Device for extending working channel

Abstract

To provide a medical device having compatibility with a plurality of auxiliary devices.SOLUTION: An extension system includes an endoscope, a transmission device, and an extension device. The extension device includes: a tubular inside member; a tubular outside member; a lock assembly configured to fix the outside member and the inside member with respect to each other; a proximal connector configured to be connected to a distal end of a handle of the transmission device and is located in the proximal end of the outside member; and a distal connector configured to be connected to the proximal end of the endoscope and is located in the distal end of the inside member. The transmission device is configured to penetrate the distal end of the endoscope and extend beyond the distal end of the endoscope so as to transmit a stent from the distal end of the transmission device.SELECTED DRAWING: Figure 2

Description

Technical Field

[0001] The present invention relates to the field of medical devices. Specifically, the present invention relates to devices, systems, and methods for expanding the working channel of an endoscope for stent delivery and the like.

Background Art

[0002] Medical devices may have components of a predetermined length (such as the shaft of a delivery catheter) to reach a specific treatment site in a patient and / or to be compatible with a specific auxiliary medical device (such as an endoscope). In the manufacture of these medical devices with a pre-determined shaft length, they may not function well in other patient treatment sites or with other auxiliary medical devices that are not designed to be compatible (such as other types of endoscopes or other patient body cavities). For example, a medical device may be attached to an endoscope for which it is not designed to be compatible, but the length of the shaft of the medical device (such as a delivery catheter) may extend far distally beyond the working channel of the endoscope, such that the device or system may not operate as intended or may not be fully incorporated. For example, the distal tip of a catheter shaft extending far distally from the end of an endoscopic ultrasound may not be imaged by ultrasound. When designing and manufacturing various alternative medical devices with appropriate design structures compatible with a variety of auxiliary medical devices, excessive additional development and inventory costs may be required. Furthermore, if it is necessary to purchase different versions of the same medical device simply to be compatible with multiple auxiliary devices, the attractiveness in the market activities may be lost.

Summary of the Invention

Problems to be Solved by the Invention

[0003] Accordingly, it may be desirable to have a device and / or system that enables a medical device to be compatible with a plurality of auxiliary devices. It is also desirable to ergonomically improve the medical device and / or system for the user operating the medical device and / or the auxiliary device. Considering these matters, the improvements according to the present invention are advantageous.

Means for Solving the Problems

[0004] The present invention in various embodiments may include a device designed to be coupled to and operate in conjunction with an ultrasonic endoscope or other endoscope. The shaft of the device can extend a predetermined distance within the patient beyond the distal end of the working channel of the ultrasonic endoscope. This predetermined distance is within the operating range of the ultrasonic endoscope for displaying the treatment site to the user via ultrasound. The length of the distal end of the device extending longer than this may exceed the functional range of the ultrasonic endoscope in this procedure, while the length of the distal end extending shorter than this may prevent proper insertion, placement, and delivery of the stent.

[0005] The present invention in various embodiments includes devices, systems, and methods for extending the working channel of an endoscope. According to one embodiment, the extension device may have a tubular inner member having a lumen extending therethrough. The tubular outer member may have a lumen extending therethrough. The lumen of the outer member can be configured to receive the inner member, and the outer member and the inner member can be slidable relative to each other telescopically to a desired position corresponding to an adjustable length of the device. A lock assembly fixes the relative positions of the outer member and the inner member relative to each other at the desired position. The proximal connector is at the proximal end of the outer member and can be configured to connect to the distal end of a first medical device. The distal connector is at the distal end of the inner member and can be configured to connect to the proximal end of a second medical device. The lumens of the inner member and the outer member can be coaxially provided. At least one of the proximal connector and the distal connector can be a luer lock connector. The plurality of desired positions can include three predetermined fixed positions. The fixed positions can include visual indicators on the inner member or the outer member, or both. The visual indicator can include markings. The fixed positions can include fasteners on one or both of the inner member and the outer member. The fastener can include a first element on the inner member and a second element on the outer member. The first and second elements can be configured to fit together. The joint can pivot such that the first longitudinal axis is at an angle of 90 degrees to 180 degrees from the second axis. The lock assembly can be a detent. The lock assembly can be a screw. The screw can lock the outer member relative to the inner member at a desired position by engaging the inner member.

[0006] In another aspect, the extension system may include an endoscope having a constant working channel. The system may include a delivery device. The shaft may extend distally from the delivery device and be receivable within the working channel. The system may include an extension device. The extension device may include a tubular inner member having a lumen extending therethrough. The device may include a tubular outer member having a lumen extending therethrough. The lumen of the outer member may be configured to receive the inner member, and the outer and inner members may be slidably nested relative to each other to a desired position corresponding to an adjustable length of the extension device. The device may include a locking assembly configured to fix the relative positions of the outer and inner members relative to each other at the desired position. The device may have a proximal connector at the proximal end of the outer member and be configured to connect to the distal end of the delivery device. The device may have a distal connector at the distal end of the inner member and be configured to connect to the proximal end of the endoscope. The predetermined distance may be about 8 centimeters. The adjustable length may be from a minimum of about 0 centimeters to a maximum of about 8 centimeters. The lumens of the inner and outer members may be coaxially provided. The proximal connector may be a male luer connector, and the distal connector may be a female luer connector. The desired position may include a plurality of predetermined fixed positions. The desired position may include three predetermined fixed positions. The joint may be pivotable such that the first longitudinal axis is at an angle of 90 degrees to 180 degrees from the second axis. The joint may include a sphere at the distal portion of the inner member. The sphere may have a first lumen therethrough that is in fluid communication with an internal lumen. The cup-shaped body may be at the distal portion of the inner member and may be disposed around the sphere. The cup-shaped body may have a second lumen therethrough that is in fluid communication with the first lumen. The sphere may be pivotable within the cup-shaped body. The first lumen and the second lumen may be configured to receive a device. The locking assembly may be a protrusion of the inner member corresponding to a preset opening of the outer member. The locking assembly may include a plurality of preset openings corresponding to a plurality of desired positions, which may define a plurality of predetermined adjustable lengths.The protrusion can include a compressible button so that the button can compress to disengage the inner member from the outer member. The locking assembly can be a screw. By engaging with the inner member, the screw can lock the outer member in a desired position relative to the inner member.

[0007] In another aspect, a method of extending the length of a working channel can include inserting an endoscope through which the working channel passes into a patient. A catheter is inserted into the patient through the working channel. The extension device may be disposed around the shaft of the catheter and have a lumen extending therethrough. The extension device can be attached to the proximal end of the working channel. The catheter may be attached to the proximal end of the extension device. The extension device can be adjusted to a desired position corresponding to the adjustable length of the extension device. The extension device can be locked in the desired position. The tip of the catheter can be visualized using an endoscope. Disposing the extension device around the shaft can be before inserting the catheter into the patient. The desired position can include at least one predetermined fixed position of a locking assembly of the extension device configured to fix the adjustable length. The desired position can include a plurality of predetermined fixed positions. The plurality of channels of the extension device can be aligned with each other so that the extension device can be disposed around and removed from the shaft. The extension device can rotate between an open configuration in which the channels are substantially aligned and a closed configuration in which the channels are not substantially aligned.

[0008] Non-limiting embodiments of the present disclosure are described by way of example with reference to the accompanying drawings, which are schematic and not intended to be drawn to scale. In the drawings, each identical or nearly identical component shown is typically represented by a single reference numeral. For clarity, not all components are labeled in all figures, nor are all components of each embodiment shown where illustration is not necessary for those skilled in the art to understand the disclosure.

Brief Description of the Drawings

[0009]

Figure 1

Figure 2

Figure 3

Figure 4

Figure 5A

Figure 5B

Figure 5C

Figure 5D

Figure 5E

Figure 5F

Figure 6A

Figure 6B

DETAILED DESCRIPTION OF THE INVENTION

[0010] The present invention is not limited to the specific embodiments described. The terms used in this specification are for the sole purpose of describing specific embodiments and are not intended to be limiting. Unless otherwise defined, all technical terms used in this specification have the same meaning as commonly understood by those skilled in the art to which the present invention pertains.

[0011] As used herein, the singular forms "a", "an", and "the" are intended to include the plural forms as well, unless the context clearly indicates otherwise. As used in this specification, the terms "comprises" and / or "comprising" or "includes" and / or "including" specify the presence of the stated features, regions, steps, elements, and / or components, but do not preclude the presence or addition of one or more other features, regions, integers, steps, operations, elements, components, and / or combinations thereof.

[0012] As used herein, "and" includes each of the structures, components, features, etc. thus combined, unless the context clearly indicates otherwise, and "or" includes one or the other of the structures, and components, functions, etc. are included alone or in any combination and number, unless the context clearly indicates otherwise.

[0013] As used herein, the term "distal" refers to the end that is farthest from the medical professional when introducing the device into the patient, and the term "proximal" refers to the end that is closest to the medical professional when introducing the device into the patient.

[0014] In this specification, all numerical values are assumed to be modified by the term "about" whether explicitly indicated or not. The term "about" generally refers to a range of numerical values that a person of ordinary skill in the art would consider equivalent (i.e., having the same function or result) in the context of the numerical value. In many cases, the term "about" may include numerical values rounded to the nearest significant digit. Other uses of the term "about" (i.e., uses in contexts other than numerical values) are understood from the context of the specification and are consistent, and thus are considered to have their normal customary definitions unless otherwise specified.

[0015] The recitation of numerical ranges by endpoints includes all numerical values within that range including the endpoints (e.g., 1 to 5 includes 1, 1.5, 2, 2.75, 3, 3.80, 4, 5). References to "embodiments", "some embodiments", "other embodiments", etc. in this specification indicate that the described embodiments may include certain features, structures, or characteristics, but not all embodiments necessarily include the specific features, structures, or characteristics. Further, such phrases do not necessarily refer to the same embodiment. Moreover, when a particular feature, structure, or characteristic is described in relation to an embodiment, it is to be understood that, whether explicit or not, and unless explicitly stated to the contrary, it is within the knowledge of a person of ordinary skill in the art to bring such feature, structure, or characteristic in relation to other embodiments. In other words, even if not explicitly shown in a particular combination, the various individual elements described below are considered combinable or arrangeable with each other by a person of ordinary skill in the art to form other additional embodiments or to complement and / or enhance the described embodiments.

[0016] Embodiments of the present invention include devices, systems, and methods for use in extending a working channel. Medical devices (e.g., catheters) that can be designed to extend to a particular treatment site of a patient and / or be compatible with a particular ancillary medical device (e.g., an endoscope) can be used with the extension devices of the present invention to reach other treatment sites and / or provide compatibility with other ancillary medical devices.

[0017] As an example, an ultrasonic endoscope can be used to deliver a self-expanding drainage stent using a delivery catheter. The stent delivery device can be designed to connect to and function with an ultrasonic endoscope. Placement of a drainage stent into the body can be performed by inserting a catheter carrying the stent under the guidance of ultrasound. The catheter is passed through the wall of a first body lumen (e.g., the gastrointestinal tract) into an adjacent lumen (e.g., a pseudocyst), and the distal retention member of the stent is deployed. Next, the catheter can be retracted, and the proximal retention member can be placed within the GI tract (e.g., the stomach). Such an ultrasound procedure can be performed using an ultrasonic endoscope in which the shaft of the delivery device is inserted through the ultrasonic endoscope. The working channel of an ultrasonic endoscope is typically a particular length, e.g., about 125 cm to about 130 cm, and the delivery catheter or device typically extends the entire length of the working channel with a shaft length of about 137 cm to about 138 cm, such that about 8 cm of the distal end of the catheter extends beyond the distal end of the working channel by a predetermined distance within the patient. This predetermined distance may be within the operating range of the ultrasonic endoscope to display to the user, via ultrasound, the treatment site including the catheter tip and the stent. The length of the distal end of the catheter extending beyond this may be beyond the functional range of the ultrasonic endoscope in this procedure, but if the length of the extended distal end is shorter than this, proper insertion, placement, and delivery of the stent may not be possible.

[0018] Referring to FIG. 1, an example of the device and the ultrasonic endoscope according to the above description for the delivery of a drainage stent is shown. Device 140 is connected to ultrasonic endoscope 130 for operation by user 150. Device 140 is connected to ultrasonic endoscope 130 via a connector 142 which is a luer lock fitting, and device 140 is provided in a locked position relative to ultrasonic endoscope 130. User 150 can operate device 140 with one hand while operating ultrasonic endoscope 130 with the other hand. The shaft of device 140 extends through the working channel of ultrasonic endoscope 130 and extends a predetermined distance from the distal end of ultrasonic endoscope 130. Device 140 is in a locked position with ultrasonic endoscope 130 and has a shaft length with a predetermined distance defined, so that it can be prevented from changing in the proximal or distal direction through the movement of device 140 relative to the ultrasonic endoscope by the user. The handle 146 of device 140 can be sequentially actuated during the procedure to deliver the stent while visualizing the distal tip of the shaft of the device with the ultrasonic endoscope.

[0019] Medical professionals may wish to use a medical device designed for a particular ancillary medical device (e.g., an ultrasonic endoscope) having a predetermined working channel length with another ancillary medical device (e.g., a direct imaging endoscope or an endoscope of a different brand or configuration) having a different working channel length. When a professional user connects a device to another ancillary device, parts necessary for the function of the device (e.g., the length of the catheter shaft) may not conform to the needs of the procedure. For example, the distance that the medical device extends from the distal end of the working channel of different ancillary devices may vary as the lengths of the different ancillary devices are different. For example, it may be necessary or desirable for the medical device to be locked to the endoscope, thereby enabling, for example, operation with one hand of the user together with the endoscope, or preventing the medical device from being partially or inadvertently pulled out of or extended from the endoscope, and maintaining a predetermined extension distance beyond the working channel by a desired amount.

[0020] Referring to FIG. 2, an embodiment of a system for extending a working channel according to the present invention is shown, including an endoscope 230 inserted into a patient having a working channel through which a device passes through the endoscope 230. The exemplary stent delivery device 240 shown herein for illustrative purposes as an AXIOS (trademark) device manufactured by Boston Scientific Corporation includes a distal end with a shaft 244 extending distally therefrom. The shaft 244 is receivable within the working channel. The shaft 244 is depicted as delivering a stent 246 to a target tissue 260 of the patient. An extension device extending between the delivery device and the endoscope enables the delivery device 240 to maintain the shaft 244 at a predetermined distance from the distal end of the endoscope 230. The extension device 200 is attached between the delivery device 240 and the endoscope 230. The extension device 200 has a tubular inner member 202 having a lumen extending therethrough. The extension device 200 also has a tubular outer member 204 having a lumen extending therethrough. The lumen of the outer member 204 is configured to receive the inner member 202. The outer member 204 and the inner member 202 are slidable relative to each other telescopically to a desired position corresponding to an adjustable length of the extension device 200. The proximal connector at the proximal end of the outer member 204 is configured to connect to the connector 210 at the distal end of the handle of the delivery device 240. The distal connector 208 at the distal end of the inner member is configured to connect to the proximal end of the endoscope 230. The adjustable length of the device 200 allows the shaft 244 to extend through the working channel from the proximal end to the distal end of the endoscope 230, through the lumens of the outer member 204 and the inner member 202 of the extension device 200, and beyond the distal end of the endoscope 230 by a predetermined distance.

[0021] In various embodiments described herein or within the scope of the present invention, a predetermined distance of the shaft from the distal end of the endoscope can be in the range of, for example, about 7.5 cm to about 8.5 cm. The extension device can be detachable from around the shaft of an auxiliary medical device such as an endoscope and a delivery device without removing the shaft proximally through the lumens of the inner and outer members of the extension device. The adjustable length of the extension device can be, for example, a minimum of about 0 centimeters, a maximum of about 3 centimeters, or a minimum of about 0 centimeters and a maximum of about 8 centimeters. The lumens of the inner and outer members can be provided coaxially. The lumen of the inner member can have a diameter that substantially matches the diameter of the working channel of the endoscope. The lumen of the outer member can have a diameter that substantially matches the outer diameter of the inner member. The extension device includes a locking assembly such as a set screw shown in FIG. 2 and can fix the outer member 204 and the inner member 202 relative to each other at a desired position corresponding to the adjustable length of the extension member 200. The locking assembly of the extension device can have a predetermined fixed position between the proximal end of the endoscope and the distal end of the medical device (e.g., a delivery device) that matches the length of the shaft of the medical device (e.g., a catheter).

[0022] Referring to FIG. 3, an embodiment of an extension device for extending a working channel according to the present invention is shown. The extension device 300 has a tubular inner member 302 having a lumen extending therethrough. The device 300 also includes a tubular outer member 304 having a lumen extending therethrough and configured to receive the inner member 302. The lumen of the outer member 304 may have a diameter that substantially matches the outer diameter of the inner member 302. The outer member 304 and the inner member 302 are slidable relative to each other in a nested manner to a desired position corresponding to the adjustable length of the device 300. A lock assembly 306 (e.g., a screw, etc.) is configured to fix the relative position of the outer member 304 and the inner member 302 relative to each other at a desired position. The lock assembly 306 locks the outer member 304 to a desired position relative to the inner member 302 by engaging the inner member 302. The lock assembly 306 shown in FIGS. 2-3 includes a threaded screw disposed through an opening in the outer member 304. The user can tighten the threaded screw to engage and lock the inner member 302 relative to the outer member 304. A proximal connector 310 (e.g., a luer lock connector) at the proximal end of the outer member 304 is configured to connect to the distal end of a first medical device (e.g., a stent delivery device). A distal connector 308 (e.g., a female luer lock connector) at the distal end of the inner member 302 is configured to connect to the proximal end of a second medical device (e.g., an endoscope).

[0023] Referring to FIG. 4, an embodiment of a device for extending a working channel according to the present invention is illustrated, which includes an extension device 400 with a locking assembly. The locking assembly includes a protrusion 406 (e.g., a compressible button, detent) on the inner member 402 that corresponds to a preset opening 412 in the outer member 404. The protrusion 406 can be radially compressed to fully enter and pass through the inner surface of the lumen of the outer member 404 and remove the inner member 402 from the opening 412 of the outer member 404. Thereby, the inner member 402 and the protrusion 406 can slide relative to the outer member 404, and as a result, the overall length of the device 400 is adjusted. In some embodiments, the locking assembly 406 may include a plurality of preset openings 412 corresponding to a plurality of desired positions. The multiple positions of the locking assembly 406 may define a predetermined adjustable length of the device 400. For example, the openings 412 and the desired positions may correspond to known lengths required for use with various auxiliary devices such as endoscopes having working channels of different lengths. Each opening 412 may correspond to a certain type of auxiliary device. The protrusion 406 can engage with the opening 412 corresponding to the auxiliary device being used to achieve an appropriate adjustable length of the device 400. The appropriate adjustable length of the device 400 may be such that the shaft extends through the device 400 and only a predetermined length of the shaft extends from the distal end of the auxiliary device. For example, FIG. 4 shows three openings 412 corresponding to three predetermined fixed positions of the inner member 402 relative to the outer member of the device. Thus, in this embodiment, the example of the three fixed positions corresponds to three predetermined adjustable lengths of the extension device that shorten the effective length of the shaft by the amount of the adjustable length of the extension device. Visual indicators such as markings may be provided on the inner member and / or the outer member corresponding to the desired positions. As an alternative to the protrusion and the opening, in other embodiments, one or both of the inner member and the outer member may have a fastener including a first element on the inner member and a second element on the outer member configured to fit together.

[0024] Refer to FIGS. 5A-5F. An embodiment of a device for extending a working channel according to the present invention is illustrated, which includes a channel 514 that extends along an inner member 502, along a distal connector 508, and into the lumen of the inner member 502. A channel 516 extends along an outer member 504, along a proximal connector 510, and into the lumen of the outer member 504. The channels 514 and 516 of the inner member 502 and the outer member 504 are configured to be aligned with each other. When the channels 514 and 516 are aligned, the device 500 can be positioned and removed around the shaft of a medical device that extends through the lumens of the inner member 502 and the outer member 504 of the extension, including cases where it is not necessary to proximally withdraw the shaft of the medical device from the extension device. One or both of the outer member 504 and the inner member 502 are rotatable relative to each other. The device can vary between an open configuration in which the channels 514 and 516 are substantially aligned (e.g., as shown in FIGS. 5A-5C) and a closed configuration in which the channels 514 and 516 are not substantially aligned (e.g., as shown in FIGS. 5D-5F). When the device 500 is in the closed position and the shaft extends through the inner member 502 and the outer member 504, the device 500 and the shaft are fixed so that they cannot be separated from each other and can only be separated by removing the shaft proximally through the inner member 502 and the outer member 504. When the device 500 is in the open position and the shaft is disposed through the inner member 502 and the outer member 504, the device 500 may be removed substantially radially from around the shaft with respect to the longitudinal axis along which the channels 514, 516 extend along the length of the shaft. In various embodiments described herein or in the original specification, etc., one or more channels 514 and / or 516 that extend along the distal connector 508 and / or the proximal connector 510 can alternatively be made of a porous material, a weakened material, and / or a material that is thinner than the remaining portion of the connector 508 and / or 510.Alternatively, the connector 508 and / or 510 may be made entirely of a material that is destructible by an intentional force by the user pulling or peeling the extension device 500 from the shaft. Such embodiments may allow the device 500 to be removed from the endoscope and / or the shaft of the medical device without first removing other parts of the system. Such embodiments may also allow the device 500 to be removed more quickly compared to removing other auxiliary devices or other medical devices of the system before removing the extension device 500.

[0025] In other embodiments described herein or within the scope of the present invention, the inner and outer members can be made of various polymers and / or metallic materials. The materials include stainless steel, aluminum, polytetrafluoroethylene (PTFE), ethylene tetrafluoroethylene (ETFE), fluorinated ethylene propylene (FEP), polyoxymethylene (POM, e.g., DELRIN® available from DuPont), polyether block ester, polyurethane (e.g., polyurethane 85A), polypropylene (PP), polyvinyl chloride (PVC), polyether ester (e.g., ARNITEL® available from DSM Engineering Plastics), ether or ester-based copolymers (e.g., butylene / poly(alkylene ether) phthalate, and / or polyester elastomers such as HYTREL® available from DuPont), polyamide (e.g., DURETHAN® available from Bayer or CRISTAMID® available from Elf Atochem), elastomeric polyamide, block polyamide / ether, polyether block amide (PEBA, e.g., available under the trade name PEBAX®), ethylene vinyl acetate copolymer (EVA), silicone, polyethylene (PE), Marlex® high density polyethylene, Marlex® low density polyethylene, linear low density polyethylene (e.g., REXELL®), polyester, polybutylene terephthalate (PBT), polyethylene terephthalate (PET), polytrimethylene terephthalate, polyethylene naphthalate (PEN), polyether ether ketone (PEEK), polyimide (PI), polyetherimide (PEI), polyphenylene sulfide (PPS), polyphenylene oxide (PPO), polyparaphenylene terephthalamide (e.g., KEVLAR®), polysulfone, nylon, nylon-12 (e.g., GRILAMID® available from EMS American Grilon), perfluoro(propyl vinyl ether) (PFA), ethylene vinyl alcohol, polyolefin, polystyrene, epoxy, and / or polyvinylidene chloride (PVdC).The material can be selected to withstand the forces associated with the advancement and retraction of medical devices and endoscopes within a patient.

[0026] Refer to FIGS. 6A and 6B. An embodiment of a device for extending a working channel according to the present invention is illustrated, including a rotatable joint 620 disposed at the distal portion of the inner member 602 of the device 600. The device 600 extends the working channel of the endoscope 630 to be compatible with the shaft of the medical device 640 such that the shaft can extend a predetermined distance beyond the distal end of the endoscope. The swivel joint 620 is proximal to the distal connector 608 that connects the device 600 to the endoscope 630. The joint 620 has a first longitudinal axis 627 that can be aligned with a part of the inner member 602 that is distal to the longitudinal axis of the endoscope 630 and the swivel joint. The joint 620 also has a second longitudinal axis 621 that can be aligned with the longitudinal axis of the remaining portion of the inner member 602. The joint 620 includes a sphere 622 at the distal portion of the inner member 602 near the distal connector 608. The sphere 620 has a lumen 624 passing through its interior, and the lumen 624 is in fluid communication with the lumen of the inner member 602. The joint 620 also includes a cup-shaped body 626 at the distal portion of the inner member 602 proximal to the distal connector 608. The cup-shaped body 626 is disposed around the spherical body 620. The cup-shaped body 626 has a lumen 628 passing through its interior, and the lumen 628 is in fluid communication with the lumen 624 of the sphere 622. The sphere 620 is rotatable within the cup-shaped body 626 while maintaining the lumens of the inner member 602, the spherical body 622, and the cup-shaped body 626 in fluid communication. The shaft 642 of the medical device 640 can extend through the lumens 624, 628 of the joint 620. The joint 620 can rotate such that the first longitudinal axis 627 forms an angle of about 90 degrees to about 180 degrees from the second axis 621. Since the medical device 640 and the device 600 can be angled and move freely with respect to the cup-shaped body 626 and the endoscope 630, the user can benefit from the rotatable joint 620. The second axis 621 has the freedom to move 360 degrees in any plane from 90 degrees (perpendicular to the first axis 627) to 180 degrees (parallel to the first axis 627). This can ergonomically assist the user during the procedure.For a user operating the medical device 640 and the endoscope 630, there can be more freedom and comfort than in other embodiments where the medical device, the extension device, and the endoscope are locked together in one position where they cannot pivot relative to each other.

[0027] In various embodiments described herein or within the scope of the present invention, the proximal and / or distal connectors may be male or female luer fittings. One or more connectors may include a rotating luer nut and / or a wrapped luer fitting. The connectors can be removably connected and tightened to various endoscopes and medical devices.

[0028] In other embodiments described herein or within the scope of the present invention, the locking assembly can include a quick release lock nut, a torsional friction fit lock, a slotted fit lock, a button fit lock, a detent lock, and the like.

[0029] In various embodiments described herein or within the scope of the present invention, the extension device can be a tubular member of a length corresponding to the endoscope such that the catheter shaft extends distally a predetermined distance from the endoscope. The tubular member can have a proximal connector at the proximal end of the member configured to connect to the distal end of the medical device. The tubular member can have a distal connector at the distal end of the member configured to connect to the proximal end of the endoscope.

[0030] In various embodiments, a method of extending the length of a working channel may include inserting an endoscope having a fixed working channel into a patient. A catheter is inserted into the patient through the working channel. The extension device may have a lumen extending through around the shaft of the catheter. The extension device may be attached to the proximal end of the working channel. The catheter may be attached to the proximal end of the extension device. The extension device can be adjusted to a desired position corresponding to an adjustable length of the extension device. The extension device can be locked in the desired position. The extension device can be adjusted to a desired position such that the distal tip of the catheter extends up to about 8 cm maximum from the distal end of the endoscope. The tip of the catheter can be visualized using the endoscope. The extension device can be removed from around the endoscope and the shaft of the catheter while the catheter remains within the working channel of the endoscope. The placement step may include placing the extension device around the shaft after inserting the catheter into the patient. The placing step may include placing the extension device around the shaft before inserting the catheter into the patient. The desired position may include at least one predetermined fixed position of a locking assembly of the extension device configured to fix the adjustable length. The desired position may include a plurality of predetermined fixed positions. The plurality of channels of the extension device can be aligned with each other such that the extension device can be placed around and removed from the shaft of the catheter. The extension device can transition between an open configuration in which the channels are substantially aligned and a closed configuration in which the channels are not substantially aligned.

[0031] (Appendix) The technical idea that can be grasped from the above embodiments will be described below. [Item 1] A tubular inner member having a lumen extending therethrough, A tubular outer member having a lumen therethrough, wherein the lumen of the outer member is configured to receive the inner member, and the outer member and the inner member are slidable relative to each other in a nested manner to a desired position corresponding to an adjustable length of the extension device, the outer member A lock assembly configured to fix an outer member and an inner member relative to each other at a desired position, configured to be removably connected to the distal end of a first medical device, and a proximal connector at the proximal end of the outer member, configured to be removably connected to the proximal end of a second medical device, and a distal connector at the distal end of the inner member, wherein the first medical device penetrates the distal end of the second medical device and extends beyond the distal end of the second medical device to deliver a stent from the distal end of the first medical device, the distal end of the first medical device further includes a shaft extending distally therefrom, and the adjustable length of the extension device is such that the shaft passes through the lumens of the outer and inner members of the extension device and from the proximal end to the distal end of the second medical device and extends beyond the distal end of the second medical device by a predetermined distance, the extension device is removable from around the shaft of the first medical device without removing the shaft proximally through the lumens of the inner and outer members. [Item 2] The extension device according to item 1, wherein the predetermined distance is 8 centimeters. [Item 3] The extension device according to item 1 or 2, wherein the first medical device is a delivery catheter and the second medical device is an endoscope. [Item 4] The extension device according to item 1, wherein the adjustable length is from 0 centimeter to 8 centimeters at maximum. [Item 5] The extension device according to item 1, wherein the desired position includes at least one predetermined fixed position of the lock assembly. [Item 6] The extension device according to item 1, wherein the desired position includes a plurality of predetermined fixed positions of the lock assembly. [Item 7] a tubular inner member having a lumen extending therethrough, a tubular outer member having a lumen therethrough, the lumen of the outer member being configured to receive the inner member, the outer member and the inner member being slidable relative to each other to a desired position corresponding to an adjustable length of the extension device in a nested manner, the outer member, a lock assembly configured to fix the outer member and the inner member relative to each other at a desired position, a proximal connector at the proximal end of the outer member, configured to be removably connected to the distal end of a first medical device, and, a distal connector at the distal end of the inner member, configured to be removably connected to the proximal end of a second medical device, and, a channel extending along the tubular inner member, along the distal connector, and into the lumen of the tubular inner member, and a channel extending along the tubular outer member, along the proximal connector, and into the lumen of the tubular outer member, the channels of the tubular inner member and the tubular outer member being aligned with each other such that the extension device is positioned around and removed from around the shaft of the first medical device, the first medical device being an extension device that penetrates the distal end of the second medical device and extends beyond the distal end of the second medical device to deliver a stent from the distal end of the first medical device. [Item 8] The extension device according to item 7, wherein at least one of the outer member and the inner member is rotatable relative to each other, whereby the extension device can transition between an open configuration in which the channel of the inner member is aligned with the channel of the outer member and a closed configuration in which the channel of the inner member is not aligned with the channel of the outer member. [Item 9] a tubular inner member having a lumen extending therethrough, A tubular outer member having a lumen therethrough, the lumen of the outer member being configured to receive the inner member, the outer member and the inner member being slidable relative to each other to a desired position corresponding to an adjustable length of the extension device in a nested manner, the outer member, A lock assembly configured to fix the outer member and the inner member relative to each other at a desired position, A proximal connector configured to connect to the distal end of a first medical device and at the proximal end of the outer member, A distal connector configured to connect to the proximal end of a second medical device and at the distal end of the inner member, At the proximal side of the distal connector, further comprising a rotatable joint disposed at the distal portion of the inner member, the joint having a first longitudinal axis alignable with the longitudinal axis of the second medical device and a portion of the inner member distal to the rotatable joint, the joint having a second longitudinal axis alignable with the longitudinal axis of the remaining portion of the inner member, The first medical device is an extension device configured to penetrate the distal end of the second medical device and extend beyond the distal end of the second medical device to deliver a stent from the distal end of the first medical device. [Item 10] The rotatable joint is, A sphere at the distal portion of the inner member, the sphere having a lumen extending therethrough and in fluid communication with the lumen of the inner member, A cup-shaped body disposed around the sphere and at the distal portion of the inner member, the cup-shaped body having a lumen extending therethrough and in fluid communication with the lumen of the sphere, The sphere is rotatable within the cup-shaped body while maintaining fluid communication of the lumens of the inner member, the sphere, and the cup-shaped body, the extension device according to item 9. [Item 11] The lock assembly is the protruding portion of the inner member corresponding to a preset opening of the outer member, the extension device according to item 10. [Item 12] The lock assembly has a plurality of preset openings corresponding to a plurality of desired positions, thereby defining a plurality of predetermined adjustable lengths, the extension device according to item 11. [Item 13] The protruding portion includes a button compressible to remove the inner member from the outer member, the extension device according to item 11 or 12. [Item 14] The lock assembly is a protruding portion on the inner member corresponding to a preset opening in the outer member, the extension device according to any one of items 1 to 8. [Item 15] The lock assembly includes a plurality of preset openings corresponding to a plurality of desired positions, and the plurality of preset openings define a plurality of predetermined adjustable lengths, the extension device according to item 14. [Item 16] The protruding portion includes a button compressible to detach the inner member from the outer member, the extension device according to item 14 or 15. All devices and / or methods disclosed and claimed in this specification can be made and executed without undue experimentation in light of the present invention. Although the devices and methods of the present invention have been described with respect to specific embodiments, it will be apparent to those skilled in the art that variations can be applied to the devices and / or methods and to the order of steps of the methods described herein without departing from the concept, spirit, and scope of the present invention. All such similar substitutes and modifications apparent to those skilled in the art are considered to be within the scope of the present invention.

Claims

【Claim 1】 The system described in the specification.

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