WO2021181503A1 - Surtube pour endoscope, système endoscopique et procédé d'insertion d'endoscope - Google Patents

Surtube pour endoscope, système endoscopique et procédé d'insertion d'endoscope Download PDF

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Publication number
WO2021181503A1
WO2021181503A1 PCT/JP2020/010187 JP2020010187W WO2021181503A1 WO 2021181503 A1 WO2021181503 A1 WO 2021181503A1 JP 2020010187 W JP2020010187 W JP 2020010187W WO 2021181503 A1 WO2021181503 A1 WO 2021181503A1
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WO
WIPO (PCT)
Prior art keywords
endoscope
overtube
space
balloon
airtight
Prior art date
Application number
PCT/JP2020/010187
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English (en)
Japanese (ja)
Inventor
達矢 樋口
Original Assignee
オリンパス株式会社
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Application filed by オリンパス株式会社 filed Critical オリンパス株式会社
Priority to PCT/JP2020/010187 priority Critical patent/WO2021181503A1/fr
Publication of WO2021181503A1 publication Critical patent/WO2021181503A1/fr

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    • 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
    • A61B1/005—Flexible endoscopes
    • A61B1/01—Guiding arrangements therefore
    • G—PHYSICS
    • G02—OPTICS
    • G02B—OPTICAL ELEMENTS, SYSTEMS OR APPARATUS
    • G02B23/00—Telescopes, e.g. binoculars; Periscopes; Instruments for viewing the inside of hollow bodies; Viewfinders; Optical aiming or sighting devices
    • G02B23/24—Instruments or systems for viewing the inside of hollow bodies, e.g. fibrescopes

Definitions

  • the present invention relates to an endoscopic overtube. Furthermore, an endoscopic system equipped with this endoscopic overtube and a method of inserting the endoscope into the endoscopic overtube are also mentioned.
  • Endoscopic overtubes for use through endoscopes are known.
  • body fluids and the like that have entered the overtube may leak from the end of the overtube outside the body.
  • gas such as air or carbon dioxide gas sent from the endoscope into the lumen of the body may leak from the end of the overtube.
  • the lumen may not be maintained in a sufficiently dilated state, and the inside of the lumen may not be properly observed.
  • Patent Document 1 describes an endoscopic overtube provided with a balloon-type airtight valve. By inflating the balloon-type airtight valve to close the gap between the endoscope and the overtube, it is possible to prevent the above-mentioned leakage of body fluid, gas, or the like.
  • an object of the present invention is to provide an endoscopic overtube capable of preventing leakage of body fluids and the like without excessively increasing the internal pressure of the balloon-type airtight valve.
  • a first aspect of the present invention is an endoscopic overtube comprising a body having a flexible tubular portion and a tubular airtight balloon joined within the body.
  • the airtight balloon is provided between two or more joints to be joined to the inner surface of the main body, and at least a part of the outer diameter is the joint in a no-load state where the pressure inside and outside the tubular shape is the same. It has an intermediate portion smaller than the portion, and a space is formed between the inner surface of the main body and the intermediate portion.
  • a second aspect of the present invention includes an endoscope overtube according to the first aspect and an endoscope having an insertion portion that can be inserted into the main body, and the insertion portion is larger than that of the endoscope overtube. It is a long endoscopic system.
  • a third aspect of the present invention relates to the first aspect, wherein an endoscope having an insertion portion having an outer diameter that can be inserted into the main body is provided in an endoscope overtube further provided with a fluid moving port communicating with the space.
  • This is a method of inserting an endoscope to be inserted.
  • step A in which the inside of the space is made negative pressure by sucking the fluid in the fluid movement port or the writing space, and the insertion part is inserted into the overtube for the endoscope to make the inside of the space negative pressure.
  • a step B for passing the intermediate portion and a step C for releasing the negative pressure are provided.
  • an endoscopic overtube capable of preventing leakage of body fluid or the like without excessively increasing the internal pressure of the balloon-type airtight valve.
  • FIG. 1 is an overall view of an endoscope overtube (hereinafter, simply referred to as “overtube”) 1 of the present embodiment.
  • the overtube 1 includes a main body 2 through which an endoscope is passed.
  • the main body 2 includes a flexible tubular portion 10 and an operating portion 20 attached to the tubular portion 10.
  • the tubular portion 10 is made of a flexible material such as silicone.
  • the tip side of the tubular portion 10 is gradually reduced in diameter, making it easier to insert into the body.
  • a tubular indwelling balloon 11 is attached to the tip of the tubular portion 10.
  • the indwelling balloon 11 is made of a flexible material such as silicone, urethane, or latex.
  • a fluid tube 12 is connected to the indwelling balloon 11, and the indwelling balloon 11 can be inflated by supplying a fluid from a syringe, a pump, or the like via the fluid tube 12.
  • FIG. 2 is a schematic cross-sectional view of the operation unit 20.
  • the operation unit 20 has a cylindrical base 21 and an airtight balloon 30 attached to the base 21.
  • the material of the base 21 is not particularly limited, and resins, metals, silicone rubber, and the like can be exemplified.
  • the base end portion of the tubular portion 10 enters the base 21 from the tip end side of the base 21, and the tubular portion 10 and the base 21 are joined to each other. As a result, the internal space of the tubular portion 10 and the internal space of the base 21 communicate with each other.
  • a tubular port (fluid moving port) 22 is formed so as to project on the outer peripheral surface of the base 21. As shown in FIG. 2, the internal space of the port 22 communicates with the internal space of the base 21.
  • the airtight balloon 30 is a tubular member made of the same material as the indwelling balloon 11.
  • FIG. 3 shows a perspective view of the airtight balloon 30, and
  • FIG. 4 shows a front view and a plan view of the airtight balloon 30.
  • the airtight balloon 30 has cylindrical joints 31 on both sides in the axial direction of the tubular shape, that is, on both the upper and lower sides in FIG. 4, and has an intermediate portion 32 between the joints 31.
  • the outer diameter of the intermediate portion 32 is smaller than the outer diameter of the joint portion 31 at least in part. In the present embodiment, the outer diameter of the intermediate portion 32 decreases as the distance from the joint portion 31 increases, and becomes the smallest at the central portion in the axial direction.
  • the airtight balloon 30 is arranged in the base 21 as shown in FIG.
  • the airtight balloon 30 covers the inner surface of the base 21 including the communication portion with the port 22 by joining the outer peripheral surface of the joint portion 31 to the inner surface of the base 21 by adhesion or the like.
  • a tubular space Sp communicating with the port 22 is formed between the intermediate portion 32 and the inner surface of the base 21.
  • the intermediate portion 32 is not joined to the inner surface of the base 21, and protrudes from the inner surface of the base 21. That is, the inner diameter of the portion of the base 21 where the intermediate portion 32 is arranged is defined by the intermediate portion 32, and the inner diameter is smaller than that of the other portions of the base 21. Since the space Sp communicates with the port 22, the fluid can be supplied into the space Sp from the port 22 or the fluid in the space Sp can be sucked out.
  • the length of the overtube 1 is shorter than the insertion portion of the colonoscope.
  • the overtube 1 is about 50 to 70 cm shorter than the insertion portion.
  • the inner diameter of the base 21 is larger than the outer diameter of the insertion portion of the colonoscope.
  • the minimum inner diameter of the intermediate portion 32 of the airtight balloon 30 is preferably slightly smaller than the outer diameter of the insertion portion. Details of this point will be described later.
  • a colonoscope (hereinafter, may be simply referred to as an "endoscope") is passed through the overtube 1.
  • the intermediate portion 32 is the airtight balloon 30 shown in FIG. It projects into the base 21 according to the initial shape.
  • ESD when only the treatment tool passed through the treatment tool channel of the endoscope is used, the endoscope is inserted into the overtube 1 from the proximal end side where the base 21 is located.
  • the minimum inner diameter of the intermediate portion 32 of the airtight balloon 30 is equal to or less than the outer diameter of the insertion portion of the endoscope, a part of the intermediate portion 32 is the entire outer peripheral surface of the insertion portion just by inserting the endoscope. The contact is made over the circumference, and the gap between the overtube 1 and the endoscope is closed. Therefore, it is not necessary to supply the fluid into the airtight balloon 30.
  • the colonoscope Ce A cap 102 to which an external channel 101 is connected is attached to the tip of the.
  • the outer diameter of the portion to which the cap 102 is attached becomes large, so that it may be difficult to insert the cap 102 into the overtube 1 when the intermediate portion 32 is projected.
  • a syringe as a fluid moving means is attached to the port 22.
  • the operation tube 50 having the cock 51 is connected to the port 22, and the syringe 60 is connected to the cock 51.
  • the syringe 60 may be directly connected to the port 22.
  • an elastic plug 52 is attached to the cock 51.
  • the plug 52 is provided with a cut 52a. When the syringe 60 is connected to the cock 51, the plug 52 is compressed to open the cut 52a, and when the syringe 60 is removed, the cut 52a is closed again.
  • the intermediate portion 32 is in close contact with the inner surface of the base 21, and the inner diameter of the portion where the intermediate portion 32 is arranged becomes large (step A).
  • step A the intermediate portion 32 is less likely to interfere with the endoscope. As a result, even the endoscope Ce to which the cap 102 is attached can be smoothly inserted into the overtube 1.
  • step C After the cap 102 has passed, the user releases the negative pressure, returns the intermediate portion 32 to the initial shape, and brings it into contact with the insertion portion of the endoscope Ce (step C).
  • the syringe 60 may be operated to supply a fluid into the space Sp, and the internal pressure of the space Sp may be higher than the atmospheric pressure.
  • step C the gap between the endoscope Ce and the external channel 101 and the base 21 is closed by the airtight balloon 30 in the base 21, as schematically shown in FIG. In FIG. 9, the internal structure of the endoscope Ce is omitted.
  • the user projects the insertion part of the colonoscope inserted into the overtube 1 by about 50 to 70 cm from the overtube 1 (step B).
  • the user inserts the colonoscope Ce from the anus into the large intestine, and moves the tip of the colonoscope Ce to the vicinity of the treatment site Ts as shown in FIG. 10 (step D).
  • step E The user observes the treatment site Ts with the endoscope Ce and determines the rough position of the endoscope Ce during the treatment. Then, the overtube 1 is inserted into the large intestine, and as shown in FIG. 11, the overtube 1 is advanced along the endoscope Ce (step E). In the example shown in FIG. 10, the overtube 1 is still outside the body at the end of step D because the treatment site Ts is close to the anus. When the treatment site Ts is located far from the anus, the overtube 1 is inserted into the large intestine before the tip of the endoscope Ce reaches the treatment site Ts, and the endoscopic Ce is advanced and overtube. The advance of 1 may be repeated alternately. That is, step E may be performed in the middle of step D.
  • the user introduces a fluid from the fluid tube 12 into the indwelling balloon 11 to inflate the indwelling balloon 11 (step F).
  • the fluid may be either a gas or a liquid.
  • the indwelling balloon 11 is sufficiently inflated, the indwelling balloon 11 comes into contact with the inner wall of the large intestine, and the overtube 1 is fixed to such an extent that it does not easily move relative to the large intestine Cl.
  • the user performs ESD of the treatment site Ts using the treatment tool protruding from the endoscope.
  • the cap 102 is attached, as shown in FIG. 13, the mucosa Mc can be lifted and held by the forceps 105 passed through the external channel 101.
  • the submucosal layer Sm below the tumor Tm can be easily peeled off with a high-frequency knife (not shown) protruding from the treatment tool channel of the endoscope Ce.
  • step D liquid or gas in the large intestine Cl may enter the overtube 1 from the tip of the overtube 1.
  • the airtight balloon 30 closes the gap between the endoscope Ce and the external channel 101 and the base 21, and the airtightness and the liquidtightness are maintained, so that body fluid, gas, or the like leaks from the base 21. Is prevented.
  • the overtube 1 of the present embodiment includes the airtight balloon 30 in which the intermediate portion 32 protrudes from the inner surface of the base 21 in the initial shape, the overtube 1 is placed between the overtube 1 and the endoscope inserted with a small fluid supply amount. Airtightness and liquidtightness can be ensured.
  • the insertion part of the colonoscope Ce described above is longer than the endoscope for the upper gastrointestinal tract. Furthermore, since the large intestine meanders in a complicated manner, when the treatment site is present in the ascending colon, a plurality of strongly curved sites may occur before reaching the treatment site. In this case, the overtube 1 is also strongly curved like the endoscope Ce, and the friction when advancing and retreating the endoscope Ce with respect to the overtube 1 is much larger than that of the endoscope for the upper gastrointestinal tract.
  • the overtube 1 of the present embodiment can secure airtightness and liquidtightness with an endoscope inserted with a small amount of fluid supply, and can secure airtightness and liquidtightness without supplying fluid by setting appropriate dimensions. Is also possible. Therefore, the endoscope system of the present embodiment provided with the overtube 1 can both prevent a decrease in operability and ensure airtightness and liquidtightness, especially when used in the large intestine.
  • the difficulty of ESD in the large intestine is higher than that in the stomach. Stabilizing the position of the endoscope Ce in the large intestine using the overtube 1 and the above-mentioned method in combination with the cap 102 are effective for simplifying ESD in the large intestine.
  • the shape and dimensions of the airtight balloon are set according to the outer diameter when the cap 102 is attached, the gap between the airtight balloon and the insertion portion after the tip portion has passed through the base becomes large. As a result, the amount of fluid required to close the gap increases, the internal pressure of the airtight balloon also increases, and the friction between the endoscope and the airtight balloon increases.
  • the airtight balloon 30 of the present embodiment can bring the intermediate portion 32 into close contact with the inner surface of the base 21 by executing step A in which the inside of the space Sp is made negative pressure. Therefore, according to the method of inserting the endoscope of the present embodiment including step A, the tip portion to which the cap 102 is attached can be easily passed regardless of the initial shape of the intermediate portion 32. Further, by executing the step C of releasing the negative pressure after passing through the cap 102, airtightness and liquidtightness can be ensured with a small amount of fluid supply even for a non-circular cross-sectional shape such as that accompanied by an external channel 101. ..
  • step C may be performed before or after step B. Further, after step C, the amount of fluid supplied into the airtight balloon 30 may be increased or decreased.
  • the entire intermediate portion does not necessarily have to follow the inner surface of the base. That is, the negative pressure may be such that the intermediate portion contracts to the extent that the endoscope or the like can pass smoothly.
  • the operation tube 50 may be connected to the port 22 in advance. The operation tube 50 does not have to include the cock 51.
  • FIG. 14 is a cross-sectional view of the operation unit 220 in the overtube 201 of the present embodiment.
  • Each joint portion 231 of the airtight balloon 230 has a disk shape and is joined to the front and rear end faces of the base 21.
  • the outer diameter of the intermediate portion 232 is the same over the entire length, and is smaller than the outer diameter of the joint portion 231.
  • the middle portion 232 covers the entire inner surface of the base 21.
  • the inner diameter of the operating portion 220 becomes the inner diameter of the intermediate portion 232 over the entire length.
  • the intermediate portion 232 can be brought into close contact with the inner surface of the base 21 by creating a negative pressure in the space Sp, which is the same as that of the first embodiment.
  • the overtube 201 of the present embodiment can secure airtightness and liquidtightness with the endoscope inserted with a small amount of fluid supply. Since the intermediate portion of the airtight balloon 230 has the same diameter over the entire length, the contact area with the inserted endoscope becomes large. As a result, it is easier to secure airtightness and liquidtightness than in the first embodiment.
  • the shape of the middle part of the airtight balloon can be changed in various ways other than the above-mentioned example.
  • it may have two or more protrusions in the axial direction.
  • -A hydrophilic coating may be applied to the inner surface of the airtight balloon.
  • the overtube may have a mechanism for adjusting the pressure in the space Sp.
  • the operation tube 50 is connected to the port 22 in advance.
  • the operation tube 50 has a pressure adjusting balloon 70.
  • the pressure adjusting balloon 70 does not expand until the pressure in the space Sp reaches a predetermined value, and then expands after reaching a predetermined value.
  • FIG. 17 shows the relationship between the amount of air supplied from the syringe 60 in the overtube 1A and the internal pressure of the space Sp. Until the internal pressure of the space Sp reaches the predetermined value P1, the pressure adjusting balloon 70 does not expand and the airtight balloon 30 expands. When the internal pressure reaches a predetermined value P1, the pressure adjusting balloon 70 starts to expand.
  • the pressure adjusting balloon 70 is inflated by the air supply from the syringe 60, and the increase in the internal pressure of the space Sp is suppressed.
  • the internal pressure value of the space Sp is maintained within a predetermined range before and after P1 in a certain range of air supply amount until the expansion limit of the pressure adjusting balloon 70 is reached, and it is prevented from being excessively increased.
  • the operation is simple because the internal pressure value of the space Sp can be maintained within a predetermined range without the user performing a detailed operation of the syringe 60.
  • the mechanism for adjusting the pressure in the space Sp is not limited to the pressure adjusting balloon 70.
  • the adjusting valve 80 may be opened by a predetermined internal pressure to release the air supply from the syringe.
  • the fluid supplied to the airtight balloon may be either a gas or a liquid.
  • the means for supplying is not limited to the syringe, but may be a pump or the like.
  • the airtight balloon may be provided at a desired position on the tubular portion instead of the operating portion.
  • the mechanism for supplying the fluid to the airtight balloon may be extended to the outside of the body.
  • the mechanism for supplying the fluid may be provided in any of the internal space of the tubular portion, the outside of the tubular portion, and the inside of the wall surface of the tubular portion.
  • the airtight balloon may have two or more intermediate portions.
  • one or more joints may be located at both ends of the airtight balloon in the axial direction, or ports may be provided corresponding to each intermediate portion.
  • the tubular portion and the operating portion may be integrally formed of the same material.
  • -A tube or the like that supplies fluid to the airtight balloon is directly connected, and the operation unit does not have to have a port.
  • the space of the airtight balloon may be sealed so that fluid cannot be supplied or sucked.
  • airtightness and liquidtightness can be ensured only by inserting the insertion portion into the overtube. If the minimum inner diameter of the middle part in the initial shape of the airtight balloon is smaller than the outer diameter of the insertion part of the endoscope to be inserted, it is easily airtight by simply inserting the endoscope without supplying fluid. And liquid tightness can be ensured.
  • the present invention can be applied to an endoscopic overtube.

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  • Physics & Mathematics (AREA)
  • Health & Medical Sciences (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Optics & Photonics (AREA)
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Abstract

Surtube pour endoscope comprenant : un corps qui comprend une section tubulaire souple ; et un ballonnet cylindrique étanche à l'air relié à l'intérieur du corps.　Le ballonnet étanche à l'air comprend : deux sections jointes ou plus pour l'assemblage avec la surface interne du corps ; et une section intermédiaire qui est disposée entre les sections jointes et qui a un diamètre externe qui est plus petit, au moins sur un site, que celui des sections jointes dans un état de non-charge dans lequel la pression à l'intérieur et la pression à l'extérieur de la forme cylindrique sont identiques. Un espace est formé entre la surface interne du corps et sa section centrale.
PCT/JP2020/010187 2020-03-10 2020-03-10 Surtube pour endoscope, système endoscopique et procédé d'insertion d'endoscope WO2021181503A1 (fr)

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PCT/JP2020/010187 WO2021181503A1 (fr) 2020-03-10 2020-03-10 Surtube pour endoscope, système endoscopique et procédé d'insertion d'endoscope

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Application Number Priority Date Filing Date Title
PCT/JP2020/010187 WO2021181503A1 (fr) 2020-03-10 2020-03-10 Surtube pour endoscope, système endoscopique et procédé d'insertion d'endoscope

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Citations (5)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
JPH0255910U (fr) * 1988-10-19 1990-04-23
JP2008220775A (ja) * 2007-03-14 2008-09-25 Fujinon Corp 内視鏡装置
JP2014104186A (ja) * 2012-11-28 2014-06-09 Sumitomo Bakelite Co Ltd 内視鏡挿入補助具
JP2015524297A (ja) * 2012-07-18 2015-08-24 アポロ エンドサージェリー，インコーポレイティド 自然身体開口部挿入用の内視鏡オーバーチューブ
WO2016136514A1 (fr) * 2015-02-26 2016-09-01 オリンパス株式会社 Overtube pour endoscope, et système médical

Patent Citations (5)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
JPH0255910U (fr) * 1988-10-19 1990-04-23
JP2008220775A (ja) * 2007-03-14 2008-09-25 Fujinon Corp 内視鏡装置
JP2015524297A (ja) * 2012-07-18 2015-08-24 アポロ エンドサージェリー，インコーポレイティド 自然身体開口部挿入用の内視鏡オーバーチューブ
JP2014104186A (ja) * 2012-11-28 2014-06-09 Sumitomo Bakelite Co Ltd 内視鏡挿入補助具
WO2016136514A1 (fr) * 2015-02-26 2016-09-01 オリンパス株式会社 Overtube pour endoscope, et système médical

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