US20200289804A1 - Flora treatment - Google Patents

Flora treatment Download PDF

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Publication number
US20200289804A1
US20200289804A1 US16/790,831 US202016790831A US2020289804A1 US 20200289804 A1 US20200289804 A1 US 20200289804A1 US 202016790831 A US202016790831 A US 202016790831A US 2020289804 A1 US2020289804 A1 US 2020289804A1
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appendico
probiotics
mucus
endoscope
bacteria
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US16/790,831
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English (en)
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Yumiko AWAU
Takeo Suzuki
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Olympus Corp
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Olympus Corp
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Publication of US20200289804A1 publication Critical patent/US20200289804A1/en
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    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61H—PHYSICAL THERAPY APPARATUS, e.g. DEVICES FOR LOCATING OR STIMULATING REFLEX POINTS IN THE BODY; ARTIFICIAL RESPIRATION; MASSAGE; BATHING DEVICES FOR SPECIAL THERAPEUTIC OR HYGIENIC PURPOSES OR SPECIFIC PARTS OF THE BODY
    • A61H1/00—Apparatus for passive exercising; Vibrating apparatus; Chiropractic devices, e.g. body impacting devices, external devices for briefly extending or aligning unbroken bones
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
    • A61M31/00—Devices for introducing or retaining media, e.g. remedies, in cavities of the body
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B1/00—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor
    • A61B1/012—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor characterised by internal passages or accessories therefor
    • A61B1/015—Control of fluid supply or evacuation
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B1/00—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor
    • A61B1/012—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor characterised by internal passages or accessories therefor
    • A61B1/018—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor characterised by internal passages or accessories therefor for receiving instruments
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B1/00—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor
    • A61B1/31—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor for the rectum, e.g. proctoscopes, sigmoidoscopes, colonoscopes
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61H—PHYSICAL THERAPY APPARATUS, e.g. DEVICES FOR LOCATING OR STIMULATING REFLEX POINTS IN THE BODY; ARTIFICIAL RESPIRATION; MASSAGE; BATHING DEVICES FOR SPECIAL THERAPEUTIC OR HYGIENIC PURPOSES OR SPECIFIC PARTS OF THE BODY
    • A61H21/00—Massage devices for cavities of the body, e.g. nose, ears and anus ; Vibration or percussion related aspects A61H23/00
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K35/00—Medicinal preparations containing materials or reaction products thereof with undetermined constitution
    • A61K35/66—Microorganisms or materials therefrom
    • A61K35/74—Bacteria
    • A61K35/741—Probiotics
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B1/00—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor
    • A61B1/00064—Constructional details of the endoscope body
    • A61B1/00071—Insertion part of the endoscope body
    • A61B1/0008—Insertion part of the endoscope body characterised by distal tip features
    • A61B1/00082—Balloons
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B1/00—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor
    • A61B1/00064—Constructional details of the endoscope body
    • A61B1/00071—Insertion part of the endoscope body
    • A61B1/0008—Insertion part of the endoscope body characterised by distal tip features
    • A61B1/00091—Nozzles
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B1/00—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor
    • A61B1/00064—Constructional details of the endoscope body
    • A61B1/00071—Insertion part of the endoscope body
    • A61B1/0008—Insertion part of the endoscope body characterised by distal tip features
    • A61B1/00094—Suction openings
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B1/00—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor
    • A61B1/00064—Constructional details of the endoscope body
    • A61B1/00071—Insertion part of the endoscope body
    • A61B1/0008—Insertion part of the endoscope body characterised by distal tip features
    • A61B1/00096—Optical elements
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61H—PHYSICAL THERAPY APPARATUS, e.g. DEVICES FOR LOCATING OR STIMULATING REFLEX POINTS IN THE BODY; ARTIFICIAL RESPIRATION; MASSAGE; BATHING DEVICES FOR SPECIAL THERAPEUTIC OR HYGIENIC PURPOSES OR SPECIFIC PARTS OF THE BODY
    • A61H2201/00—Characteristics of apparatus not provided for in the preceding codes
    • A61H2201/10—Characteristics of apparatus not provided for in the preceding codes with further special therapeutic means, e.g. electrotherapy, magneto therapy or radiation therapy, chromo therapy, infrared or ultraviolet therapy
    • A61H2201/105—Characteristics of apparatus not provided for in the preceding codes with further special therapeutic means, e.g. electrotherapy, magneto therapy or radiation therapy, chromo therapy, infrared or ultraviolet therapy with means for delivering media, e.g. drugs or cosmetics
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K35/00—Medicinal preparations containing materials or reaction products thereof with undetermined constitution
    • A61K2035/11—Medicinal preparations comprising living procariotic cells
    • A61K2035/115—Probiotics
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
    • A61M2210/00—Anatomical parts of the body
    • A61M2210/10—Trunk
    • A61M2210/1042—Alimentary tract
    • A61M2210/1064—Large intestine

Definitions

  • the present invention relates to a flora treatment of improving an intestinal environment by oral ingestion of probiotics.
  • a method of improving an intestinal environment by oral ingestion of probiotics has been known. Such a method is disclosed in US2018/0000875, for example.
  • a flora treatment includes: a step (A) in which an instrument is introduced into a lumen; a step (B) in which the instrument is made to reach an intestinal cecum; a step (C) in which an appendico is recognized; and a step (D) in which probiotics is supplied to the appendico.
  • FIG. 1 is a diagram of a flow for supplying probiotics to an appendico, which includes all embodiments and modified examples in a flora treatment according to the present invention.
  • FIG. 2 illustrates the step (A) in FIG. 1 .
  • FIG. 3 illustrates the step (B) in FIG. 1 .
  • FIG. 4 illustrates the step (C) in FIG. 1 .
  • FIG. 5 illustrates the step (D) in FIG. 1 .
  • FIG. 6 illustrates the step (Q) in FIG. 1 .
  • FIG. 7 is a partial perspective view illustrating, together with an endoscope, a spoon-shaped mucus removal tool for removing an appendico mucus.
  • FIG. 8 is a partial perspective view illustrating, together with the endoscope, a stick-shaped mucus removal tool for removing the appendico mucus.
  • FIG. 9 is a partial perspective view illustrating, together with the endoscope, a spatula-shaped mucus removal tool for removing the appendico mucus.
  • FIG. 10 is a partial perspective view illustrating, together with the endoscope, a brush-shaped mucus removal tool for removing the appendico mucus.
  • FIG. 11 is a partial perspective view illustrating, together with the endoscope, a mucus removal fluffy tool for removing the appendico mucus.
  • FIG. 12 illustrates a state where a thin-diameter endoscope inserted into the endoscope channel in FIG. 2 is inserted in the appendico.
  • FIG. 13 illustrates a state where the mucus removal fluffy tool is inserted from the endoscope channel into the appendico.
  • FIG. 14 illustrates a state where the probiotics is jetted (applied) to the appendico, with a position of the endoscope fixed by inflating the balloon in FIG. 6 .
  • FIG. 15 illustrates the step (J) in FIG. 1 .
  • FIG. 16 illustrates a configuration of the step (J) in FIG. 1 , which is different from the configuration of the step (J) in FIG. 15 .
  • FIG. 17 illustrates an example in which the probiotics is supplied to the appendico through a catheter inserted into the endoscope channel in FIG. 2 .
  • FIG. 18 illustrates a funnel-shaped indwelling body.
  • FIG. 19 illustrates a tuft-like indwelling body.
  • FIG. 20 illustrates a thread-like indwelling body.
  • FIG. 21 illustrates a fluff impregnated with the probiotics and a bar holding the fluff, as an example of a treatment instrument to be used in the step (L) in FIG. 1 .
  • FIG. 22 illustrates a state where an incision is made on a part of the intestinal cecum.
  • FIG. 23 illustrates forming of the appendico by suturing the incision in FIG. 22 .
  • probiotics indicates at least one kind of microorganism that provides a beneficial effect to a living body.
  • the beneficial effect here includes, for example, improvement of an intestinal bacterial flora, an effect to an intestinal immune, and the like.
  • bacteria as a simple substance, are called as bad bacteria or opportunistic bacteria, the bacteria that provide a beneficial effect is included in the probiotics.
  • the probiotics is not specifically limited, but includes the bacteria that belong to Bacteroidetes phylum, Firmicutes phylum, Actinobacteria phylum, Proteobacteria phylum, and the like.
  • the bacteria When using the above-described bacteria, the bacteria may be used as a simple substance as described above, or a plurality of kinds of bacteria may be used.
  • the kinds, amounts, and ratio of the bacteria can be appropriately selected depending on purposes for production, storage, and treatment.
  • a colonization ratio of main purpose bacteria to a subject can be increased by adding symbiotic bacteria capable of producing mucus decomposing enzyme to the main purpose bacteria, for example.
  • Bacteria that produce the mucus decomposing enzyme include, for example, B. bifidum, C. perfringens, B. longum subsp. Longum, and B. breve, etc.
  • FIG. 1 is a diagram of a flow for supplying probiotics to the appendico, which includes all embodiments and modified examples in a flora treatment according to the present invention
  • FIG. 2 illustrates the step (A) in FIG. 1
  • FIG. 3 illustrates the step (B) in FIG. 1
  • FIG. 4 illustrates the step (C) in FIG. 1
  • FIG. 5 illustrates the step (D) in FIG. 1 .
  • probiotics 100 As illustrated in FIG. 1 , when probiotics 100 (see FIG. 5 ) is supplied to an appendico 19 , the procedure is performed as follows: the steps (A) ⁇ (B) ⁇ (C) ⁇ (D) ⁇ (M) in the present embodiment.
  • an endoscope 1 as an instrument, is introduced into a lumen, as illustrated in FIG. 2 .
  • a large intestine 10 to which the endoscope 1 reaches through the lumen is generally composed of, in the following order from the anus 11 : the lower rectum 12 ; the upper rectum 13 ; the sigmoid colon 14 , the descending colon 15 , the transverse colon 16 ; the ascending colon 17 ; the intestinal cecum 18 , the appendico 19 , and the ileum 20 .
  • the route for introducing the endoscope 1 into a body may be oral or transanal (through anus 11 ) as illustrated in FIGS. 2 to 5 .
  • the endoscope 1 may be a flexible endoscope or a capsule endoscope in the present invention.
  • the flexible endoscope may be an endoscope for the upper digestive tract or an endoscope for the lower digestive tract.
  • the diameter of the flexible endoscope may be appropriately selected depending on a subject.
  • the endoscope 1 may be used individually, a sheath and an endoscope 1 insertable into a channel of the sheath may be used in combination, or a mother endoscope and a baby endoscope configured to be insertable into a channel of the mother endoscope may be used in combination.
  • endoscope 1 and a treatment instrument configured to be insertable into a channel 2 of the endoscope 1 may be used in combination, or the endoscope 1 and a treatment instrument configured to be fittable to the distal end of the endoscope 1 may be used in combination.
  • a guiding apparatus configured to control the movement and indwelling of the capsule endoscope from outside the body may be used with the capsule endoscope.
  • the endoscope 1 is made to reach the intestinal cecum 18 , as illustrated in FIG. 3 .
  • a gas may be introduced into the lumen, to expand the lumen.
  • the probiotics 100 when anaerobic bacteria are used as the probiotics 100 , it is preferable to use a non-oxygen gas, as the gas, to purge the atmosphere with the non-oxygen gas at the latest immediately before the supply of the probiotics 100 to the appendico 19 .
  • the non-oxygen gas includes a carbon dioxide gas, a nitrogen gas, or a noble gas.
  • an oxygen-containing gas or the non-oxygen gas may be used.
  • the oxygen-containing gas has such an advantage that the number of indigenous bacteria in the large intestine 10 can be reduced.
  • the oxygen-containing gas includes air.
  • Using the non-oxygen gas has such an advantage that there is no need for switching the kinds of gases.
  • an orifice 19 i of the appendico 19 (hereinafter, referred to as the appendico orifice 19 i ) is recognized, as illustrated in FIG. 4 .
  • the position of the appendico orifice 19 i is confirmed by using the field of view of the observation portion 3 of the endoscope 1 .
  • the probiotics 100 is supplied to the appendico 19 , as illustrated in FIG. 5 .
  • the probiotics 100 is jetted to the appendico orifice 19 i. Note that the probiotics 100 is supplied into a mucus 64 of the appendico 19 (see FIG. 15 ).
  • FIG. 5 illustrates the step (S): jetting of the probiotics 100 toward the appendico orifice 19 i as a specific example of the step (D): supply of the probiotics 100 to the appendico 19 .
  • the jetting of the probiotics 100 may be performed with an air/water feeding conduit of the endoscope 1 , with the endoscope channel 2 , or with a channel of a sheath, when the sheath is used in combination with the endoscope 1 .
  • the step (R) in FIG. 1 leading out from the channel, which will be described later, may be performed to jet the probiotics 100 from the treatment instrument or tube inserted in the endoscope channel 2 .
  • the strength of the jetting may be appropriately selected depending on the closing state of the appendico orifice 19 i.
  • the probiotics 100 to be jetted is preferably a powder or a fluid.
  • the powder includes the freeze-dried probiotics 100 .
  • the fluid includes the culture solution of the probiotics 100 , a liquid in which the probiotics 100 is mixed, or liposome having at least a single layer containing the probiotics 100 .
  • the viscosity of the fluid can be appropriately set.
  • the liquid includes degassed water, carbonic water, mucin, collagen, or hyaluronic acid.
  • the powder or the fluid may contain components for growing the probiotics 100 .
  • the components include bacteria, iron, dietary fiber, or oligosaccharide.
  • the bacteria as the components for growing the probiotics 100 may be live bacteria or dead bacteria.
  • the endoscope 1 is extracted from the inside of the body.
  • the endoscope 1 is extracted from the inside of the body by being pulled out.
  • the capsule endoscope When the capsule endoscope is used, the capsule endoscope may be excreted by spontaneous passage, or may be guided to the colon, the rectum, or the anus by using the guiding apparatus located outside the body.
  • the probiotics 100 is surely supplied to the mucus 64 of the appendico 19 , which improves the colonization of the probiotics 100 in the mucus 64 .
  • step (G) may be further performed.
  • FIG. 6 illustrates the step (Q) in FIG. 1 .
  • the endoscope 1 may be positioned in the step (Q) as illustrated in FIG. 6 .
  • the positioning is performed by inflating a balloon 8 provided to a sliding tube 7 , to thereby enable the distance between the endoscope 1 and the appendico 19 to be stabilized.
  • Another method for the positioning includes a method of discharging the gas in the lumen to bring the inside of the lumen into a negative pressure state, to thereby cause the endoscope 1 to stick to the intestinal tract.
  • the gas in the intestine is discharged, the gas can be discharged by using the air/water feeding conduit of the endoscope 1 , for example.
  • the cleaning of the inside of the appendico 19 is performed by supplying a fluid to the inside of the appendico 19 .
  • a fluid When gas is used as the fluid, if the bacteria inside the appendico, which are desired to be removed, are anaerobic, it is preferable to supply oxygen-containing gas.
  • oxygen-containing gas When a liquid is used as the fluid, it is preferable to use normal saline or mucin.
  • the fluid may be supplied through the air/water feeding conduit of the endoscope 1 or the endoscope channel 2 .
  • the fluid may be supplied from the channel of the sheath.
  • the fluid may be supplied from the treatment instrument or the tube inserted into the endoscope channel 2 , or from a catheter inserted independently from the endoscope 1 .
  • the removal of the mucus 64 in the step (F) may be performed on the entirety or only a part of the appendico 19 .
  • both an outer mucus layer 61 and an inner mucus layer 62 (for both, see FIG. 15 ) of the appendico mucus 64 may be removed, but more preferably, the outer mucus layer 61 is removed with the inner mucus layer 62 remained.
  • FIG. 7 is a partial perspective view illustrating, together with the endoscope, a spoon-shaped mucus removal tool for removing the appendico mucus.
  • FIG. 8 is a partial perspective view illustrating, together with the endoscope, a stick-shaped mucus removal tool for removing the appendico mucus.
  • FIG. 9 is a partial perspective view illustrating, together with the endoscope, a spatula-shaped mucus removal tool for removing the appendico mucus.
  • FIG. 10 is a partial perspective view illustrating, together with the endoscope, a brush-shaped mucus removal tool for removing the appendico mucus.
  • FIG. 11 is a partial perspective view illustrating, together with the endoscope, a mucus removal fluffy tool for removing the appendico mucus.
  • the removal of the appendico mucus 64 may be performed with a mucolytic agent, a normal saline containing an abrasive, an abrasive, laser, or water pressure.
  • mucus removal tools 31 to 35 such as a spoon, a stick, a spatula, a brush, or a fluffy member, as illustrated in FIGS. 7 to 11 may be used.
  • a sharp curette, a brush, a spatula, or a fluffy member, each of which includes an abrasive disposed on the surface thereof can be used.
  • a brush, a spatula, or a fluff, each of which impregnates a mucolytic agent can be used.
  • each of the sharp curette, the brush, the spatula, and the fluffy member is preferably made of a member which is more flexible than the inner mucus layer 62 and harder than the outer mucus layer 61 .
  • the thickness of the roughness is preferably equal to or smaller than 1 mm, or more preferably equal to or less than 0.7 mm.
  • the length of the bristles of the brush as illustrated in FIG. 10 is smaller than the thickness of the outer mucus layer 61 .
  • the length of the bristles is preferably equal to or less than 1 mm, or more preferably equal to or less than 0.7 mm.
  • step (F): removal of the appendico mucus 64 may be performed in combination with the step (E): cleaning of the inside of the appendico 19 .
  • the order of the steps in this case is not specifically limited, but can be appropriately selected depending on the state of the appendico 19 of a patient.
  • at least one of the steps may be performed plurality of times.
  • the steps may be performed as follows: the step (E) ⁇ the step (F) ⁇ the step (E), for example.
  • FIG. 12 illustrates a state where a thin-diameter endoscope inserted into the endoscope channel in FIG. 2 is inserted into the appendico.
  • step (F) cleaning of the inside of the appendico 19 in the step (F) or the removal of the appendico mucus 64 in the step (F) may be performed. Furthermore, before inserting the thin-diameter endoscope 40 into the appendico 19 in the step (R), the positioning of the endoscope 1 in the step (Q) may be performed.
  • the appendico 19 differs in the shape, the thickness, and the length depending on a living body. Therefore, only the observation of the appendico orifice 19 i with the observation portion 3 is not sufficient for accurately recognizing the shape and the depth of the appendico 19 .
  • Using the thin-diameter endoscope 40 makes it easier to perform the cleaning of the inside of the appendico 19 in the step (E) and the removal of the appendico mucus 64 in the step (F).
  • FIG. 6 , and FIGS. 12 to 14 exemplify the flow of the step (Q) ⁇ the step (R) ⁇ the step (O) ⁇ the step (F) ⁇ the step (D)/(S).
  • FIG. 13 illustrates a state where the mucus removal fluffy tool is inserted from the endoscope channel into the appendico
  • FIG. 14 illustrates a state where the probiotics is jetted (applied) to the appendico, with the position of the endoscope fixed by inflating the balloon in FIG. 6 .
  • dyeing of the appendico mucus 64 in step G may be performed before the removal of the appendico mucus 64 in the step (F) illustrated in FIG. 13 .
  • Dyeing of the mucus 64 makes it easier to confirm the thickness of the mucus 64 and the removed amount of the mucus 64 .
  • the mucus dyeing agent is not specifically limited, but includes Alcian blue, for example.
  • dyeing may be performed with the mucus dyeing agent carried by the mucus removal tool, or the mucus dyeing agent may be sprayed using the channel of the mucus removal tool, the endoscope channel 2 , and the channel of the sheath.
  • step (P) may be performed. Or, at least one of the steps (Q), (R), (E), or (F) shown in the first modified example of the first embodiment may be performed.
  • step (f) the probiotics 100 in the protective form, which have been orally ingested in advance and reached inside the lumen, are captured with the endoscope 1 , the sheath of the endoscope, or the treatment instrument in the step (R).
  • the probiotics 100 is discharged from the protective form of the probiotics, when the appendico orifice 19 i is recognized in the step (C), or the endo scope 1 or the like contacts the appendico 19 in the step (O).
  • the method of capturing can be appropriately selected depending on the tool to be used and the protective form.
  • the method includes a suction by bringing the channel into the negative pressure state, or capturing with a grasping forceps, for example.
  • the method of discharging can be appropriately selected depending on the protective form.
  • the protective form is a capsule and the probiotics is contained in the capsule, the method of discharging the probiotics includes opening of the capsule or dissolution of the capsule.
  • the method of discharging the probiotics includes dissolution or cutting of the coating, or crushing of the tablet.
  • the method of discharging the probiotics includes dissolution, cutting, puncturing, or pressing of the bag.
  • the procedure is performed as follows: steps (A) ⁇ (B) ⁇ (C) ⁇ (O) ⁇ (D)/(J) ⁇ (M) in the present embodiment.
  • the distal end of the endoscope 1 is brought into contact with the appendico orifice 19 i or the distal end of the endoscope 1 is inserted into the lumen of the appendico 19 .
  • the distal end of the treatment instrument is brought into contact with the appendico orifice 19 i, the distal end of the treatment instrument is inserted into the lumen of the appendico 19 , or the distal end of the treatment instrument is separated and inserted into the lumen of the appendico 19 .
  • the surface of the capsule endoscope is brought into contact with the appendico orifice 19 i, a part of the capsule endoscope is inserted into the lumen of the appendico 19 , or the entirety of the capsule endoscope is inserted into the lumen of the appendico 19 .
  • the capsule endoscope When the capsule endoscope is used, the capsule endoscope may be indwelled inside the body to enable the probiotics to be supplied periodically from the capsule endoscope for a predetermined period.
  • FIG. 15 illustrates the step (J) in FIG. 1
  • FIG. 16 illustrates a configuration of the step (J) in FIG. 1 , which is different from the configuration illustrated in FIG. 15 .
  • the probiotics 100 When the probiotics 100 is introduced into the mucus 64 on a cross section of the appendico 19 including the mucus 64 and the mucosa 63 , the probiotics 100 may be introduced into the inside of the outer mucus layer 61 , may be introduced between the outer mucus layer 61 and the inner mucus layer 62 , may be introduced into the inside of the inner mucus layer 62 , or may be introduced between the inner mucus layer 62 and the epithelial cells. Alternatively, the introduction may be performed in combination of these.
  • introduction in the present embodiment means disposing the probiotics 100 directly on the mucus 64 .
  • the probiotics 100 to be introduced is the same as described above (Step (S): Jetting of the probiotics 100 toward the appendico orifice 19 i ).
  • the treatment instrument for introducing the probiotics 100 into the mucus 64 can be appropriately selected depending on the form of the probiotics 100 to be introduced and the introducing position.
  • a hole 42 h may be open on a side surface of the tube. Forming the hole on the side surface of the tube makes it easier to introduce the probiotics 100 into the mucus 64 located at the position apart from the sensitive mucosa 63 .
  • the probiotics 100 is introduced into the mucus 64 , which improves the colonization of the probiotics 100 in the mucus 64 .
  • a spoon-shaped treatment instrument 44 for removing the appendico mucus which is used in the step (F)
  • the probiotics 100 may be introduced into the mucus 64 in the step (J).
  • the treatment instrument for removing the appendico mucus may include a channel for supplying the probiotics or a structure for carrying the probiotics. Such a configuration enables the number of inserting and extracting the treatment instrument into and from the channel to be reduced.
  • FIG. 16 exemplifies the treatment instrument 44 for removing the appendico mucus, as described above.
  • the treatment instrument 44 includes, in the spoon, a flow path 44 k and a hole 44 h that are used for supplying the probiotics.
  • introduction of probiotics 100 into the mucus 64 in the step (J) instead of the introduction of probiotics 100 into the mucus 64 in the step (J), introduction of the probiotics 100 into the lumen of the appendico 19 in the step (K) or application of the probiotics 100 to a removed part of the mucus 64 in the step (L) may be performed as illustrated in FIG. 14 .
  • at least two of the steps (J), (K), and (L) may be performed.
  • FIG. 17 illustrates an example in which the probiotics is supplied to the appendico through a catheter inserted into the endoscope channel in FIG. 2 .
  • the introduction is performed toward the appendico orifice 19 i in the step (K) in the same way as the jetting of the probiotics in the step (S).
  • step (K) may be performed with the distal end of the endoscope 1 being brought into contact with the appendico 19 in the step (O).
  • An indwelling body for indwelling the probiotics 100 in the appendico 19 may be used in combination with the endoscope 1 .
  • the indwelling body may be a capsule containing the probiotics 100 , or a tablet made by solidifying the probiotics 100 by an excipient, or a thread, a sheet, a fluff, or a sponge, each of which is impregnated with or containing the probiotics 100 .
  • the shape of the sheet may be flat or three-dimensional.
  • FIG. 18 illustrates a funnel-shaped indwelling body
  • FIG. 19 illustrates a tuft-like indwelling body
  • FIG. 20 illustrates a thread-like indwelling body.
  • the three-dimensional sheet such as the funnel-shaped indwelling body 17 as illustrated in FIG. 18 , the tuft-like indwelling body 72 as illustrated in FIG. 19 , and the string-like indwelling body 73 as illustrated in FIG. 20 may be used.
  • the material of the indwelling body is not specifically limited. However, the material is preferably decomposed or absorbed in the body, or excreted outside the body, and the material includes starch, collagen, mucin, bioabsorbable polymer, or human hair, a botanical thread, or an animal thread, for example.
  • the botanical thread includes a cotton thread or a hemp thread.
  • the animal thread includes a silk thread, a wool thread, or a spider's thread.
  • FIGS. 18 to 20 exemplify the three-dimensional sheets exposed to the outside the appendico.
  • a thread, a sheet, a fluff, a sponge, a powder, or a gel, each of which contains the probiotics may be arranged on the outer surface of the capsule endoscope.
  • the method of removing the mucus 64 and the treatment instrument for removing the mucus 64 are the same as recited in the above-described step (F).
  • the treatment instrument for applying the probiotics 100 to the part where the mucus 64 is removed may be any instrument as long as the instrument can be impregnated with the probiotics 100 .
  • the treatment instrument includes a brush, a non-woven cloth, a fluff, a sponge, or a solid substance including a surface on which roughness is formed.
  • FIG. 21 illustrates a fluff impregnated with the probiotics and a bar holding the fluff, as an example of a treatment instrument to be used in the step (L) in FIG. 1 .
  • a treatment instrument 47 includes at the distal end thereof a fluff and a fluff 47 w, and includes inside thereof a conduit 47 k for supplying the probiotics 100 to the fluff and the fluff 47 w.
  • the probiotics 100 may be impregnated to the fluff before the treatment instrument is inserted into the endoscope channel 2 , or the bar is provided with a tube and a hole for supplying the probiotics 100 in the liquid form.
  • the bar can be combined with the brush, the non-woven cloth, the sponge, and the solid substance.
  • the flow according to the present embodiment is a flow for removing the bacteria harmful to a living body from the appendico.
  • the removal of the appendico mucus 64 in the step (F) may be performed.
  • the order of the steps in this case is not specifically limited, but can be appropriately selected depending on the state of the appendico of a patient.
  • the number of times of performing each of the steps is not limited, and at least one of the steps (E) or (F) may be performed plural times in such an order of (E) ⁇ (F) ⁇ (E), for example.
  • the first to third embodiments may be performed singly, in combination with an endoscopic examination, or in combination with an endoscopic treatment such as polyp resection.
  • the warming of the appendico 19 from the body surface in the step (H) or the application of vibration to the appendico 19 from the body surface in the step (I) may be performed.
  • step (H) or the step (I) may be performed before or after the extraction of the endoscope 1 from the inside of the body in step (M).
  • the method of warming the appendico 19 from the body surface in the step (H) a known method of warming the entirety or a part of the body can be employed.
  • the known method includes bathing, warming with a compress, a hot-water bottle, a hot stone, far infrared irradiation, or hyperthermia.
  • the known method includes hyperthermia, a massager, or a jet bath.
  • probiotics 100 is diffused in the appendico 19 or permeates in the mucus 64 by performing the step (H) or the step (I).
  • Step Z Ingestion of Probiotics 100 or Probiotic Nourishment
  • step (Z) the ingestion of the probiotics 100 after performing the step (M), (H), or (I).
  • step (Z) may be performed orally or through a suppository.
  • the ingesting form of the probiotics 100 includes a powder including the probiotics 100 , a tablet including the probiotics 100 , and a capsule containing the probiotics 100 , or a fluid including the probiotics 100 .
  • the fluid includes degassed water, carbonic water, mucin, collagen, hyaluronic acid, yogurt, milk, or a juice.
  • the nourishment of the probiotics 100 includes a chemical compound such as ferrous sulfate, manganese sulphate, magnesium sulfate, sodium acetate, ammonium citrate, potassium dihydrogenphosphate, glucose, or tripton, or yeast, lactic acid bacteria, butyrate-producing bacteria, Bifidobacteria, or the like.
  • yeast lactic acid bacteria, butyrate-producing bacteria, or Bifidobacteria
  • the intestinal environment restoration treatment for restoring the intestinal environment to the environment before the execution of the first to third embodiments.
  • absorption rate of nutrition is increased in a healthy body to withstand a harsh living environment, and thereafter in accordance with a change in the living environment, the intestinal environment restoration process in the step (V) is performed.
  • step (V) includes dietary restriction, medicinal agent ingestion, intestine cleaning, or intestinal mucus removal. These specific methods are the same as pre-treatment steps (b), (c), (d), and (e) to be described later.
  • the intestinal environment restoration process in the step (V) includes fecal transplantation of intestinal substances of a near relative or a housemate of a subject, or the intestinal substances of the subject himself or herself collected before the execution of the first to third embodiments.
  • the fecal transplantation may be performed in combination with the dietary restriction, the medicinal agent ingestion, the intestine cleaning, or the intestinal mucus removal.
  • a plastic surgery of appendico for forming the appendico 19 may be performed on a person whose appendico 19 has been removed due to appendico hypoplasia or appendicitis or a person with aging-related weakened immune system of the appendico 19 , prior to the execution of the first to third embodiments.
  • FIG. 22 illustrates a state where an incision is made on a part of the intestinal cecum
  • FIG. 23 illustrates forming of the appendico by suturing the incision in FIG. 22 .
  • the forming of the appendico may be performed by abdominal operation or using a laparoscope.
  • the method of forming the appendico 19 is not specifically limited, but as exemplified in FIGS. 21, 22 , the method includes “a method of forming the appendico 19 ′ by making an incision 18 c on a part of the intestinal cecum 18 to suture the cut surface”, “a method of transplanting a diverticulum formed in the intestinal tract”, “a method of excising a part of the jejunum and closing one end of the excised part and then transplanting the excised part to the intestinal cecum”, “a method of indwelling an appendico forming instrument in the intestinal cecum 18 to make the appendico 19 gradually grow in the body”, or “a method of transplanting the intestine including at least the appendico 19 ”.
  • an instrument to be used in the tissue expander method may be applied, for example.
  • the muscle layer may be partially removed.
  • suturing may be performed in the forming of the appendico, the suturing may be performed with a needle and a thread, with a clip, with a stapler, or with heat sealing, or suturing may be performed with a combination of heat sealing and ultrasound vibration.
  • a flexible endoscope may be inserted into a body prior to the forming of the appendico, to confirm the site suitable for forming the appendico.
  • locations where the Peyer's patches are present in the intestine may be confirmed, for example, and the site including a predetermined percentage of the Peyer's patches may be a candidate for the site at which the appendico is formed.
  • the number of bacteria in the intestine may be decreased by dietary restriction prior to the execution of the first to third embodiments.
  • the period of the dietary restriction can be appropriately set.
  • the dietary restriction may be performed by starvation, restriction of caloric intake, or intake of food which is less likely to be the nutrition for the bacteria.
  • ingestion of a medicinal agent for reducing the number of bacteria in the intestine may be performed.
  • the medicinal agent inoculation may be performed by hypodermic injection, oral ingestion, a suppository, or inhalation through the bronchi.
  • the medicinal agent may be an antibiotic or allicin that acts directly on the bacteria, or a purgative that acts on the intestine.
  • intestinal cleaning may be performed by introducing a liquid from the anus 11 .
  • the liquid to be used for the intestinal cleaning is not specifically limited, but includes normal saline, oxygenated water, or degassed water, for example.
  • the liquid may include a medicinal agent for reducing the number of bacteria in the intestine.
  • the intestinal cleaning may be performed by using a plurality of kinds of liquids. For example, after the cleaning using the liquid including the medicinal agent for reducing the number of bacteria, rinsing and cleaning may be performed with normal saline, for example.
  • At least a part of the mucus of the large intestine 10 or the mucus of the small intestine may be removed.
  • the removal of the appendico mucus in the step (H) is diverted to the method of removing the mucus.
  • the probiotics 100 in a protective form may be orally ingested.
  • the protective form referred to here indicates protecting and housing the probiotics 100 so as not to be killed by the digestive juice until the probiotics 100 reaches the intestinal tract.
  • the protective form includes, for example, a capsule, a tablet coating, or a bag with which the probiotics 100 are protected.
  • the ingestion of the probiotics 100 in the above-described step (Z) can be diverted.
  • the timing of the oral ingestion of the probiotics 100 in the protective form is not specifically limited, and the timing of the oral ingestion is any timing as long as the probiotics 100 in the protective form reaches the intestinal tract when the procedure using the endoscope 1 is performed.
  • the timing of the oral ingestion can be appropriately selected depending on the protective form, the body condition, the body size, the age, the type of procedure, the timing of performing the procedure, or the like.
  • the ingestion quantity and the number of ingestions of the probiotics 100 in the protective form are not specifically limited, but can be appropriately selected depending on the protective form, the body condition, the body size, the age, the type of procedure, the timing of performing the procedure, or the like.
  • steps (b), (c), (d), (e), and (f) may be performed in combination.
  • indigenous bacteria in the intestine may be collected, cultured, and analyzed. Based on the result of the analysis, insufficient bacteria or bacteria that are good match with the indigenous bacteria may be selected, and the selected bacteria may be used as the probiotics in the present invention.
  • the flora treatment according to the present invention is applicable to all ages, but the age of the appendico 19 is preferably under 30 years.
  • the treatment is likely to take effect.
  • the age of the intestinal tract including the appendico 19 is 10 years or older.
  • the intestinal tract of 10 years or older has a sufficient tissue strength, which makes it easier for endoscope 1 to reach the intestinal cecum 18 .
  • the present invention can be applied to allergy treatment.
  • the allergy includes a hay fever, an atopic dermatitis, an animal allergy, a food allergy, a sick house syndrome, an ulcerative enteritis, or a Crohn disease.
  • the present invention can be applied to treatment of drug-induced enterocolitis.
  • the present invention can be applied to immunity reinforcement before endoscopic examination and endoscopic treatment.
  • the present invention can be applied to health care.
  • the health care includes an obesity treatment, cholesterol lowering, or metabolic rate enhancement.
  • the present invention can be applied to an inborn error of metabolism. Furthermore, the present invention can be applied to malabsorption syndrome treatment, improvement of absorption rate of nutrition in a healthy body.
  • the malabsorption syndrome includes a postgastrectomy syndrome, a short bowel syndrome, a celiac disease, or an amyloidosis.
  • the present invention can be applied to enhancement of the absorption rate of nutrition in a healthy body.
  • People having healthy body that requires such treatment includes people withstand harsh living environments such as athletes, alpinists, or people in military service.

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