insertion path for a biopsy forceps.

  The length, inner diameter, and outer diameter of the tube main body can be appropriately set according to, for example, the patient to be processed, the type of endoscope to be inserted, the material of the tube main body, and the like. In general, the length of the tube body may be equal to or longer than the length of the endoscope to be used, and is generally about 1.5 m to 2 m, but is not limited to this range. Absent. The outer diameter of the tube main body is not limited as long as it passes through the treatment instrument insertion path of a normal endoscope, and usually about 2 to 3 mm can be suitably employed. The inner diameter of the tube body is not limited as long as a loop wire, a guide wire, and the like can be passed and manipulated, but can be appropriately set within a range of 1 to 2 mm.

  The material of the tube main body and the handle part is not limited as long as it has predetermined flexibility and flexibility, for example, synthetic resin, synthetic rubber, natural rubber, fibrous material (woven fabric or non-woven fabric), metal, etc. Can be adopted. Also, commercially available materials can be used. The present invention encompasses not only the case where the device is made of a highly rigid and self-supporting material but also the case where the device is made of a highly flexible and non-self-supporting material.

2. The control method of the capsule endoscope guiding treatment tool The control method of the present invention is a method of controlling the capsule endoscope guiding treatment tool of the present invention,
(1) A step of penetrating the tube body of the treatment instrument into the insertion passage of a separately prepared non-capsule endoscope (penetration step),
(2) A step of exposing the outlet and the fixing portion of the tube body from the distal end portion of the non-capsule endoscope and attaching the capsule endoscope to the fixing portion (capsule endoscope attachment step),
(3) a step of inserting the distal end portion of the non-capsule endoscope to the vicinity of the target site (insertion step);
(4) a step (guide operation step) of causing the distal end of the wire-shaped guide member of the treatment instrument to reach a target site; and (5) a capsule endoscope by moving the tube body along the wire-shaped guide member. The process of guiding to the site (final induction process)
It is characterized by including.

  In the control method of the present invention (the method of the present invention), the steps (1) to (2) are usually performed before treatment (mainly outside the body) in advance, and then the steps (3) to (5) are performed in the body. To implement.

Penetration process In the penetration process, the tube body of the treatment instrument is penetrated into the insertion path of a non-capsule endoscope prepared separately. FIG. 5 shows a schematic diagram of the state in which the capsule endoscope 20 is attached to the tip after the penetration. The tube body 12 of the treatment instrument of the present invention is inserted through the insertion passage 52 of the non-capsule endoscope 51 in order from the tip. The non-capsule endoscope in the present invention means a normal wire type (fiberscope type) endoscope.

Capsule endoscope attachment step In the capsule endoscope attachment step, the outlet of the tube main body and the fixing portion are exposed from the distal end portion of the non-capsule endoscope 51, and the capsule endoscope is attached to the fixing portion. As shown in FIG. 5, the tube body 12 is protruded from the distal end portion (treatment instrument channel) of the non-capsule endoscope so that the lead-out portion 15 and the fixing portion 16 of the tube body 12 are exposed. Then, the capsule endoscope 20 is attached to the fixed portion 16 protruding from the distal end portion of the non-capsule endoscope. Although the attachment method is not limited, for example, a method of binding with a loop wire 17 as shown in FIG. 2 can be suitably employed.

Insertion Step In the insertion step, the distal end portion of the non-capsule endoscope 51 is inserted to the vicinity of the target site. More specifically, as shown in FIG. 6, the distal end is advanced to the vicinity of the target site while being orally inserted into the body sequentially from the distal end. That is, the non-capsule endoscope 51 is inserted while being advanced in the traveling direction from the mouth to the vicinity of the target site of the digestive tract with the capsule endoscope attached to the distal end portion. For example, as shown in FIG. 7, when the target site is a bile duct or a pancreatic duct, it is inserted up to the duodenal papilla. Prior to the insertion step, the non-capsule endoscope may be easily inserted into the body using an overtube or the like in advance. A known or commercially available overtube can be used. If the target site is the bile duct or pancreatic duct, prior to the insertion step, the bile duct opening or the like is expanded beforehand by duodenal papillary sphinctertomy (EST) or endoscopic papillary balloon dilatation (EPBD). Also good.

Guide Operation Process In the guide operation process, the tip of the wire-shaped guide member 13 of the treatment instrument is made to reach the target site. As shown in FIG. 8 (in FIG. 8 and the like, the notation of the loop wire 17 that binds the capsule endoscope is omitted), the wire from the tube body 12 of the treatment instrument of the present invention attached to the non-capsule endoscope 51 is used. The wire-shaped guide member 13 is pushed out, and the tip of the wire-shaped guide member is advanced to the target site (shaded area in FIG. 8). As a non-capsule endoscope, a duodenoscope having a screen and a forceps insertion passage opening on the side of the long axis direction of the endoscope, and having a forceps lifting device capable of adjusting the advancing angle of the treatment instrument to be guided ( If the target site is the bile duct or pancreatic duct, it is bent at an acute angle toward the direction of progression of the gastrointestinal tract. Even if the wire itself cannot reach the target site, the wire-shaped guide member can proceed smoothly. As the above-mentioned side endoscope, a known or commercially available one may be used.

Final Guidance Step In the final guidance step, the capsule endoscope is guided to the target site by moving the tube body 12 along the wire-shaped guide member 13. As shown in FIG. 10, the tube main body 12 advances to the target site along the wire-shaped guide member 13 in the insertion passage of the tube main body. In this case, if an endoscopic forceps (such as a biopsy forceps) is used as one of the wire-shaped guide members, the tissue at the target site can be collected or removed. After the necessary treatment is completed, the wire-like guide may be returned to the original position (stored) and the treatment tool of the present invention may be slowly pulled out from the body.

  The features of the present invention will be described more specifically with reference to examples. However, the scope of the present invention is not limited to the examples.

Example 1
An example of performing observation and biopsy of a bile duct lesion using the treatment tool of the present invention as shown in FIG. Non-capsule endoscopes, commercially available upper gastrointestinal endoscopes (direct endoscopes) or duodenoscopes (side endoscopes) that can be easily inserted into the bile ducts and pancreatic ducts by facing the bile duct or pancreatic duct entrance part A flexible mirror).

  First, pretreatment is performed prior to treatment with the treatment tool of the present invention. Endoscopic papillary sphincterotomy (EST) or endoscopy, which is an existing technique, to insert a non-capsule endoscope into the duodenal papilla, which is the bile duct / pancreatic duct opening, and open the bile duct / pancreatic duct opening Mirror papillary balloon dilatation (EPBD) is performed. By this operation, the capsule endoscope can be easily inserted into the bile duct or pancreatic duct, and the capsule can be easily removed from the bile duct or pancreatic duct even after the examination is completed. Thereafter, the non-capsule endoscope is once removed from the body. At this time, as shown in FIGS. 10 and 11, the non-capsule endoscope 51 is inserted into a commercially available overtube 61, and the overtube 61 is inserted and placed in the throat or esophagus before the endoscope is removed. This makes it easy to reach the duodenal papilla even when the capsule endoscope 20 is attached to the treatment instrument 10 of the present invention that has come out from the tip of the non-capsule endoscope.

  Next, outside the body, the treatment instrument 10 of the present invention is inserted into the treatment instrument insertion path of the non-capsule endoscope 51 from the distal end, and the treatment according to the present invention is performed from the treatment instrument channel (opening) at the distal end of the non-capsule endoscope. The tip region of the tube body 12 of the tool is exposed. Then, as shown in FIG. 6, a commercially available capsule endoscope 20 is tied and fixed using a loop wire 17 provided in a fixing portion in the distal end region. In this case, the lens of the capsule endoscope is directed in the traveling direction of the non-capsule endoscope.

  With the capsule endoscope attached to the distal end region of the tube main body 12 exposed from the distal end of the non-capsule endoscope 51 as described above, the non-capsule endoscope is inserted again into the duodenal papilla. After inserting the non-capsule endoscope up to the duodenal papilla, the wire-shaped guide member is taken out from the lead-out portion of the tube body of the treatment tool of the present invention at the tip of the non-capsule endoscope, and the wire is connected to the target site such as the bile duct and pancreatic duct The guide member is pushed forward. After the tip of the wire-shaped guide member reaches the target site, the tube body 12 of the treatment tool of the present invention is advanced to the target site so as to follow the wire-shaped guide member. In this state, the state of the bile duct, pancreatic duct and the like can be observed directly through the capsule endoscope 20.

  Furthermore, when treatment such as biopsy is necessary, the wire-shaped guide member 13 is removed from the treatment tool of the present invention as necessary, or the biopsy forceps is separately connected to the tube while the wire-shaped guide member 13 is left. By inserting it into the main body, a sniper biopsy can be accurately performed from a target site under direct viewing by a capsule endoscope. Thereafter, after all treatments are completed, the wire-shaped guide member 13 is returned to a predetermined position, and then the treatment instrument 10 of the present invention is gently extracted from the body together with the non-capsule endoscope 51.

Claims (3)

A treatment tool for guiding a capsule endoscope to a target site,
(1) The treatment instrument has a handle, a tube body, and a wire-shaped guide for guiding the tube body to a target site,
(2) The wire-shaped guide is inserted inside the tube body,
(3) The tube body includes: a) an introduction port for introducing the wire-shaped guide member into the tube body; b) a lead-out port for leading the distal end portion of the wire-shaped guide member to the outside from the tube body; and c) a capsule endoscope. Including a fixing part for fixing,
(4) The outlet is provided at the tip of the tube body ,
(5) In the fixing portion, the capsule endoscope is fixed by a loop wire derived from an opening formed in the distal end region of the tube body.
A treatment device for guiding a capsule endoscope. The treatment device for guiding a capsule endoscope according to claim 1 , wherein the capsule endoscope is fixed by attaching an adapter to which the loop wire can be attached to the capsule endoscope and interposing the adapter. The treatment device for guiding a capsule endoscope according to claim 1 or 2 , wherein the tube body has a size and a shape capable of penetrating the insertion passage of the non-capsule endoscope.