WO2019142911A1

WO2019142911A1 - Endoscope treatment instrument

Info

Publication number: WO2019142911A1
Application number: PCT/JP2019/001471
Authority: WO
Inventors: 博美佐貫; 工藤　貢一; 勇太杉山; 啓太小澤; 千賀宮島; 典子小平
Original assignee: オリンパス株式会社
Priority date: 2018-01-19
Filing date: 2019-01-18
Publication date: 2019-07-25
Also published as: JP2021065244A

Abstract

This endoscope treatment instrument (1) is characterized by comprising: a sheath (10) that can be inserted into a channel (102) of an endoscope device (100); a connection wire (30) to be inserted into the sheath so as to be reciprocatable in a longitudinal axis direction of the connection wire; and an incision portion (20) that is connected to the connection wire, is protrudable from a distal end opening (11) of the sheath, and is made of a conductive member, wherein the incision portion is constituted of a linear member in which the thickness in a distal end region from the distal end thereof to a predetermined position on the base end side is less than 0.2 mm.

Description

Treatment tool for endoscope

The present invention relates to a treatment tool for an endoscope. Priority is claimed on Japanese Patent Application No. 2018-007713, filed January 19, 2018, the content of which is incorporated herein by reference.

Conventionally, in the treatment of early malignancy and the like, for example, on the mucous membrane in a luminal organ such as the digestive tract such as EMR (endoscopic mucosal resection) and ESD (endoscopic submucosal dissection) Procedures for endoscopically resecting the developed lesion are being performed. A high-frequency knife or a high-frequency snare is used as an endoscopic treatment tool for excising diseased tissue.

An endoscope snare is, for example, a sheath, an operation wire axially movably inserted in the sheath, and an operation wire as in the treatment tool for endoscopes of Patent Document 1 to Patent Document 3 And a snare loop consisting of connected elastic wires. The snare loop disclosed in each of Patent Document 1 to Patent Document 3 is formed by bending back the superelastic wire at the tip of the snare loop. In such a snare, when the operation wire is advanced and retracted in the axial direction, the snare loop projects from the distal end of the sheath. When the snare loop protrudes from the tip of the sheath, the opening width of the snare loop is expanded by its own elasticity. The snare loop in the expanded state is narrowed by being drawn into the sheath.

In ESD, when translesionally resecting a lesion that has developed on a mucous membrane in a luminal organ, a swelling agent is injected into the lower part of the tissue to be resected as needed to raise the lesion, The tissue surrounding the lesion is incised using a high-frequency knife, and then the incision is exfoliated little by little. At this time, the operator inserts the high frequency knife into the body through the endoscope until the high frequency knife is positioned in the vicinity of the diseased tissue to be removed.

In EMR, when translesionally resecting a lesion that has occurred on a mucous membrane in a luminal organ, a bulge agent is injected to elevate the lesion, and then the operator makes the root of the tissue to be resected. Apply a snare loop and pull the operation wire proximally. As a result, a part of the snare loop is drawn into the sheath, and the opening width of the snare loop is reduced. As a result, the tissue to be ablated is tied in a snare loop, a high frequency current is supplied in this binding state, and the tissue to be ablated is removed from the digestive tract.

Japanese Patent Laid-Open Publication No. 2008-206996 Japanese Patent Application Laid-Open No. 10-014922 Japanese Patent Application Laid-Open No. 2002-224136

When ESD is performed in the large intestine, the tip of the endoscope insertion portion is mainly moved in the forward and backward directions, and the movable range is restricted, and the relative position between the intestine and the endoscope is not fixed. Therefore, it is necessary to use a high-frequency knife to cut and remove the whole circumference of the lesion and the submucosal layer with a high level of skill. In addition, when EMR is performed, it is also difficult to hook a high frequency snare to a tumor. In the endoscope treatment tool of Patent Document 3, in order to restrain the position of the snare wire with respect to the lesion, a plurality of non-slip members provided with claws projecting inside the loop of the snare wire are attached to the snare wire. However, it takes time to lock the claws of the non-slip member around the lesion.

Also, in the case of the large intestine etc., since the intestinal wall is thin, if there is too much amount of tissue binding with a snare loop during EMR, there is a risk that perforation may occur in the intestinal wall by incising the muscle layer with poor elasticity. Only tumors of size (less than 2 cm) could be resected with the snare. Therefore, it is possible to grasp only a highly elastic submucosal layer with a snare and cut a larger tumor with a snare by incising the entire circumference of the tumor with a high-frequency knife before applying a snare (Non-Patent Document 1) . This method is called hybrid ESD or perimeter incision EMR. In this case, since the whole circumference incision is the work of the high frequency knife, a careful operation is required, and there is a problem that the treatment time is prolonged as compared with the conventional EMR.

The present inventors arrived at the present invention, thinking that a larger tumor than the conventional EMR can be resected by a simple and short-term treatment at the EMR level if the peripheral incision of the lesioned part by the high frequency knife is simplified. .

The present invention has been made in view of the above-described problems, and an object of the present invention is to provide a treatment tool for an endoscope which can incise the periphery of a lesion in a short time by a simple operation.

A treatment tool for an endoscope according to a first aspect of the present invention includes a sheath insertable in a channel of an endoscope apparatus, and a connection wire inserted in the sheath so as to be movable back and forth in the longitudinal axis direction of the sheath. And a cutting portion connected to the connection wire and projectable from the distal end opening of the sheath and made of a conductive member, wherein the cutting portion is a distal end from a distal end of the sheath to a predetermined position from the distal end. It is characterized in that the region is constituted by a linear member having a thickness of less than 0.2 mm.

As a second aspect of the present invention, in the treatment tool for endoscope according to the first aspect, the thickness of the distal end region of the incision may be less than 0.1 mm.

As a third aspect of the present invention, the endoscopic treatment tool according to the first or second aspect may have at least one weight in the distal end region of the incision.

As a fourth aspect of the present invention, in the endoscope treatment tool according to the first aspect, a water jet function may be provided in the sheath.

According to the present invention, it is possible to provide an endoscope treatment tool capable of incising the periphery of a lesion in a short time by a simple operation.

BRIEF DESCRIPTION OF THE DRAWINGS It is a general view of the treatment tool for endoscopes which concerns on 1st Embodiment of this invention. It is a schematic diagram which shows the tissue incision method using the treatment tool for endoscopes which concerns on 1st Embodiment of this invention. It is a schematic diagram which shows the tissue incision method using the treatment tool for endoscopes which concerns on 1st Embodiment of this invention. It is a flowchart which shows the tissue incision method using the treatment tool for endoscopes which concerns on 1st Embodiment of this invention. It is a top view which shows the modification of the incision part which concerns on 1st Embodiment of this invention. It is a top view which shows the treatment tool for endoscopes which concerns on 2nd Embodiment of this invention. It is a general view which shows the modification of the treatment tool for endoscopes which concerns on 1st Embodiment and 2nd Embodiment of this invention.

First Embodiment
An endoscope treatment tool 1 according to the present embodiment will be described with reference to FIGS. 1 and 2. FIG. 1 is an overall view of an endoscope treatment tool 1 according to the present embodiment. As shown in FIG. 1, the endoscope treatment tool 1 according to the present embodiment includes a sheath 10, a connection wire 30, an all-round incision device (incision portion) 20, and an operation unit 40. FIG. 1 shows a cross-sectional view along the longitudinal axis X direction except the all-round incision device 20. The endoscope treatment tool 1 is inserted into the treatment tool channel 102 formed in the endoscope insertion portion 110 of the endoscope apparatus 100 and used (see FIG. 2).

The sheath 10 is formed extending along the longitudinal axis X, and is an elongated member that can be inserted into a body cavity. The sheath 10 is formed of an insulating material, for example, a fluorine resin such as PTFE (polytetrafluoroethylene). The sheath 10 has flexibility, and is configured to be insertable into and removable from a treatment instrument channel (not shown) of the endoscope along a curved shape such as luminal tissue in a body cavity. The sheath 10 has a lumen 12 formed over its entire length, and has a distal opening 11 and a proximal opening 13. An operating portion 40 is provided at the proximal end of the sheath 10, and the proximal end opening 13 and the distal end opening 44 of the operating portion 40 communicate with each other.

The connection wire 30 is inserted into the lumen 12 of the sheath 10, the proximal end thereof is disposed on the operation unit 40, and the distal end thereof extends to the distal end of the sheath 10. The connection wire 30 is a stranded wire 31 made of a conductive member, and the outer peripheral surface is covered with a nonconductive member 32.

The total incision device 20 is connected to the tip of the connection wire 30. In this embodiment, as the incision portion, the all-round incision device 20 configured of the conductive wire 33 in a closed ring shape is provided at the tip of the connection wire 30, and the proximal end of the all-round incision device 20 is electrically and physically Is connected to the connection wire 30. Specifically, the conductive stranded wire 31 portion of the connection wire 30 and the proximal end of the all-round incision device 20 are connected so as to be conductive.

The total incision device 20 consists of a single wire of 0.1 mm in diameter. The entire circumferential incision device 20 is formed of, for example, a conductive material such as stainless steel or tungsten. That is, the circumferential incision device 20 according to the present embodiment is smaller in diameter than the conventional high-frequency snare wire, and therefore has high flexibility. Therefore, when protruding from the lumen 12 of the sheath 10, the entire circumferential incision device 20 of the endoscopic treatment tool 1 is bent and curved by its own weight. Since the conventional high frequency snare is constituted by a superelastic wire, it can be maintained at a position along the axis of the sheath even when it protrudes from the distal end of the sheath. On the other hand, the all-round incision device 20 of the endoscopic treatment tool 1 according to the present embodiment has a small diameter and high flexibility, and thus bends when it protrudes from the tip of the sheath 10, along the tissue to be dissected As a result, substantially the entire area of the total circumferential incision device 20 adheres.

The thickness (diameter) of the conductive wire 33 constituting the total circumferential incision device 20 is less than 0.2 mm. When a high frequency current equivalent to that of the conventional high frequency snare is applied to the conductive wire 33 having a thickness of less than 0.2 mm, the tissue cutting performance is higher than that of the conventional high frequency snare. As a result, the tissue can be easily dissected simply by attaching the all-round incision device 20 to the tissue and flowing a high frequency current. In addition, the cross-sectional shape of the direction orthogonal to the longitudinal-axis direction of the wire which comprises the perimeter cutting device 20 is not limited circularly. The thickness of the wire constituting the all-round incision device 20 means the maximum dimension in the direction orthogonal to the longitudinal axis direction of the wire.

In the full circumference incision device 20, the thickness of the tip region 20d from the tip of the full circumference incision device 20 to the predetermined position from the tip end side may be configured by a linear member having a diameter of less than 0.2 mm. The predetermined position from the distal end to the proximal end of the entire circumferential incision device 20 where the distal end region 20d is formed is appropriately set according to the size of the lesion P to be ablated. Taking into account the simultaneous incision of the lesion P, it is assumed that the length of 1.2 to 2.0 times the dimension of the lesion P in the insertion direction (longitudinal axis direction) of the endoscope insertion portion 110 is a predetermined length. A wide range of incisions is possible with a single energization.

If the thickness of the tip region 20 d of the all-round incision device 20 is further less than 0.1 mm, a higher density high frequency current can be supplied to the all-round incision device 20. Furthermore, the adhesion area of the circumferential incision device 20 to the tissue to be ablated is reduced, and the adhesion to the tissue is improved. In addition, since the size of the portion attached to the tissue to be ablated in the direction orthogonal to the longitudinal axis direction of the all-round incision device 20 becomes extremely small, the high frequency current concentrates and flows in the extremely narrow region. As a result, the tissue is easily incised and sharply incised. Therefore, the tissue can be clearly cut along the all-round incision device 20 by a simple operation as compared with the conventional high-frequency snare that applies a high-frequency current while tightening a lesion with a snare. Also, a sharp cut is formed along the shape of the all-round incision device 20.

As shown in FIG. 1, the operation unit 40 includes an operation unit main body 41 connected to the proximal end of the sheath 10, a slider 42 attached to the operation unit main body 41, and a connector 43.

The connection wire 30 is connected to the slider 42. Therefore, by advancing and retracting the slider 42 with respect to the operation unit main body 41, the connection wire 30 advances and retracts with respect to the sheath 10, and the all-round incision device 20 projects and retracts with respect to the sheath 10 at the distal end side of the sheath 10. Be done. In the present embodiment, when the slider 42 is advanced with respect to the operation unit main body 41, the entire circumferential incision device 20 is protruded from the distal end opening 11 of the sheath 10. When the slider 42 is retracted with respect to the operation unit main body 41, the full circumferential incision device 20 is sequentially housed inside the sheath 10.

The connector 43 can be connected to a high frequency power supply (not shown) and is connected to the proximal end of the connection wire 30. The connector 43 can supply the high frequency current supplied from the high frequency power supply device to the connection wire 30. Since the connection wire 30 is electrically connected to the all-round incision device 20, the high frequency current supplied from the high-frequency power supply device is transmitted to the all-round incision device 20 via the connection wire 30.

Next, a mode of use of the endoscopic treatment tool 1 will be described by taking a submucosal dissection method for excising a lesion site (early cancer etc.) P formed in the large intestine using the endoscopic treatment tool 1 as an example. FIG.2 and FIG.3 is a schematic diagram which shows the usage example of the treatment tool 1 for endoscopes. FIG. 4 is a flowchart showing a submucosal dissection method (tissue dissection method) using the endoscopic treatment tool 1.

As preparation work, the operator identifies the lesion P by a known method and bulges the lesion P. Specifically, the endoscope insertion portion 110 of the endoscope apparatus 100 is inserted into the large intestine, and the operator specifies the lesion P while observing the image obtained by the endoscope 101. Next, a known submucosal injection needle (not shown) is inserted into the treatment instrument channel 102 of the endoscope insertion portion 110, and a local injection between the lesion P and the muscle layer W3 is performed by the submucosal injection needle. The lesion P is inflated by injecting a liquid (bulking agent) for injection.
After injecting the bulging agent, the submucosal injection needle is withdrawn from the treatment instrument channel 102.

Subsequently, the endoscope treatment tool 1 is inserted into the treatment tool channel 102 and is protruded from the distal end of the endoscope insertion portion 110. The distal end portion of the sheath 10 is projected to the upper side of the lesion P while confirming the image of the endoscope 101 (step S1). Thereafter, the slider 42 of the operation unit 40 is advanced with respect to the operation unit main body 41 and the tip of the all-round incision device 20 is protruded from the tip opening 11 of the sheath 10. Placed on the side. The all-round incision device 20 is small in diameter, highly flexible, and can be bent by its own weight. Thus, when pushed out from the distal end opening 11 of the sheath 10, the all-round incision device 20 bends and bends and abuts on the mucosal tissue. In this state, the endoscope insertion unit 110 or the endoscope treatment tool 1 is appropriately advanced and retracted, and the entire circumferential incision device 20 is retracted while being in contact with the surface of the mucous layer, as shown in FIG. The total circumferential incision device 20 is disposed so as to surround the portion P, and the total circumferential incision device 20 is in close contact with the mucosal layer W1 around the lesion P (step S2).

Since the all-round incision device 20 is made of a small diameter wire, the all-round incision device 20 can be adhered by the viscosity of the mucous layer W1 simply by arranging and attaching it on the mucous layer W1. Therefore, the operation for strongly pressing the all-round incision device 20 on the mucosal layer W1 and the structure for strongly pressing the all-round incision device 20 on the mucosal layer W1 become unnecessary, and the all-round incision device 20 is formed into the mucosal layer W1 by a simple operation. It can be attached closely.
At this time, if the all-round incision device 20 is disposed after applying a known bioadhesive to the mucous layer in advance, the all-round incision device 20 can be more easily adhered to the mucous layer.

Subsequently, the operator operates the high frequency power supply device to supply a high frequency current to the circumferential incision device 20 through the connector 43 and the connection wire 30. At this time, first, the mucosal layer W1 to which the all-round incision device 20 is attached is incised first, and then the snare 21 is attached to the underlying layer W2 which is the lower layer, and the incision is incised. Since the total circumferential incision device 20 has a small diameter, the high frequency density is high even with the same amount of current as the conventional high frequency incision device. Therefore, in a short time (a few seconds), the mucous layer W1 and the submucosal layer W2 of the portion to which the all-round incising device 20 is attached are incised (step S3). That is, the mucosal layer W1 and the submucosal layer W2 are incised along the all-round incision device 20 by performing the step of supplying a high-frequency current following the step of attaching the all-round incision device 20 onto the mucosal layer W1. . Thereafter, the endoscopic treatment tool 1 is removed from the all-round incision device 20 or the treatment tool channel 102, and a conventional high frequency snare is inserted, and the lesion P is squeezed by narrowing the all-round incision device 20 or the conventional high frequency snare. By binding, the tumor can be excised at once (step S4).

In addition, by applying a high-frequency current to the all-round incision device 20 while pulling the entire endoscope toward the near side in a state where the entire surrounding incision device 20 surrounds the lesion P, the all-round incision device 20 is viewed from the tip The tissue is incised while moving toward the proximal end, and finally the lesion P can be easily excised at once. As a result, since it is not necessary to bind the lesion P as in the prior art, it is possible to prevent the muscle layer W1 from being incised. Therefore, the endoscopic treatment tool 1 according to the present embodiment can easily perform a total circumferential incision in a shorter time than conventional ESD, can collectively excise a larger tumor than conventional EMR, and can perform hybrid ESD or all ESD It is possible to easily incise the treatment target site without requiring a long and delicate operation such as in the case of the incision of the mucosal layer and the submucosal layer with a high frequency knife as in the circumferential incision EMR.

The “incision” of the tissue by the incision (full circumferential incision device 20) in the present embodiment refers to cutting open the tissue around the lesion P. Therefore, the “incision” of the tissue includes a step before incision is made in the mucous layer and the submucosal layer as in this embodiment to separate the lesion P from the large intestine.
Also, “ablation of diseased tissue” refers to cutting into the mucous layer and submucosal layer to separate the lesion P from the large intestine.

According to the endoscope treatment tool 1 according to the present embodiment, the all-round incision device 20 for cutting tissue is made of a conductive member, and from the tip of the all-round incision device 20 to a predetermined position from the proximal end side The high-frequency current flows in the all-round incision device 20 when the high-frequency current is supplied to the all-round incision device 20, because . As a result, the tissue can be incised without the operation of reducing the diameter of the conventional snare only by attaching the all-round incision device 20 through which the high-density high-frequency current flows to the tissue to be resected (mucosal tissue). As a result, it is possible to make an incision in a short time without the need for an incision with a high-frequency knife for a long time using a high-frequency knife as in the conventional ESD, hybrid ESD, and all-round incision EMR.

In addition, since the mucous membrane can be dissected simply by attaching the all-round incision device 20 through which high-density high-frequency current flows to the mucous membrane tissue, the amount of incision (incision depth) It can be adjusted. As a result, it is possible to prevent excessive dissection of tissue, and it is possible to easily dissect only the mucous layer W1 and the submucosal layer W2 even if the intestinal wall is a thin tissue such as the large intestine.

According to the endoscopic treatment tool 1 according to the present embodiment, since the linear members constituting the all-round incision device 20 are thin and highly flexible, the all-round incision device 20 protruding from the distal end opening 11 of the sheath 10 is It easily adheres to the tissue to be resected. Therefore, the high frequency current is supplied in a state where the whole circumferential incision device 20 is in close contact with the mucous layer W1, and the mucosal layer W1 and the submucosal layer W2 of the portion to which the full circumferential incision device 29 is attached It becomes possible to perform a batch incision by energizing. As a result, a wide range of incisions can be performed by a single short time of energization, and an incision around the lesion can be made in a short time.

In addition, according to the endoscopic treatment tool 1 according to the present embodiment, the diameter of the linear member (conductive wire 33) constituting the all-round incision device 20 is reduced to be equivalent to the conventional high frequency snare. The tissue in contact with the circumferential incision device 20 can be dissected only by flowing a high frequency current through the circumferential incision device 20. Therefore, the existing high frequency current supply device can be used, and the versatility is high.

In the above embodiment, the conductive wire 33 of the entire closed loop shape portion of the all-round incision device 20 is exposed and the whole of the all-round incision device 20 constitutes an incision. It may be formed in the tip region 20d. For example, as shown in FIG. 5, the conductive wire 33 is exposed in a predetermined range from the tip of the all-round incision device 20, and the conductive wire 33 is exposed and the nonconductive member 32 covering the connection wire 30 is extended to the tip side The conductive wire may be covered on the proximal side of the region 20 d.

In addition, the connection portion between the tip of the connection wire 30 and the base end of the closed ring-shaped conductive wire 33 is covered with the nonconductive member 32 covering the connection wire 30, thereby forming a Y-shaped branch portion. May be Thus, by forming the branched portion, it is possible to easily maintain the closed ring shape even in the conductive wire 33 having high flexibility.

Besides, as shown in FIG. 5,

weights

241, 242, 243 may be provided in the tip region 20 d of the total circumferential incision device 20. The

weights

241, 242, 243 are easily attached to the tissue around the lesion P by providing the

weights

241, 242, 243 in portions excluding the portion where the circumferential incision device 20 adheres to the tissue around the lesion P can do. When providing a weight, by providing at least one weight in the tip region of the all-round incision device 20, an effect of assisting the adhesion of the all-round incision device 20 can be obtained. The example shown in FIG. 5 shows an example in which a weight 241 at the tip end of the snare 21 and

weights

242 and 243 provided on the base end side at equal distances from the weight 241 at the tip end are provided. Further, by arranging a plurality of weights at equal intervals, it is easy to arrange the all-round incising device 20 at the targeted portion in step S2 of attaching the all-round incising device 20 to the tissue around the lesion P. it can.

In the modified example shown in FIG. 5, an example in which the incision is provided only in the tip region 20d, an example in which the Y-shaped branch 25 is provided, and an example in which the

weights

241, 242 and 243 are provided are shown in one figure. It is not necessary to have all these. Therefore, any one of the modifications may be added, or a plurality of modifications may be combined.

Second Embodiment
The endoscope treatment tool 1A of the second embodiment will be described. In the second embodiment, the same parts as those in the first embodiment are indicated by the same reference numerals and the description thereof is omitted. FIG. 6 is a plan view showing the endoscope treatment tool 1A according to the second embodiment.

The endoscope treatment tool 1A according to the present embodiment differs from the first embodiment in the configuration of the incision. The incision in this embodiment is a linear wire (incision) 23 having an end at the tip. The linear wire 23 has a diameter of 35 mm, and a weight 244 is provided at the tip. The other configuration of the incision is the same as that of the first embodiment.

In the endoscope treatment tool 1A according to the present embodiment, as in the first embodiment, after the distal end portion of the sheath 10 is disposed above the lesion P, the linear wire 23 is protruded. At this time, when the sheath 10 is moved so as to avoid the upper part of the lesion P under observation of the endoscope 101, the linear wire 23 is around the lesion P and the length of the endoscope insertion portion 110 It is arranged on one side on the extension of the axis (one side to the left and right of the observation view of the endoscope 101).

At this time, if the bending wire is provided in advance to the wire forming the linear wire 23, when projecting the linear wire 23, the upper portion of the lesion P is avoided and the linear wire 23 is It can be easily placed around.

As in step S3 of the first embodiment, a high frequency current is supplied to the linear wire 23, and the mucous layer W1 and the submucosal layer W2 on one side of the periphery of the lesion P are cut. Subsequently, the operation unit 40 is rotated 180 degrees, and the linear wire 23 is disposed on the other side of the extension of the longitudinal axis of the endoscope insertion unit 110 (the other side of the observation field of the endoscope 101). . Thereafter, as in step S3 of the first embodiment, a high frequency current is supplied to the linear wire 23, and the mucous layer W1 and the submucosal layer W2 on the other side of the lesion P are incised. That is, the entire circumference of the lesion P is incised by two energizations.
Subsequently, the same procedure as step S4 and subsequent steps in the first embodiment is performed.

The present invention, unlike the conventional high frequency knife, eliminates the step of incising the tissue around the lesion P for a long and delicate operation, and adheres the linear wire 23 to the tissue to supply a high frequency current. Tissue can be dissected. For this reason, the cut-out portion is not limited to a loop-shaped snare, and even if the linear wire 23 as shown in FIG. 6 is a cut-out portion through which high-density high-frequency current flows as in the first embodiment. The mucosal tissue can be dissected simply by attaching

Furthermore, according to the endoscopic treatment tool 1A according to the present embodiment, the weight 244 is provided at the distal end region 20d of the linear wire 23, whereby the linear wire 23 is in close contact with the tissue to be cut. Can be kept stable. In addition, since the linear wire 23 can be positioned by moving the weight 244, the operation of arranging the wire around the lesion P can be facilitated even if the incision is highly flexible.

Also in the linear wire 23 of the present embodiment, as in the modification shown in the first embodiment, the incision may be provided only in the distal end region 20 d and the proximal end may be covered with the nonconductive member 32. Further, a plurality of weights may be provided on the linear wire 23.

When the

endoscopic treatment tools

1 and 1A shown in the first and second embodiments are used for excision of a lesion P such as a polyp of the large intestine, the size of the lesion P is 2 cm or more. It can be used suitably.

In the

endoscopic treatment tools

1 and 1A of the first and second embodiments, a water jet function may be provided inside the sheath 10.
In the hybrid ESD and the all-round incision EMR, which is the prior art, after the whole circumference of the lesion P is incised, the fluid such as saline is again localized to widen the space between the mucosal layer W1 and the muscle layer W3. To inject. At the time of this relocalization injection, it takes time and effort to replace the

endoscope treatment instrument

1 or 1A with the treatment instrument for the local injection through the endoscope channel 102. Therefore, as in the endoscopic treatment tool 1B of the modified example shown in FIG. 7, the water treatment port 45 is provided in the operation unit 40 in the

endoscopic treatment tools

1 and 1A of the first and second embodiments, A water jet function (not shown) is provided inside the sheath 10. After making a full incision around the lesion P, the distal end opening 11 of the sheath 10 is disposed close to the portion to be incised, liquid is supplied to the inside of the sheath 10 through the water supply port 45, and the water jet function of the sheath 10 is achieved. The liquid is jetted from the tip opening 11. As a result, it is possible to locally inject the liquid from the incision site which has been cut all around. According to the endoscopic treatment tool 1B of the present modification, since it has been possible to carry out all-round incision, relocal injection, and snare removal with one device, it is possible to perform all-round incision of the lesion P in a short time.

Example 1
A stainless steel single-wire wire with a diameter of 0.1 mm was prepared as a wire constituting the incision of the incision device. The connection wire was a stainless steel stranded wire with a diameter of 0.5 mm. A wire for incision was fixed in a closed loop shape at the tip of the connecting wire. The outer periphery of the connection wire was covered with an insulator. An incision was attached to the mucosal tissue of the bovine large intestine which was injected locally with a bulging agent. As a high frequency current supply device, a high frequency current was supplied to the incision for 10 seconds in "cut mode" using an Olympus product (ESG-100). As a result, it was visually confirmed that the mucosal tissue was incised to a depth of 5 mm along the adhesion position of the incision. In addition, no tissue coagulation was observed on the cut surface.

(Example 2)
A single-wire wire made of tungsten with a diameter of 0.1 mm was prepared as a wire constituting the incision of the incision device. The connection wire was a stainless steel stranded wire with a diameter of 0.5 mm. A wire for incision was fixed in a closed loop shape at the tip of the connecting wire. In the same manner as in Example 1, a high frequency current is supplied to the incision for 3 seconds in the "cut mode" of the high frequency current supply device with the incision being in contact with the mucosal tissue of the bovine large intestine locally injected with a bulging agent. did. As a result, it was visually confirmed that the mucosal tissue was incised along the adhesion position of the incision.

(Comparative example 1)
A 0.3 mm diameter stainless steel stranded wire was prepared as a wire constituting the incision of the incision device. The other configuration was the same as that of the first embodiment, and a treatment tool for endoscope was prepared. As in Example 1, a high frequency current was supplied to the incision for 20 seconds in the “cut mode” of the high frequency current supply device while the incision was in contact with the mucous membrane tissue of the bovine large intestine.

(Comparative example 2)
A 0.3 mm diameter stranded wire made of tungsten was prepared as a wire forming the incision of the incision device. The rest of the configuration is the same as that of the embodiment. As in Example 1, a high frequency current was supplied to the incision for 20 seconds in the “cut mode” of the high frequency current supply device while the incision was in contact with the mucous membrane tissue of the bovine large intestine.

As a result of conducting the same test as Example 1 using the treatment tool for endoscopes of Comparative Example 1 and Comparative Example 2, although a place where the mucous membrane was burnt was visually observed, the cut off part was I could not confirm. Also, the burnt area of the mucous membrane was dispersed at the position corresponding to the closed loop-shaped incision. This is considered to be due to the fact that the incision did not adhere to the mucous membrane and the current density was insufficient.

From the above, it is shown that Example 1 and Example 2 both have high cutting performance.
On the other hand, in Comparative Example 1 and Comparative Example 2, the mucosal tissue could not be dissected.
(Example 3)
A device in which a water jet function was added to the sheath portion of the incision device of Example 1 was prepared. In the same manner as in Example 1, a circular incision is made on the mucosal tissue of the bovine large intestine locally injected with a bulging agent, and then saline is locally injected to the tissue (section to be incised) incised from the tip opening of the sheath by a water jet function. did. Thereafter, the wire portion of the same incision device was drawn into the sheath to narrow the tissue into a snare shape, and the local injection portion was excised. As a result, no perforations occurred, and all circumferential incisions, relocalized injection, and snare excision could be performed with one device, so it was possible to respond in a short time.

The present invention includes the following technical ideas.
(Appendix 1)
A sheath which can be inserted into a channel of an endoscopic device, a connection wire which can be inserted back and forth in the longitudinal axis of the sheath, and the connection wire, which can be protruded from a distal end opening of the sheath And a method of incising the periphery of a lesion using an endoscopic treatment tool comprising an incision made of a conductive member.
The incision portion is formed of a linear member having a diameter of less than 0.2 mm in a distal end region from a distal end to a proximal end of the incision.
Projecting the incision from the distal end opening of the sheath and attaching the incision around the lesion;
Applying a high frequency current to the incised portion to collectively incise the periphery of the affected area;
A tissue incision method comprising:

(Appendix 2)
The tissue incision method according to item 1, wherein the periphery of the lesion area having a diameter of 2 cm or more is incised at the incision.

(Appendix 3)
A sheath which can be inserted into a channel of an endoscopic device, a connection wire which can be inserted back and forth in the longitudinal axis of the sheath, and the connection wire, which can be protruded from a distal end opening of the sheath And a method of incising the periphery of a lesion using an endoscopic treatment tool comprising an incision made of a conductive member.
An incision step in which a high-frequency current is applied to the incision portion to partially or completely surround the periphery of the lesion expanded by the local injection;
After the dissection step, using a loop-like endoscopic treatment tool, an excision step of cutting out the affected area by squeezing the affected area without applying a high frequency current;
Lesion resection technique with.

(Appendix 4)
The incision constitutes a closed loop;
The lesion portion excision procedure according to claim 3, wherein the lesion portion is narrowed using the incision portion in the excision step.

According to the aforementioned lesion excision procedure, it is possible to suppress the occurrence of heat invasion to the muscle layer as in the conventional high frequency snare. Specifically, since the musculoskeletal plate on the upper surface of the tumor has hardened, conventionally, when excising the tumor with a snare without applying a high frequency current, the range in which the tumor can be narrowed with the snare was narrow. However, if the mucous membrane plate around the tumor is incised in advance at the above-mentioned incision, only the soft submucosa layer may be squeezed with a snare. As a result, even in the case of a relatively large tumor, it is possible to make an incision with a snare without conducting a high frequency current after making an incision at the periphery of the tumor. Further, since heat invasion to the muscle layer does not occur as in the case of tumor incision with a conventional high frequency snare, delayed hemorrhage does not occur, and early healing after incision can be realized.

The embodiment of the present invention has been described in detail with reference to the drawings, but the specific configuration is not limited to this embodiment, and design changes and the like within the scope of the present invention are also included.
Moreover, it is possible to combine and comprise the component shown in the above-mentioned each embodiment suitably.

It is possible to provide an endoscopic treatment tool capable of incising the periphery of a lesion in a short time by a simple operation.

1, 1A, 1B Treatment tool for endoscope 20d Tip region 20 Whole circumference incision device (incision portion)
23 Wire Wire (Incision)
30 connection wire 100 endoscope apparatus 102 treatment instrument channel (channel)
241, 242, 243, 244 weights

Claims

A sheath that can be inserted into the channel of the endoscopic device;
A connection wire which can be advanced and retracted in its longitudinal axis direction in the sheath;
An incision portion connected to the connection wire and projectable from the distal end opening of the sheath and made of a conductive member;
The endoscope treatment tool according to claim 1, wherein the incision portion is formed of a linear member having a diameter of less than 0.2 mm in a distal end region from a distal end to a proximal end side of the incision.
The endoscope treatment tool according to claim 1, wherein the thickness of the distal end region of the incision portion is less than 0.1 mm.
The endoscope treatment tool according to claim 1, further comprising at least one weight in the tip end region of the incision.
The endoscope treatment tool according to claim 1, further comprising a water jet function in the sheath.