WO2019131713A1

WO2019131713A1 - Treatment instrument for endoscope

Info

Publication number: WO2019131713A1
Application number: PCT/JP2018/047741
Authority: WO
Inventors: 智啓山田
Original assignee: 日本ゼオン株式会社
Priority date: 2017-12-28
Filing date: 2018-12-26
Publication date: 2019-07-04
Also published as: JPWO2019131713A1; JP7302481B2; KR20200103670A

Abstract

[Problem] To provide a treatment instrument for an endoscope, configured so that the dislodgement of an opening/closing section can be reliably prevented. [Solution] A connection hook (opening/closing section) 11 is mounted to the distal end of a drive wire 13 through a hook-side annular section (first annular section) affixed to the proximal end (U-shaped section 11c) of the connection hook 11, and through a wire-side annular section (second annular section) 19 affixed to the distal end of the drive wire 13 inserted in a sheath 12.

Description

Treatment tool for endoscope

The present invention relates to a treatment tool for endoscope for treating a body tissue by an operation outside the body using an endoscope.

The clip device as one of the endoscope treatment tools comprises a medical clip connected to the distal end of the sheath that is passed through the treatment tool guide tube of the endoscope from the operation unit attached to the rear end of the sheath The device is used for indwelling in a state in which internal tissue is held for hemostasis, marking, etc.

As such a clip device, at the distal end of the drive wire inserted into the sheath, there are a pair of arm portions arranged in a substantially V-shape with each other and a U-shaped portion connecting these proximal end sides. And by sliding the sheath to the proximal end side with respect to the drive wire, it projects from the distal end of the sheath and unfolds by its own elasticity, and by sliding it to the distal end side, the distal end of the sheath There is known one in which a connection hook (opening / closing portion) which is embedded in and closed off is attached (for example, see Patent Document 1).

In order to facilitate the treatment while increasing the degree of freedom regarding the attitude of the connection hook with respect to the drive wire, and reducing deformation, breakage and the like, the one described in Patent Document 1 has a circle at the distal end of the drive wire. The connection hook is made swingable relative to the drive wire by providing a ring and passing the U-shaped part at the proximal end of the connection hook through the ring part.

WO 2015/151629

In the clip device described in Patent Document 1, the annular portion at the distal end of the drive wire is set to be present inside the distal end of the sheath, not by sliding the sheath against the drive wire. Usually, the connecting hook does not come off the ring part. However, if the sheath portion including the drive wire and the sheath is wound multiple times with an appropriate diameter for cleaning and storage of the clip device, the drive is performed due to the difference in inner and outer diameters during winding of the drive wire and the sheath. It has been found that the annulus at the distal end of the wire may protrude outwardly from the distal end of the sheath, and the connecting hook may fall out of the annulus.

This invention is made in view of such a point, and an object of this invention is to provide the treatment tool for endoscopes which can prevent drop-off | omission of an opening-and-closing part reliably.

A treatment tool for an endoscope according to the present invention is
Tube-shaped sheath,
A drive wire inserted through the sheath;
An operating unit provided at a proximal end of the sheath for sliding the drive wire relative to the sheath;
The elastic body has a pair of arm portions attached to the distal end of the drive wire and disposed so as to open in a substantially V shape toward each other as it goes to the tip, and the sheath is attached to the drive wire By sliding to the proximal end side, it projects from the distal end of the sheath and self-elastically opens, and by sliding the sheath distally with respect to the drive wire, the sheath An opening / closing portion which is buried and closed in the distal end,
The opening / closing portion is provided via a first annular portion provided at the proximal end of the opening / closing portion and a second annular portion provided at the distal end of the drive wire and passed through the first annular portion. It is the treatment tool for endoscopes attached to the said drive wire.

In the endoscope treatment tool according to the present invention, the opening and closing portion is attached to the drive wire via the first annular portion and the second annular portion passed through the first annular portion. It is possible to reliably prevent the opening and closing portion from falling off while maintaining the high state.

The present invention can be suitably used for a clip device which is a treatment tool for an endoscope provided with a connecting hook that releasably connects a medical clip held by holding a body tissue and placed as the opening / closing unit.

FIG. 1 is a view showing the overall configuration of a clip device according to an embodiment of the present invention. FIG. 2 is a cross-sectional view taken along the line II-II of FIG. FIG. 3 shows the configuration of the distal end of the drive wire of the clip device of FIG. 1; FIG. 4 is a side view of the configuration of FIG. FIG. 5 is a view showing the connecting hook attached to the distal end of the drive wire of the clip device of FIG. 1; 6 is a perspective view of the arrangement of FIG. 5 from another angle. FIG. 7 is a plan view showing the configuration of a medical clip used in connection with the clip device of FIG. FIG. 8 is a side view of the medical clip of FIG. 7; FIG. 9 is a view showing a state in which the connection hook of the clip device of FIG. 1 is protruded from the distal end of the inner sheath to open the connection hook. FIG. 10 is a view showing a medical clip connected to the distal end of the inner sheath of the clip device of FIG. 1 and housed in the outer sheath. FIG. 11 is a view showing a state in which the clip device of FIG. 1 is inserted into the treatment instrument guide tube of the curved endoscope.

Hereinafter, referring to the drawings, as an embodiment of the treatment tool for an endoscope according to the present invention, a medical clip for performing hemostasis, marking, etc. is connected via an endoscope and transported into the body, The clip device for gripping (clipping) the image will be described.

However, the present invention is not limited to the clip device, and it is composed of an elastic body having a pair of arm portions disposed so as to open in a substantially V shape toward each other as it goes to the tip, and the sheath By sliding it toward the proximal end, it projects from the distal end of the sheath and opens itself by its own elasticity, and by sliding the sheath distally with respect to the drive wire, the distal end of the sheath The present invention can be widely applied to an endoscope treatment tool having an opening and closing portion which is buried and closed in the end.

More specifically, for example, a snare ligation apparatus including a connection hook for connecting an indwelling snare to ligate a body tissue as the opening and closing part, a forceps device including a forceps for gripping an inside tissue as the opening and closing part, a high frequency electrode opening and closing Applied to a bipolar high-frequency device including the opening / closing portion, a ligature cutting device etc. that cuts the ligature by grasping the ligature that sutures a defect portion of internal tissue and the like by the opening / closing portion and pulling it into the sheath. can do.

First, FIG. 1 and FIG. 2 will be referred to. The clip device 1 includes a connection hook (opening and closing unit) 11, an inner sheath (sheath) 12, a drive wire 13, an outer sheath 14, a reinforcing coil 15, a first slider 16, a base 17, and a second slider (operation unit ) Is roughly configured.

The tube-shaped inner sheath 12 is inserted through the tube-shaped outer sheath 14, and the drive wire 13 is inserted through the inner sheath 12. The inner sheath 12 is slidable (slidable) in the outer sheath 14, and the drive wire 13 is slidable (slidable) in the inner sheath 12.

The outer sheath 14 is formed of a flexible hollow tube, and in the present embodiment, a coiled tube is used. As the coil tube, a flat wire coil tube formed by spirally winding a long flat plate made of metal (stainless steel) or the like can be used. However, a round coiled tube or an inner flat coiled tube may be used.

The inner sheath 12 is made of a flexible hollow tube, and in the present embodiment, a wire tube is used. A wire tube is a tube which consists of a hollow stranded wire spirally twisted so that a plurality of wires (cables) which consist of metal (stainless steel) etc. may become hollow, for example. As the inner sheath 12, a wire tube may be mainly used, and only a part of the distal end side may be a coil tube.

The drive wire 13 is made of a flexible wire, and in the present embodiment, a wire rope is used. The wire rope is a rope made of a stranded wire formed by helically twisting a plurality of wires (cables) made of, for example, metal (stainless steel) or the like. However, as the drive wire 13, a wire tube similar to the inner sheath 12 may be used.

The use of a wire tube made of such a coiled tube or a stranded wire as the outer sheath 14 or the inner sheath 12 is because, when the clip device 1 is ultrasonically cleaned using a cleaning solution, the cleaning solution is sufficiently inside the tube In order to be able to wash well inside and outside.

In addition, it is preferable from a viewpoint of making the sliding resistance which arises between mutually reverse that the winding direction of the outer sheath 14 and the winding direction of the inner sheath 12 mutually reverse. For example, when the outer sheath 14 is Z-wound, the inner sheath 12 is S-wound. When using the wire rope or wire tube which consists of a stranded wire for the drive wire 13, it is similarly preferable to make the winding direction into the reverse direction to the winding direction of the inner sheath 12. As shown in FIG.

The connection hooks 11 disposed at the sheath distal end of the clip device 1 have a pair of arm portions made of an elastic body disposed substantially in a V-shape toward the distal end as shown in FIGS. 5 and 6 11a and 11a are provided, and by cooperation with the inner sheath 12, two states of an open leg (open) state and a closed leg (closed) state can be taken. The front end portions of the

arm portions

11a and 11a of the connection hook 11 are bent inward (sides facing each other) to form

claw portions

11b and 11b, and grip the connection portion 21 of the medical clip 2 described later Can be connected.

The proximal end portion of the connection hook 11 is a U-shaped portion 11c formed in a substantially U-shape continuously with the proximal end portions of the pair of

arm portions

11a and 11a. The

arm portions

11a and 11a including the

claw portions

11b and 11b and the U-shaped portion 11c can be formed by appropriately bending (plastically deforming) one elongated plate made of an elastic body. Although not particularly limited, the plate thickness of the plate constituting the connection hook 11 is about 0.20 to 0.24 mm, and the width is about 0.6 mm. For example, stainless steel is used as the plate material.

A hook side annular portion (first annular portion) 11 d is provided at the proximal end of the U-shaped portion 11 c of the connection hook 11. In the present embodiment, the hook side annular portion 11 d integrally fixes the pair of open ends of the U-shaped member to the outer (proximal end side) surface of the proximal end of the U-shaped portion 11 c. It makes it a cyclic part. The fixing of the hook side annular portion 11d to the U-shaped portion 11c is performed by laser welding in the present embodiment, but may be performed by adhesion or the like.

As a U-shaped member which comprises the hook side cyclic | annular part 11d, what bent suitably the board material similar to the board | plate material which comprises the connection hook 11 can be used (plastically deformed). As a raw material of the U-shaped member which comprises the hook side cyclic | annular part 11d, stainless steel can be used, for example. The outer diameter of the semicircular arc portion of the hook side annular portion 11d is about 1.0 to 1.2 mm, and the inner diameter is about 0.8 to 1.0 mm. The cross section of the hook side annular portion 11d is rectangular in this embodiment, but may be circular or semicircular.

The member constituting the hook side annular portion 11 d is not limited to a U-shaped member, and may be an annular member (annular ring, elliptical ring, oval round ring, semicircular ring, semielliptic ring, semi long ring ring, etc.) or a member A member having an annular portion may be fixed to the outer surface on the proximal end side of the proximal end of the U-shaped portion 11 c of the connection hook 11 by laser welding or the like. As a member having an annular portion in this case, for example, a member having an annular portion and a rod-like portion integrally formed on the annular portion or a through member forming an annular portion in a plate material having a substantially U-shaped outer shape A hole (a hole having a circular shape, an oval shape, an oval shape, a semicircular shape, a semielliptical shape, a semielliptical shape, or the like) can be exemplified.

In the present embodiment, the member constituting the hook side annular portion 11d is integrally provided on the outside of the base end portion of the U-shaped portion 11c, but from the viewpoint of realizing the swing function of the connection hook 11. May be integrally provided inside the proximal end of the U-shaped portion 11c. However, when the hook side annular portion 11d is provided inside the U-shaped portion 11c, there is a possibility that the opening and closing of the

arm portions

11a and 11a may be impeded, so as in the present embodiment, the U-shaped portion 11c It is better to provide it on the outside of the proximal end of

The distal end (distal end) of the drive wire 13 slidably inserted in the inner sheath 12 is provided with a wire side annular portion (second annular portion) 19 as shown in FIGS. 3 and 4. It is done. In the present embodiment, the wire side annular portion 19 is integrally fixed by laser welding a pair of open ends of the U-shaped member to the distal end of the drive wire 13 to form an annular portion. The fixation of the wire side annular portion 19 to the drive wire 13 may be performed by bonding or the like. In the present embodiment, the fixing of the U-shaped member constituting the wire-side annular portion 19 to the drive wire 13 is U-shaped as shown in FIG. 3 from the viewpoint of securing the fixing strength. This is performed by joining the inner surface of the U-shaped member and the side surface of the distal end of the drive wire 13 so as to sandwich the distal end of the drive wire 13 with the pair of open ends of the member. Further, in the present embodiment, by polishing the outer peripheral surface side of the U-shaped member, the thickness of the U-shaped member at the junction with the drive wire 13 becomes thinner toward the proximal end. There is. By doing this, a phenomenon in which the U-shaped member (wire side annular portion 19) is caught on the distal end surface of the inner sheath 12 when the distal end of the drive wire 13 is pulled into the inner sheath 12 It can prevent.

As a U-shaped member which comprises the wire side cyclic | annular part 19, the thing which bend | folded the board | plate material suitably (plastic-deformed) can be used. As a raw material of the U-shaped member which comprises the wire side cyclic | annular part 19, stainless steel can be used, for example. The outer diameter and the inner diameter of the semicircular arc portion of the wire-side annular portion 19 are preferably substantially the same as the hook-side annular portion 11 d, and the outer diameter is about 1.0 to 1.2 mm, and the inner diameter is 0.8 It can be about 1.0 mm. The cross section of the wire side annular portion 19 is rectangular in this embodiment, but may be circular or semicircular.

The member constituting the wire-side annular portion 19 is not limited to a U-shaped member, and may be an annular member (annular ring, elliptical ring, oval round ring, semicircular ring, semielliptic ring, semi long ring ring, etc.) or a member A member having an annular portion may be fixed to the distal end of the drive wire 13 by laser welding or the like. As a member having an annular portion in this case, for example, a member having an annular portion and a rod-like portion integrally formed on the annular portion or a through member forming an annular portion in a plate material having a substantially U-shaped outer shape A hole (a hole having a circular shape, an oval shape, an oval shape, a semicircular shape, a semielliptical shape, a semielliptical shape, etc.) may be formed.

One of the hook side annular portion 11 d and the wire side annular portion 19 is connected in a state of being passed through the other, so that the connecting hook 11 is swingably attached to the distal end of the drive wire 13. By attaching the connecting hook 11 to the distal end of the drive wire 13 via the wire side annular portion 19 and the hook side annular portion 11d passed through the wire side annular portion 19, the connecting hook 11 is in the direction of arrow B in FIG. 6 can be freely rotated in the direction of the arrow C in FIG.

Here, an example of the attachment procedure (the manufacturing method) of the connection hook 11 to the drive wire 13 will be described. First, each open end of a U-shaped member constituting the hook side annular portion 11d is fixed to the U-shaped portion 11c of the connection hook 11 by laser welding, and burrs and the like of the welded portion are appropriately polished and removed. Then, a U-shaped member constituting the wire-side annular portion 19 is passed through the hook-side annular portion 11d, and the open ends are fixed to the distal end of the drive wire 13 by laser welding, and the outer periphery of the U-shaped member Appropriately polish and remove burrs on the surface side and welds.

In the present embodiment, the U-shaped member is disposed and driven so that the distal end of the drive wire 13 is sandwiched from the side by each open end of the U-shaped member constituting the wire side annular portion 19 The end face of each open end of the U-shaped member may be fixed to the distal end face of the drive wire 13 by welding, though it is fixed to the distal end of the wire 13 by welding. Further, in the present embodiment, each open end of the U-shaped member is directly welded and fixed to the drive wire 13, but may be fixed via another member. For example, each open end of a U-shaped member is welded and fixed to one end of a substantially cylindrical pipe member, and the distal end of the drive wire 13 is inserted from the other end, and the pipe member is inserted into the drive wire 13 It may be fixed by welding.

In the present embodiment, since both the hook side annular portion 11 d and the wire side annular portion 19 are formed of U-shaped members, the U-shaped members constituting the wire side annular portion 19 are welded to the drive wire 13. After fixing and polishing the welded portion and passing the U-shaped member constituting the hook side annular portion 11 d through the wire side annular portion 19, the U-shaped member constituting the hook side annular portion 11 d is connected to the hook It is also possible to set it as the procedure of performing welding fixation and the grinding process of a welding part to 11. However, after the connection hook 11 is connected to the drive wire 13, the work of grinding the welded portion of the connection hook 11 is longer than the case where the connection hook 11 is polished without being connected to the drive wire 13. Because the drive wire 13 and the like are obstructive and work is difficult, the procedure as in the above-described embodiment is advantageous from the viewpoint of the ease and accuracy of the work.

Referring back to FIGS. 1 and 2, the proximal end (proximal end) side of the outer sheath 14 is inserted into the reinforcing coil 15 and integrally fixed to the reinforcing coil 15. The reinforcing coil 15 is integrally fixed to the first slider portion 16, and a portion on the distal end side of the base portion 17 is inserted and disposed inside the first slider portion 16. The first slider portion 16 slides relative to the base portion 17 between a position moved to the distal end (distal end) side and two positions moved to the proximal end (proximal end) side. It is supposed to get.

The second slider portion 18 is slidably held by the base portion 17, and the inner sheath 12 is fixed to the base portion 17. The proximal end of the drive wire 13 is fixed to the second slider portion 18.

Next, a medical clip 2 for gripping internal tissue using such a clip device 1 will be described. The clip 2 has a connecting plate portion 21 bent in a substantially U shape as shown in FIGS. 7 and 8. At each U-shaped end of the connecting plate portion 21, a pair of arm plate portions 22 disposed so as to be opened (opened) in a substantially V shape as they go to the tip are integrally formed. ing.

A claw portion 23 is integrally formed at the tip of each arm plate portion 22. The claw portion 23 is formed by bending the tip end of the arm plate portion 22 toward the inside (that is, the closing direction). Each claw portion 23 has a notch (not shown) which is recessed in the middle portion of the tip.

The connecting plate portion 21 constituting the clip 2, the pair of arm plate portions 22, and the pair of claw portions 23 are formed by bending and forming (plastically deforming) a plate material made of a thin and elongated elastic body. Can. The thickness of the plate material constituting the clip 2 is not particularly limited, but is preferably 0.10 to 0.30 mm. For example, stainless steel is used as the plate material.

The arm plate portions 22 each have a base end portion 22a and a grip portion 22b, as shown in FIG. A penetrating portion 22 c is formed in the grip portion 22 b of each arm plate portion 22. The penetrating portions 22c are formed to reduce the weight without impairing the desired strength of the arm plate portion 22 (gripping portion 22b).

A clamping ring 24 is slidably fitted in the connection plate portion 21. The clamping ring 24 is configured of a substantially cylindrical ring member. However, the clamping ring 24 may be configured by a spring formed by winding a wire in a coil shape. The connection plate portion 21 is inserted into the inner guide hole of the tightening ring 24, and axially movable (slidable) between the outer periphery of the connection plate portion 21 and the outer periphery of the base end 22a of the arm plate portion 22. It is mounted on (externally fitted).

When the clamping ring 24 is disposed rearward (the connecting plate 21) as shown in FIG. 7 or 8, the arm plate 22 is in an open (open leg) state by its own elasticity. If necessary, the arm plate 22 can be closed (closed) by moving (sliding) the clamping ring 24 to a position (proximal end 22a) closer to the distal end.

Next, how to use the above-described clip device 1 will be described. First, as shown in FIG. 9, the first slider portion 16 is slid to a position on the proximal end side with respect to the base portion 17 so that the distal end of the inner sheath 12 is the distal end of the outer sheath 14 It shall be in the state which made it project from. Further, the second slider portion 18 is slid to the proximal end side with respect to the base portion 17 to draw in the inner sheath 12 with respect to the drive wire 13, and the connection hook 11 at the distal end of the drive wire 13 is It is made to project from the distal end of the arm, and is self-opened in a substantially V shape by its own elasticity.

From this state, when the second slider portion 18 is slid to the distal end side with respect to the base portion 17, the drive wire 13 is drawn into the inner sheath 12, and the connection hook 11 at the distal end of the drive wire 13. Since the legs are gradually closed while entering the inner sheath 12, the connection plate portion 21 of the clip 2 is positioned so that the connection hook 11 grips, and is buried in the inner sheath 12 to completely close the legs. , Clip 2 can be coupled to the distal end of the inner sheath 12.

Next, the first slider portion 16 is slid to a position on the distal end side with respect to the base portion 17 so that the distal end of the inner sheath 12 to which the clip 2 is connected is inserted into the outer sheath 14 together with the clip 2. Contain (fill in). In this state, the clamp ring 24 of the clip 2 remains at the connecting plate portion 21, and the arm plate portion 22 is closed by the inner wall of the outer sheath 14.

Then, although not shown, the distal end of the sheath portion (the drive wire 13, the inner sheath 12 and the outer sheath 14) of the clip device 1 to which the clip 2 is connected via an endoscope Position in the vicinity of the body tissue to be treated. Thereafter, the clip 2 is protruded from the distal end of the outer sheath 14 by sliding the outer sheath 14 to the proximal end side. As a result, the arm plate portion 22 of the clip 2 is in an open state by its own elasticity (see FIG. 7).

The arm plate portion 22 is positioned in the vicinity of the region to be grasped of the mucous membrane (body tissue) in a state where the arm plate portion 22 is opened. Next, the inner ring 12 is slid to the distal end side with respect to the drive wire 13, whereby the clamp ring 24 slides to the distal end side of the arm plate portion 22. As a result, the arm plate portions 22 gradually close (close to each other), and the internal tissue is pinched by the claws 23 at the tip of the arm plate portion 22.

By further sliding the inner sheath 12 with respect to the drive wire 13 to the distal end side, the clamping ring 24 is moved to the side of the gripping portion 22 b of the arm plate portion 22, and gripping of the internal tissue by the clip 2 is completed. In this state, by sliding the inner sheath 12 to the proximal end side with respect to the drive wire 13, as shown in FIG. 9, the connection hook 11 is pushed out from the distal end of the inner sheath 12 and opened. Thus, the grip (engagement) of the clip 2 by the connection hook 11 is released, and the clipping of the clip 2 to the body tissue is completed.

According to the embodiment described above, since the connecting hook 11 as the opening and closing part is attached to the drive wire 13 via the hook side annular part 11 d and the wire side annular part 19 passed therethrough, the connecting hook 11 is The drive wire 13 can be freely oscillated (that is, the degree of freedom of the posture with respect to the drive wire 13 is increased). Therefore, for example, as shown in FIG. 11, the distal end of the drive wire 13 and the inner end of the inner sheath 12 when passing through the relatively large-curved endoscope instrument guide tube 3 Since the connecting hook 11 and the wire side annular portion 19 and the hook side annular portion 11d are bent without stress, it is possible to eliminate the application of a large force to this portion.

Thereby, when the inner sheath 12 is inserted into the treatment instrument guiding tube 3, the distal end portion of the inner sheath 12 in which the connection hook 11 is accommodated and the vicinity thereof smoothly follow the bending of the treatment instrument guiding tube 3. At the same time, it is possible to reduce troubles in sliding the drive wire 13 in the inner sheath 12 and to carry out the work smoothly. In addition, deformation (plastic deformation), breakage or the like in the connection portion between the drive wire 13 and the connection hook 11 can be reduced. In FIG. 11, the outer sheath 14 is not shown.

In addition, when the sheath portion (the drive wire 13, the inner sheath 12 and the outer sheath 14) is wound a plurality of times with an appropriate diameter for cleaning and storing the clip device 1, the drive wire 13 and the inner sheath 12 There is a risk that the wire-side annular portion 19 at the distal end of the drive wire 13 may protrude outward from the distal end of the inner sheath 12 due to the difference between the inner and outer diameters at the time of winding. The connection hook 11 does not fall off the drive wire 13.

The embodiments described above are described to facilitate the understanding of the present invention, and are not described to limit the present invention. Therefore, each element disclosed in the embodiment described above is intended to include all design changes and equivalents that fall within the technical scope of the present invention.

1 ... clip device (treatment tool for endoscope)
11 ... Connection hook (opening and closing part)
11a: Arm portion 11b: Claw portion 11c: U-shaped portion 11d: Hook side annular portion (first annular portion)
12 ... Inner sheath (sheath)
13 ... drive wire 14 ... outer sheath 16 ... first slider section 17 ... base section 18 ... second slider section (operation section)
19: Wire side annular portion (second annular portion)
DESCRIPTION OF SYMBOLS 2 ... Medical clip 21 ... Connection plate part 22 ... Arm plate part 22a ... Base end part 22b ... Holding part 23 ... Claw part 24 ... Clamping ring 3 ... Treatment tool guide tube of an endoscope

Claims

Tube-shaped sheath,
A drive wire inserted through the sheath;
An operating unit provided at a proximal end of the sheath for sliding the drive wire relative to the sheath;
The elastic body has a pair of arm portions attached to the distal end of the drive wire and disposed so as to open in a substantially V shape toward each other as it goes to the tip, and the sheath is attached to the drive wire By sliding to the proximal end side, it projects from the distal end of the sheath and self-elastically opens, and by sliding the sheath distally with respect to the drive wire, the sheath An opening / closing portion which is buried and closed in the distal end,
The opening / closing portion is provided via a first annular portion provided at the proximal end of the opening / closing portion and a second annular portion provided at the distal end of the drive wire and passed through the first annular portion. An endoscope treatment tool attached to the drive wire.
The endoscope treatment tool according to claim 1, wherein the opening and closing portion is a connection hook which releasably connects a medical clip to be held by holding a body tissue.