WO2021181503A1

WO2021181503A1 - Overtube for endoscope, endoscopic system, and method for inserting endoscope

Info

Publication number: WO2021181503A1
Application number: PCT/JP2020/010187
Authority: WO
Inventors: 達矢樋口
Original assignee: オリンパス株式会社
Priority date: 2020-03-10
Filing date: 2020-03-10
Publication date: 2021-09-16

Abstract

This overtube for an endoscope comprises: a body that includes a flexible tubular section; and a cylindrical airtight balloon joined with the inside of the body.　The airtight balloon includes: two or more joined sections for joining with the inner surface of the body; and a middle section that is provided between the joined sections and that has an outer diameter which is smaller, at least at one site, than that of the joined sections under a no-load state in which the pressure inside and the pressure outside the cylindrical shape are the same. A space is formed between the inner surface of the body and the middle section thereof.

Description

Endoscopic overtube, endoscopic system, and how to insert an endoscope

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.
When the overtube is inserted into the body, body fluids and the like that have entered the overtube may leak from the end of the overtube outside the body.
In addition, 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. In this case, the lumen may not be maintained in a sufficiently dilated state, and the inside of the lumen may not be properly observed.

In relation to the above problem, 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.

Japanese Patent No. 6251261

In the technique described in Patent Document 1, it is necessary to considerably increase the internal pressure of the balloon type airtight valve in order to surely close the gap. As the internal pressure increases, the friction between the balloon-type airtight valve and the endoscope increases. As a result, a large force is required to move the endoscope forward and backward with respect to the overtube, and the operability is reduced.

Based on the above circumstances, 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.
In this method, 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.

According to the present invention, it is possible to provide 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.

It is an overall view of the endoscope overtube which concerns on 1st Embodiment of this invention. It is a partial cross-sectional view of the overtube for the endoscope. It is a perspective view of the airtight balloon related to the overtube for the endoscope. It is a front view and a plan view of the indwelling balloon. It is a figure which shows one process at the time of using the endoscope system equipped with the overtube for the endoscope. It is a figure which shows the state which connected the syringe to the port of the overtube for the endoscope. It is a schematic diagram which shows the structure of a cock. It is a schematic diagram which shows the state which connected the syringe to the cock. It is sectional drawing in one process at the time of using the same endoscope system. It is a figure which shows one process at the time of using the endoscope system. It is a figure which shows one process at the time of using the endoscope system. It is a figure which shows one process at the time of using the endoscope system. It is a figure which shows one process at the time of using the endoscope system. It is a partial cross-sectional view of the overtube for an endoscope which concerns on the 2nd Embodiment of this invention. It is a partial cross-sectional view which shows one form at the time of use of the overtube for the endoscope. It is a figure which shows the operation part of the overtube for an endoscope which concerns on the modification of this invention. It is a graph which shows the relationship between the amount of air supply from a syringe and the internal pressure of an airtight balloon in the modified example. It is a figure which shows the operation part of the overtube for an endoscope which concerns on another modification of this invention.

The first embodiment of the present invention will be described with reference to FIGS. 1 to 13.
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. As a result, 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 operation when the overtube 1 configured as described above is used will be described. In this description, an example will be described in which ESD (endoscopic submucosal dissection) is performed in the large intestine by an endoscopic system in which the overtube 1 is combined with a colonoscope.

In the endoscopic system, the length of the overtube 1 is shorter than the insertion portion of the colonoscope. For example, it is preferable that 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.

First, a colonoscope (hereinafter, may be simply referred to as an "endoscope") is passed through the overtube 1.
In the overtube 1, in the no-load state where the internal pressure of the space Sp and the air pressure of the internal space of the base 21 are the same due to the port 22 being opened to the atmosphere or the like, the intermediate portion 32 is the airtight balloon 30 shown in FIG. It projects into the base 21 according to the initial shape. In 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. At this time, if 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.

When ESD is performed by combining a treatment tool that has been passed through the treatment tool channel of the endoscope and a treatment tool that has been passed through an external channel attached to the endoscope, as shown in FIG. 5, the colonoscope Ce A cap 102 to which an external channel 101 is connected is attached to the tip of the. In the insertion portion of the colonoscope Ce, 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.

In such a case, the user operates the airtight balloon 30 to deform the intermediate portion 32.
First, a syringe as a fluid moving means is attached to the port 22. In the example shown in FIG. 6, 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.
As shown in FIG. 7, 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.

When the user pulls the plunger 60a of the syringe 60, the gas in the space Sp is sucked and moves to the outside of the cock 51, and the inside of the space Sp becomes a negative pressure. As a result, as shown in FIG. 5, 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).
By performing the above 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. 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). In step C, if necessary, 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.
In 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).

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.

When the tip of the overtube 1 reaches the vicinity of the tip of the endoscope Ce, 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. As shown in FIG. 12, when 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. When 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. As a result, 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.

After step D, liquid or gas in the large intestine Cl may enter the overtube 1 from the tip of the overtube 1. However, in the base 21, 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.

As described above, since 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.

In such a situation, if the friction between the balloon and the endoscope for ensuring airtightness and liquidtightness becomes large, the operation of advancing and retreating the endoscope Ce becomes more complicated.
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.
On the other hand, if 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. ..

In this embodiment, 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.
In step A, 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.

The second embodiment of the present invention will be described with reference to FIGS. 14 and 15. In the following description, the same reference numerals will be given to the configurations common to those already described, and duplicate description will be omitted.

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.

In the present embodiment, the middle portion 232 covers the entire inner surface of the base 21. As a result, the inner diameter of the operating portion 220 becomes the inner diameter of the intermediate portion 232 over the entire length. As shown in FIG. 15, 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.

Similarly to 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.

Although each embodiment of the present invention has been described above, the technical scope of the present invention is not limited to the above-described embodiment, and the combination of components may be changed or each component may be changed without departing from the spirit of the present invention. Can be modified or deleted. Some of the changes are illustrated below, but not all. In addition, a plurality of these can be combined as appropriate.

-The shape of the middle part of the airtight balloon can be changed in various ways other than the above-mentioned example. For 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.
In the overtube 1A shown in FIG. 16, 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. After that, 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. As a result, 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.
In the overtube 1A, 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. For example, as shown in FIG. 18, 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. Further, 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. In this case, 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. In this case, 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. In this case as well, by appropriately setting the dimensional relationship with the endoscope insertion portion to be combined, 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.

1, 1A, 201 Endoscope overtube 2 Main body 10

Tubular part

20, 220 Operation part 22 Port (fluid movement port)
30, 230

Airtight balloon

31, 231

Joint

32, 232 Intermediate Sp space

Claims

A body with a flexible tubular part and
A tubular airtight balloon joined inside the main body,
With
The airtight balloon
Two or more joints to be joined to the inner surface of the main body,
It has an intermediate portion which is provided between the joint portions and whose outer diameter is smaller than that of the joint portion in a no-load state where the pressure inside and outside the tubular shape is the same.
A space is formed between the inner surface of the main body and the intermediate portion.
Overtube for endoscopes.
The endoscope overtube according to claim 1, further comprising a fluid moving port communicating with the space.
The endoscope overtube according to claim 1, wherein the main body has an operating portion that is connected to the tubular portion and communicates with the internal space of the tubular portion.
The endoscope overtube according to claim 1 and
An endoscope having an insertion part that can be inserted into the main body,
With
The insertion part is longer than the endoscopic overtube,
Endoscopic system.
The minimum inner diameter of the intermediate portion in the no-load state is equal to or less than the outer diameter of the insertion portion.
The endoscope system according to claim 4.
A method of inserting an endoscope into which an endoscope having an insertion portion having an outer diameter that can be inserted into the main body is inserted into the endoscope overtube according to claim 2.
Step A to create negative pressure in the space by sucking the fluid in the space from the fluid movement port, and
Step B, in which the insertion portion is inserted into the endoscope overtube and the intermediate portion whose space is negatively pressured is passed through.
Step C to release the negative pressure and
To prepare
How to insert an endoscope.