JP6955650B2 - Endoscopic treatment aid - Google Patents

Description

The present invention relates to an endoscopic treatment aid.

In recent years, as a technique for excising a lesion such as an early tumor in the gastrointestinal tract, the entire circumference of the lesion is incised endoscopically with a high-frequency knife or the like, and then the submucosa is further peeled off to excise the lesion. Endoscopic submucosal dissection is known. The endoscopic submucosal dissection is advantageous in that the lesion can be resected in a wider area than the endoscopic mucosal resection in which the lesion is resected using a snare.

However, in the endoscopic submucosal dissection, the lesion becomes easier to move as the submucosal dissection progresses, so that a sufficient visual field cannot be obtained, which may lead to accidents such as perforation and bleeding. Therefore, it has been studied to secure the field of view under the endoscope by grasping the lesion portion by using a clip device that is inserted through the forceps channel of the endoscope and attached. As the clip device, for example, a device including an insertion portion inserted into a body cavity via a forceps channel of an endoscope and a clip detachably attached to the tip of the insertion portion are known (for example,). , Patent Document 1).

Japanese Unexamined Patent Publication No. 2008-36003

However, the clip described in Patent Document 1 is used for hemostasis and the like by being separated from the insertion portion and placed in the lesion portion after grasping the lesion portion, and the clip is used for endoscopy. It is desired to develop an endoscopic treatment aid that secures the field of view under the mirror.

In view of the above circumstances, it is an object of the present invention to provide an endoscopic treatment assisting tool capable of securing a field of view under an endoscope when performing endoscopic submucosal dissection.

In order to achieve such an object, the endoscopic treatment assisting tool of the present invention is an endoscopic treatment assisting tool attached to an endoscopic clip device that is separated from the endoscope after grasping the lesion. An outer cylinder sheath made of a rigid tube, an inner cylinder sheath inserted through the outer cylinder sheath, a linear member disposed in the inner cylinder sheath and having a tip protruding from the inner cylinder sheath, and the like. The inner cylinder sheath is provided with an operating means for allowing the inner cylinder sheath to move forward and backward relative to the outer cylinder sheath, and the linear member is provided with an annular portion at a tip portion protruding from the inner cylinder sheath.

In the endoscopic treatment assisting tool of the present invention, the endoscope clip device is inserted into an annular portion provided at the tip of the linear member, and the operating means is operated to adjust the size of the annular portion. By squeezing (narrowing), it is attached to the endoscope clip device. The endoscope clip device is separated from the endoscope after grasping the lesion.

Since the endoscopic treatment assisting tool of the present invention is attached to the endoscope clip device by the annular portion, when the endoscope clip device is separated from the endoscope, the operation means. Therefore, the inner cylinder sheath and the linear member can be pulled toward the base end side. Alternatively, the outer cylinder sheath may be relatively advanced with respect to the inner cylinder sheath by the operating means to come into contact with the endoscope clip device and push the endoscope clip device toward the tip side. can.

As a result, according to the endoscopic treatment assisting tool of the present invention, the field of view under the endoscope can be secured, while the lesion can be fixed.

Further, in the endoscopic treatment assisting tool of the present invention, the linear member has a first annular portion provided on the proximal end side and a second annular portion provided on the distal end side and having a diameter smaller than that of the first annular portion. It is preferable that the second annular portion communicates with the tip end side of the first annular portion on the proximal end side.

In the endoscopic treatment assisting tool of the present invention, since the linear member includes the first annular portion and the second annular portion, first, the clip device for an endoscope has a larger diameter. It is inserted through the first annular portion, and then the inner cylinder sheath and the linear member are pulled toward the base end side by the operating means. As a result, the endoscope clip device can be guided from the first annular portion to the second annular portion having a smaller diameter, and the endoscopic treatment aid of the present invention can be easily clipped for the endoscope. It can be attached to the device.

Explanatory sectional view which cuts out and shows a part of the structure of the endoscopic treatment assisting tool of this invention. A is a plan view showing a first aspect of the linear member shown in FIG. 1, B is a plan view showing a second aspect of the linear member shown in FIG. 1, and C is a second aspect of the linear member shown in FIG. The plan view which shows the aspect of. A is a perspective view showing a state in which the clip device for an endoscope is inserted through the annular portion of the linear member of the first aspect shown in FIG. 2A and the operation of the clip device for the endoscope, and B is an internal view of the annular portion. The perspective view which shows the state attached to the clip device for a mirror. A is a perspective view showing a state in which the endoscope clip device is inserted into the first annular portion of the linear member of the second aspect shown in FIG. 2B, and B is a state in which the endoscope clip device is inserted in the second embodiment. A perspective view showing a state in which the linear member has been moved to the second annular portion, and C is a perspective view showing a state in which the second annular portion is attached to the clip device for an endoscope. A is an explanatory cross-sectional view showing a state in which the endoscope with the endoscope treatment aid of the present invention attached to the clip is brought close to the lesion, and B is the clip holding the lesion separated from the endoscope. Explanatory cross-sectional view showing the state, C is the explanatory cross-sectional view showing the state of pulling the lesion with the clip attached to the endoscopic treatment aid of the present invention, D is the endoscopic treatment aid of the present invention. Explanatory cross-sectional view showing a state in which the lesion is pushed by the attached clip.

Next, embodiments of the present invention will be described in more detail with reference to the accompanying drawings.

As shown in FIG. 1, the endoscopic treatment assisting tool 1 of the present embodiment has a hollow cylindrical grip portion 2, an outer cylinder sheath 3 connected to the tip side of the grip portion 2, and an outer cylinder sheath 3. It includes an inserted inner cylinder sheath 4, a linear member 5 arranged in the inner cylinder sheath 4, and an operating portion 6 slidable along the inner surface of the grip portion 2.

The grip portion 2 is formed of, for example, an acrylonitrile-butadiene-styrene copolymer resin (ABS resin) or the like, and the outer cylinder sheath 3 is formed of a tube made of a rigid material such as polyethylene resin.

The inner cylinder sheath 4 is formed of a material having excellent slidability with respect to the outer cylinder sheath 3 such as tetrafluoroethylene resin, and is integrally provided with a linear member 5 made of a polyamide resin or the like inside. The base end side of the inner cylinder sheath 4 and the linear member 5 is connected to the tip end side of the operation portion 6 which is an operation means in the grip portion 2. Further, the linear member 5 is provided with an annular portion 7 at a tip portion protruding from the inner cylinder sheath 4.

The operation unit 6 is connected to a sliding portion 6a made of, for example, ABS resin or the like, which is made of a columnar body and whose tip end side is arranged in the grip portion 2, and to the base end side of the sliding portion 6a outside the grip portion 2. It is provided with a lever portion 6b that forms a T-shape as a whole. The sliding portion 6a is provided with an O-ring 6c made of silicone rubber between the sliding portion 6a and the inner peripheral surface of the grip portion 2.

The linear member 5 may include a single circular annular portion 7 as shown in FIG. 2A, and as shown in FIG. 2B, the linear member 5 may have a circular first annular portion provided on the proximal end side. A second annular portion 7b having a circular shape and a diameter smaller than that of the first annular portion 7a provided on the tip end side is provided, and the second annular portion 7b is on the proximal end side and the tip of the first annular portion 7a. It may be connected to the side.

Further, as shown in FIG. 2C, the tip of the linear member 5 may be tied rearward, and the end of the knot 5a may be an annular portion 7. In this case, the knot 5a may be knotted in any way as long as it is slidable along the length direction of the linear member 5.

Next, a method of using the endoscopic treatment assisting tool 1 of the present embodiment will be described.

As shown in FIGS. 3 and 4, when using the endoscopic treatment assisting tool 1, the annular portion 7 is first attached to the clip device 11. The clip device 11 is connected to the tip of an insertion portion (not shown) inserted into the forceps channel (not shown) of the endoscope, and is provided on the outer tube 12 and the tip of the outer tube 12. It has a main body 13.

The clip main body 13 includes, for example, a pair of arm portions 14a and 14b which are made of leaf springs and are urged in a direction in which they are separated from each other, and grip portions 15a and 15b provided at the tip portions of the arm portions 14a and 14b. I have. The arm portions 14a and 14b are connected at the base end side, and by moving the outer tube 12 toward the tip end side as shown by a virtual line in FIG. 3A, the arm portions 14a and 14b are moved in a direction close to each other. , The lesion or the like is gripped between the gripping portions 15a and 15b.

When the annular portion 7 having a single circular shape shown in FIG. 2A is attached to the clip device 11, first, as shown in FIG. 3A, one of the arm portions 14a and 14b, for example, the arm portion 14a is attached to the annular portion 7. Insert into. Next, by pulling the lever portion 6b, as shown in FIG. 3B, the outer cylinder sheath 3 is relatively advanced with respect to the inner cylinder sheath 4 and the linear member 5 to be brought into contact with the arm portion 14a, while being brought into contact with the outer cylinder portion 14a. By storing the inner cylinder sheath 4 and the annular portion 7 in the accommodating portion with the tip end portion of the tubular sheath 3 as the accommodating portion, the annular portion 7 is narrowed and fixed to the arm portion 14a for mounting.

When the annular portion 7 is composed of the first annular portion 7a and the second annular portion 7b shown in FIG. 2B, first, as shown in FIG. 4A, one of the arm portions 14a and 14b, for example, the arm portion 14a is inserted through the first annular portion 7a. Next, as shown in FIG. 4B, the arm portion 14a is moved from the first annular portion 7a to the second annular portion 7b by moving the entire endoscopic treatment assisting tool 1 toward the proximal end side. Then, by pulling the lever portion 6b, as shown in FIG. 4C, the outer cylinder sheath 3 is relatively advanced with respect to the inner cylinder sheath 4 and the linear member 5 to be brought into contact with the arm portion 14a, while being brought into contact with the outer cylinder portion 14a. By storing the inner cylinder sheath 4, the first annular portion 7a and the second annular portion 7b in the accommodating portion with the tip end portion of the tubular sheath 3 as the accommodating portion, the first annular portion 7a and the second annular portion 7a and the second annular portion are accommodated. 7b is narrowed and fixed to the arm portion 14a for mounting.

When the annular portion 7 is composed of the first annular portion 7a and the second annular portion 7b shown in FIG. 2B, the arm portion 14a is first inserted into the large diameter first annular portion 7a as described above. Then, the arm portion 14a may be moved to the second annular portion 7b having a small diameter. Therefore, the operation of attaching the annular portion 7 to the clip device 11 can be easily performed, and the stress of the operator due to the operation can be reduced.

Further, as shown in FIG. 2C, when the tip end portion of the linear member 5 is tied rearward to form a knot 5a and the annular portion 7 is formed on the tip end side from the knot 5a, the arm portions 14a and 14b On the other hand, for example, by inserting the arm portion 14a into the annular portion 7 and pulling the lever portion 6b, the sheath 4 and the linear member 5 are retracted (not shown). At this time, since the knot 5a is slidable along the length direction of the linear member 5, when the sheath 4 and the linear member 5 are retracted, the annular portion 7 remains hung on the arm portion 14a. The size is reduced, and the arm portion 14a is finally fixed and attached.

In the endoscopic treatment assisting tool 1 of the present embodiment, the operation of attaching the annular portion 7 to the clip device 11 can be performed outside the body before inserting the endoscope into the body cavity, but the grasping forceps of the endoscope The annular portion 7 can be attached to the clip device 11 after grasping the endoscopic treatment assisting tool 1 and inserting it into the body cavity and endoscopically guiding it to the vicinity of the affected portion.

Further, when the operation of attaching the annular portion 7 to the clip device 11 is performed outside the body before inserting the endoscope into the body cavity, the line including the clip device 11 and the annular portion 7 attached to the clip device 11 It is preferable that the shape member 5 is inserted into the body cavity while being housed in the endoscopic hood and guided to the vicinity of the affected area. By doing so, it is possible to prevent the clip device 11 from inadvertently damaging the tissue or the like in the body cavity.

Next, as shown in FIG. 5A, the endoscopic treatment aid 1 having the annular portion 7 attached to the clip device 11 is inserted together with the endoscope E into the digestive tract such as the esophagus, and the lesion portion L is inserted. Guide to the vicinity. The gastrointestinal tract is generally composed of three layers, a mucosa, a submucosa, and a muscular layer, in this order from the body cavity side, and the lesion L is in the mucosa.

When excising the lesion L, the lesion L is first raised in a polyp shape by marking the periphery of the lesion L and then performing local injection to the submucosa. Then, the mucous membrane around the lesion L is incised along the marking with a high-frequency knife K or the like provided in the forceps channel of the endoscope E. FIG. 5A shows a state in which the mucous membrane around the lesion L is incised.

Next, the submucosa below the lesion L is incised with a high-frequency knife K to detach the lesion L from the submucosa, but the mobility of the lesion L increases as the detachment progresses, and the endoscope E The field of view underneath is narrowed, and the view of the part to be peeled off is obstructed. Therefore, by moving the clip device 11 closer to the lesion portion L and then moving the outer tube 12 toward the tip side, as shown in FIG. 5B, the lesion portion is located between the grip portions 15a and 15b of the arm portions 14a and 14b. Let L be gripped. After the clip device 11 grips the lesion L, the clip device 11 is then separated from the endoscope E. To separate the clip device 11 from the endoscope E, for example, a fragile portion is provided between the base end portion of the clip device 11 and the insertion portion, and the insertion portion is pulled toward the proximal end side to pull the fragile portion. It can be done by breaking.

The clip device 11 separated from the endoscope E can be operated by the endoscopic treatment assisting tool 1 by the annular portion 7 attached to the arm portion 14a. Therefore, as shown in FIG. 5C, the field of view of the endoscope E can be secured by operating the endoscope treatment assisting tool 1 and pulling the lesion portion L in a direction away from the endoscope E. On the other hand, since the lesion L can be fixed, the submucosal layer can be easily incised with the high-frequency knife K.

Further, in the endoscopic treatment assisting tool 1, since the outer cylinder sheath 3 having rigidity is in contact with the arm portion 14a of the clip device 11, as shown in FIG. 5D, each outer cylinder sheath 3 is required. It is also possible to move the lesion L from the tip of the endoscope E to the back side of the body cavity by moving it to the tip side and pushing the clip device 11 toward the tip side.

After that, when the incision of the submucosal layer below the lesion L is completed and the lesion L is detached, the detached lesion L is taken out of the body by operating the endoscopic treatment aid 1. It can be recovered.

In the present embodiment, the annular portion 7 is narrowed when the endoscopic treatment aid 1 having the annular portion 7 attached to the clip device 11 is inserted into the digestive tract such as the esophagus together with the endoscope E. However, in this way, the inner cylinder sheath 4 may interfere with the tip end portion of the endoscope E. Therefore, without constricting the annular portion 7, the endoscopic treatment aid 1 is inserted into the gastrointestinal tract such as the esophagus together with the endoscope E, guided to the vicinity of the lesion portion L, and then the annular portion 7 is constricted. You may do so.

Further, after the clip device 11 is separated from the endoscope E as shown in FIG. 5B, the endoscope treatment assisting tool 1 is grasped by the grasping forceps of the endoscope and inserted into the body cavity as described above. When the annular portion 7 is attached to the clip device 11 after being endoscopically guided to the vicinity of the affected portion, the clip device 11 is separated from the endoscope E instead of attaching the annular portion 7 to the arm portion 14a. It may be attached to the base end portion of the. The operation of attaching the annular portion 7 to the base end portion of the clip device 11 can be performed in the same manner as when the annular portion 7 is attached to the arm portion 14a.

1 ... Endoscopic treatment aid, 3 ... Outer cylinder sheath, 4 ... Inner cylinder sheath, 5 ... Linear member, 6 ... Operating means, 7 ... Ring part, 11 ... Clip device.

Claims (2)

Flexible that with an endoscope is guided through to the vicinity of the lesion in the gastrointestinal tract, the endoscope is attached to the endoscopic clipping device which is separated from the endoscope after grasping the lesion It ’s a mirror treatment aid,
An inner cylinder sheath made of tetrafluoroethylene resin and
A tube formed of polyethylene resin and more rigid than the inner cylinder sheath through which the inner cylinder sheath is inserted, and an outer cylinder sheath through which the inner cylinder sheath is inserted.
A linear member disposed in the inner cylinder sheath, formed of a polyamide resin, and having an annular portion at a tip protruding from the inner cylinder sheath.
The inner cylinder sheath and the base end side of the linear member are connected to each other, and the inner cylinder sheath and the linear member are provided with an operating means for allowing the inner cylinder sheath and the linear member to move forward and backward relative to the outer cylinder sheath.
The tip of the outer cylinder sheath has a storage portion for accommodating the inner cylinder sheath and the annular portion in its internal space, and the endoscope clip device is inserted into the annular portion to be inserted into the inner space by the operating means. It is characterized by having a tip surface to which the endoscope clip device can be fixedly attached by narrowing the annular portion by relatively retracting the tubular sheath and bringing it into contact with the endoscope clip device. Endoscopic treatment aid. In the endoscopic treatment assisting tool according to claim 1, the linear member has a first annular portion provided on the proximal end side and a second annular portion provided on the distal end side and having a diameter smaller than that of the first annular portion. An endoscopic treatment assisting tool comprising the above, wherein the second annular portion communicates with the distal end side of the first annular portion on the proximal end side.

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