Device for endoscope

Abstract

To provide a device for an endoscope improved in insertability when inserting a treatment instrument into a biliopancreatic duct.SOLUTION: An endoscopic device includes a sheath extending in a longitudinal direction, a treatment tool opening portion communicating with a treatment tool lumen through which the sheath is inserted in the longitudinal direction and configured to allow a treatment tool inserted through the treatment tool lumen to protrude and retract to and from a distal end side of the sheath in the longitudinal direction, and a suction opening portion communicating with a suction lumen through which the sheath is inserted in the longitudinal direction.SELECTED DRAWING: Figure 3

Description

[Technical Field]

[0001] The present invention relates to an endoscopic device. This application claims priority to U.S. Provisional Patent Application No. 63 / 663,406, filed June 24, 2024, the contents of which are incorporated herein by reference. [Background technology]

[0002] Conventionally, there are treatment tools such as catheters that are inserted into the biliary pancreatic duct for the purpose of examination, treatment, etc. of the biliary pancreatic duct (for example, Patent Document 1). An example of an examination that involves a procedure of inserting a treatment tool into the biliary pancreatic duct is endoscopic retrograde cholangiopancreatography (ERCP). [Prior art documents] [Patent documents]

[0003] [Patent Document 1] Japanese Patent Application Publication No. 2023-135253 Summary of the Invention [Problem to be solved by the invention]

[0004] However, since the biliary pancreatic duct has narrowed and tortuous sections, it is difficult to insert a treatment tool into the biliary pancreatic duct, and there is a demand for improved insertability of the treatment tool.

[0005] In view of the above circumstances, an object of the present invention is to provide an endoscopic device that improves the ease of insertion when inserting a treatment tool into the biliary pancreatic duct. [Means for solving the problem]

[0006] In order to solve the above problems, the present invention proposes the following means. The endoscopic device of the present invention comprises a sheath extending in the longitudinal direction, a treatment instrument opening communicating with a treatment instrument lumen inserted through the sheath in the longitudinal direction and allowing a treatment instrument inserted through the treatment instrument lumen to be protruded and retracted toward the longitudinal tip side of the sheath, and a suction opening communicating with a suction lumen inserted through the sheath in the longitudinal direction, wherein the treatment instrument opening and the suction opening are provided in an insertion region that is positioned inside the biliary pancreatic duct when the sheath is inserted into the biliary pancreatic duct, and the suction opening is capable of suctioning the inner wall of the biliary pancreatic duct. [Effects of the Invention]

[0007] According to the endoscopic device of the present invention, it is possible to provide an endoscopic device that improves the ease of insertion when inserting a treatment tool into the biliary pancreatic duct. [Brief explanation of the drawings]

[0008] [Figure 1] 1 is an overall view of an endoscope system according to an embodiment of the present invention. [Figure 2] FIG. 2 is an overall view showing an endoscopic device of the endoscope system. [Figure 3] FIG. 2 is a perspective view of the distal end portion of the endoscopic device. [Figure 4] FIG. 4 is a cross-sectional view taken along line IV-IV in FIG. [Figure 5] FIG. 1 shows the biliary pancreatic duct to be treated. [Figure 6] 10A to 10C are diagrams showing a suction step of the treatment tool insertion method according to the embodiment. [Figure 7] 10A and 10B are diagrams showing a guide wire insertion step of the treatment tool insertion method. [Figure 8] 10A and 10B are diagrams showing a guide wire insertion step of the treatment tool insertion method. [Figure 9] 10A and 10B are diagrams showing a guidewire placement step of the treatment tool insertion method. [Figure 10] 10A and 10B are diagrams showing a stent insertion step of the treatment tool insertion method. [Figure 11] FIG. 10 is a perspective view showing a modified example of the treatment section of the endoscopic device. [Figure 12]FIG. 12 is a cross-sectional view taken along line XII-XII in FIG. [Figure 13] FIG. 10 is a perspective view showing another modified example of the treatment portion. [Figure 14] FIG. 14 is a cross-sectional view taken along line XIV-XIV in FIG. [Figure 15] FIG. 10 is an overall view showing a modified example of the endoscopic device. [Figure 16] FIG. 10 is a perspective view showing another modified example of the treatment portion. [Figure 17] FIG. 17 is a cross-sectional view taken along line XVII-XVII in FIG. DETAILED DESCRIPTION OF THE INVENTION

[0009] An endoscope system 300 according to an embodiment of the present invention will be described with reference to the drawings.

[0010] [Endoscope system 300] FIG. 1 is an overall view of an endoscope system 300 according to this embodiment.

[0011] The endoscope system 300 includes an endoscopic device 100 and an endoscope 200. The endoscopic device 100 is inserted into the endoscope 200 when in use.

[0012] [Endoscope 200] The endoscope 200 is a known side-viewing flexible endoscope, and includes a long insertion section 210 and an endoscope operation section 220 provided at the base end of the insertion section 210. Note that the endoscope 200 may also be a direct-viewing flexible endoscope.

[0013] The insertion section 210 has a tip hard section 211 provided at the tip, a bending section 212 that can be bent and is provided on the base end side of the tip hard section 211, and a flexible tube section 213 provided on the base end side of the bending section 212.

[0014] On the side surface of the distal end rigid portion 211, a light guide 215 and an imaging unit 216 having a CCD are provided in an exposed state to the outside.

[0015] The insertion section 210 is formed with a treatment tool channel 230 for inserting the endoscopic device 100 therethrough.

[0016] A distal end opening 230a of the treatment instrument channel 230 opens on the side surface of the distal end hard portion 211. A proximal end of the treatment instrument channel 230 extends to the endoscope operation portion 220.

[0017] A lifting base 214 is provided on the distal end hard portion 211 of the treatment instrument channel 230. The proximal end of the lifting base 214 is supported by the distal end hard portion 211 so as to be rotatable.

[0018] An elevator operating wire (not shown) fixed to the tip of the elevator 214 extends through the insertion section 210 to the endoscope operating section 220 .

[0019] The bending portion 212 is configured to be bendable in the up-down and left-right directions. The tip of a bending operation wire (not shown) is fixed to the tip side of the bending portion 212. The bending operation wire passes through the insertion portion 210 and extends to the endoscope operation portion 220.

[0020] The endoscope operation section 220 is provided with a knob 223 for operating a bending operation wire and a switch 224 for operating the imaging unit 216, etc. The surgeon can bend the bending section 212 in a desired direction by operating the knob 223.

[0021] Furthermore, a knob or the like for operating the elevator operating wire may be provided on the endoscope operation unit 220. By operating the endoscope operation unit 220, the surgeon can rotate the elevator 214 in any direction and at any angle.

[0022] A forceps port 222 that communicates with the treatment instrument channel 230 is provided on the distal end side of the endoscope operation section 220. The surgeon can insert the endoscopic device 100 through the forceps port 222. A forceps plug 225 is attached to the forceps port 222 to prevent leakage of bodily fluids.

[0023] [Endoscopic device 100] FIG. 2 is an overall view showing the endoscopic device 100. As shown in FIG.

[0024] The endoscopic device 100 includes a sheath 1 and an operation section 8.

[0025] In the following description, in the longitudinal direction A of the endoscopic device 100, the side inserted into the patient's body will be referred to as the "tip side (distal side) A1", and the side of the operation section 8 will be referred to as the "base side (proximal side) A2".

[0026] Fig. 3 is a perspective view of the distal end portion of the endoscopic device 100. Fig. 4 is a cross-sectional view taken along line IV-IV in Fig. 3.

[0027] The distal end of the endoscopic device 100 is provided with a treatment instrument opening 2 and a suction opening 3 .

[0028] In the following description, the distal end portion of the endoscopic device 100 provided with the treatment instrument opening 2 and the suction opening 3 will be referred to as the "treatment portion 110."

[0029] The sheath 1 is a flexible, long member extending from a distal end 1a to a proximal end 1b. The sheath 1 has an outer diameter that allows it to be inserted into a treatment instrument channel 230 of the endoscope 200.

[0030] 1, when the sheath 1 is inserted into the treatment instrument channel 230, the distal end 1a of the sheath 1 can protrude and retract from a distal end opening 230a of the treatment instrument channel 230. The sheath 1 may be insulating.

[0031] As shown in FIG. 3, a treatment tool lumen 20 and a suction lumen 30 are inserted in the sheath 1 in the longitudinal direction A.

[0032] The treatment instrument opening 2 is an opening communicating with the treatment instrument lumen 20, and is provided on the distal end surface 1t of the sheath 1. Here, the distal end surface 1t of the sheath 1 is the surface of the treatment section 110 facing the distal end side A1.

[0033] In this embodiment, the distal end surface 1t of the sheath 1 is a flat surface extending perpendicular to the longitudinal direction A, but the distal end surface 1t of the sheath 1 may have an uneven shape.

[0034] The suction opening 3 is an opening that communicates with the suction lumen 30 and is provided on the distal end surface 1t of the sheath 1.

[0035] In the following description, as shown in FIG. 4, in the radial direction R of the sheath 1, the side approaching the central axis O1 of the sheath 1 will be referred to as the "inner side R1" and the side away from the central axis O1 will be referred to as the "outer side R2".

[0036] In this embodiment, the suction opening 3 is provided on the outer side R2 of the treatment instrument opening 2 in the radial direction R. In addition, the suction lumen 30 is provided on the outer side R2 of the treatment instrument lumen 20.

[0037] The suction opening 3 does not have to be positioned on the outer side R2 of the treatment instrument opening 2, and for example, the suction opening 3 and the treatment instrument opening 2 may be positioned at approximately the same position in the radial direction R.

[0038] In this embodiment, three suction openings 3 are provided on the distal end surface it of the sheath 1. Furthermore, the sheath 1 is formed with three suction lumens 30 that communicate with the three suction openings 3, respectively.

[0039] The number of suction openings 3 provided in the treatment section 110 may be less than three, or may be four or more.

[0040] In this embodiment, the central axis of the treatment instrument lumen 20 coincides with the central axis O1 of the sheath 1. The central axis O2 of the suction lumen 30 extends in the longitudinal direction A parallel to the central axis O1 of the sheath 1.

[0041] The central axis of the treatment instrument lumen 20 does not have to coincide with the central axis O1 of the sheath 1. In addition, the central axis O2 of the suction lumen 30 does not have to be parallel to the central axis O1 of the sheath 1.

[0042] In this embodiment, the three suction openings 3 are arranged at equal intervals in the circumferential direction C of the central axis O1 of the sheath 1, as shown in FIG.

[0043] The three suction openings 3 do not have to be arranged at strictly equal intervals in the circumferential direction C.

[0044] The treatment tool lumen 20 has a size that allows a predetermined treatment tool to be inserted therethrough. The guidewire GW shown in FIG. 4 is an example of a treatment tool that is inserted through the treatment tool lumen 20. The guidewire GW can protrude and retract from the treatment tool opening 2. The guidewire GW is a long guidewire that extends in the longitudinal direction A.

[0045] The treatment tool protruding from and retracting into the treatment tool opening 2 is not limited to the guide wire GW, and may be various treatment tools used in procedures using the endoscope system 300.

[0046] In the treatment section 110, the treatment instrument opening 2 and the suction opening 3 are provided in an insertion region IR. The insertion region IR is a region that is disposed inside the biliary pancreatic duct when the sheath 1 is inserted into the biliary pancreatic duct in a treatment instrument insertion method that will be described later.

[0047] The insertion region IR is a region that includes the distal end of the treatment section 110, as shown in FIG.

[0048] The operation section 8 is provided on the proximal end side A2 of the sheath 1. The operation section 8 includes an operation section main body 81, a treatment instrument port 84, and a suction port 85.

[0049] The distal end of the operation portion main body 81 is connected to the proximal end 1 b of the sheath 1 .

[0050] The treatment instrument port 84 is an opening through which a treatment instrument such as a guide wire GW can be inserted into the treatment instrument lumen 20. The treatment instrument such as a guide wire GW inserted from the treatment instrument port 84 passes through the treatment instrument lumen 20 and protrudes from the treatment instrument opening 2 to the distal end side A1.

[0051] The suction port 85 is an opening that communicates with the suction lumen 30. For example, a pump device can be connected to the suction port 85 and the suction lumen 30 can be made to have a negative pressure by driving the pump device.

[0052] [Operation of endoscope system 300] Next, the operation of the endoscope system 300 according to this embodiment will be described. Specifically, the procedure for placing a stent inside the biliary pancreatic duct by endoscopic retrograde cholangiopancreatography (ERCP) will be described.

[0053] The operation of the endoscope system 300 described below is an example of a treatment tool insertion method using the endoscope system 300.

[0054] 5 is a diagram showing the biliary-pancreatic duct B, which is the treatment target. In this embodiment, the biliary-pancreatic duct B includes the bile duct, the pancreatic duct, and a portion where the bile duct and the pancreatic duct join together to form a single duct.

[0055] (Endoscope insertion process) First, the surgeon performs an endoscope insertion step. In the endoscope insertion step, the surgeon inserts the insertion section 210 of the endoscope 200 into the patient's lumen through a natural opening such as the mouth. If necessary, the surgeon operates the endoscope operation section 220 to bend the bending section 212.

[0056] The surgeon inserts the tip rigid portion 211 of the endoscope 200 into the duodenum DU through the stomach ST. At this time, the surgeon positions the tip rigid portion 211 near the papilla PA so that the direction in which the endoscopic device 100 protrudes from the endoscope 200 coincides with the direction in which the biliary pancreatic duct extends. The surgeon may insert the insertion portion 210 of the endoscope 200 into the lumen of the patient using an overtube.

[0057] (Sheath insertion process) Next, the operator performs the sheath insertion step.

[0058] 6 is a diagram showing the suction step of the treatment tool insertion method according to this embodiment. The suction step will be described later.

[0059] In the sheath insertion step, the surgeon inserts the endoscopic device 100 into the biliary pancreatic duct B from the opening PA1 of the papilla PA.

[0060] Specifically, the endoscopic device 100 is inserted into the treatment instrument channel 230 of the endoscope 200, the treatment section 110 of the endoscopic device 100 is protruded from the tip opening 230a, and the tip of the sheath 1 is inserted into the inside of the biliary pancreatic duct B from the opening PA1 of the papilla PA.

[0061] At this time, at least the insertion region IR of the treatment section 110 is inserted into the biliary-pancreatic duct B, and therefore the treatment instrument opening 2 and the suction opening 3 are disposed inside the biliary-pancreatic duct B.

[0062] (Suction process) Next, the surgeon performs the suction step. In the suction step, the surgeon suctions the inner wall of the biliary pancreatic duct B using the suction opening 3 of the treatment section 110.

[0063] At this time, the surgeon drives the pump device connected to the suction port 85 to create a negative pressure in the suction lumen 30. By creating a negative pressure in the suction lumen 30, the surgeon sucks the inner wall of the biliary-pancreatic duct B through the suction opening 3, and the inner wall of the biliary-pancreatic duct B is adsorbed onto the distal end surface 1t of the sheath 1.

[0064] In this embodiment, the inner wall of the biliary-pancreatic duct B that is sucked by the suction opening 3 is a portion of the biliary-pancreatic duct B that is closer to the opening PA1 than the portion where the bile duct and the pancreatic duct join together.

[0065] For example, as shown in FIG. 6, the suction opening 3 sucks and adsorbs the duct wall in the papilla PA in a region closer to the opening PA1 of the papilla PA than the area in the biliary pancreatic duct B where the folds H are located.

[0066] (Towing process) Next, the surgeon performs the traction step.

[0067] 7 and 8 are diagrams showing the guide wire insertion step of the treatment tool insertion method, which will be described later.

[0068] In the traction step, the surgeon pulls the sheath 1, which is sucking the inner wall of the biliary pancreatic duct B, toward the proximal end side A2, thereby causing the sheath 1 to traction the papilla PA.

[0069] At this time, the surgeon may move the endoscopic device 100 toward the base end side A2 relative to the endoscope 200, as shown in FIG. 7, to cause the sheath 1 to pull the papilla PA.

[0070] Furthermore, as shown in FIG. 8, the surgeon may cause the sheath 1 to pull the papilla PA by bending the bending section 212 (angle movement) so that the distal end rigid section 211 of the endoscope 200 moves away from the papilla PA.

[0071] (Guidewire insertion process) Next, the surgeon performs a guidewire insertion step. In the guidewire insertion step, the surgeon advances the guidewire GW inserted into the treatment instrument lumen 20, causing the guidewire GW to protrude from the treatment instrument opening 2. The surgeon further advances the guidewire GW protruding from the treatment instrument opening 2, and inserts the guidewire GW into the biliary pancreatic duct B.

[0072] When inserting a guidewire GW into the biliary pancreatic duct B, the shape of the biliary pancreatic duct B may make it difficult to insert the guidewire GW. For example, if the biliary pancreatic duct B is sharply bent or tortuous at the papilla PA, or if a portion of the biliary pancreatic duct B is narrowed by a fold H or the like, it is difficult to insert the guidewire GW into the biliary pancreatic duct B.

[0073] Furthermore, the biliary pancreatic duct B near the folds H and the opening PA1 is very soft, and the biliary pancreatic duct B may be easily bent or buckled simply by lightly pressing the endoscopic device 100 near the opening PA1.

[0074] In particular, if the biliary pancreatic duct B has a narrow distal segment (NDS; the portion of the extrahepatic bile duct distal to the duodenum that narrows due to the influence of the sphincter of Oddi), it becomes difficult to insert the guidewire GW into the biliary pancreatic duct B.

[0075] In the guidewire insertion step of this embodiment, the papilla PA is pulled by the sheath 1 to stretch the papilla PA, thereby changing the shape of the biliary pancreatic duct B into a shape that makes it easy to insert the guidewire GW.

[0076] It is desirable for the surgeon to pull the papilla PA with the sheath 1 until the shape of the biliary pancreatic duct B becomes straight. However, the surgeon does not necessarily have to pull the papilla PA until the shape of the biliary pancreatic duct B becomes straight. The surgeon only needs to pull the papilla PA until the shape of the biliary pancreatic duct B changes to a shape that makes it easy to insert the guidewire GW. For example, the surgeon may pull the papilla PA until the shape of the biliary pancreatic duct B changes to a gently curved shape.

[0077] In the treatment tool insertion method of this embodiment, the insertion region IR of the treatment section 110 is inserted into the biliary-pancreatic duct B in the sheath insertion step, and the inner wall of the biliary-pancreatic duct B is sucked onto the suction opening 3 in the suction step.

[0078] Therefore, compared to when the opening PA1 is sucked and adsorbed from the outside of the papilla PA, deformation of the opening PA1 can be suppressed, and an insertion path large enough to insert the guidewire GW can be secured.

[0079] Furthermore, since the guidewire GW protrudes from the treatment instrument opening 2 provided at the distal end of the sheath 1 inserted into the biliary pancreatic duct B, the guidewire GW can be reliably inserted into the biliary pancreatic duct B.

[0080] Furthermore, the suction opening 3 that sucks the inner wall of the biliary pancreatic duct B is located outside R2 of the treatment instrument opening 2 through which the guidewire GW protrudes and retracts, thereby preventing the treatment instrument opening 2 from being blocked by the inner wall of the biliary pancreatic duct B and allowing the guidewire GW to be reliably inserted into the biliary pancreatic duct B.

[0081] As described above, the guidewire GW is an example of a treatment tool used in a procedure using the endoscope system 300. In the following description, the guidewire insertion step will also be referred to as a treatment tool insertion step.

[0082] (Guidewire placement process) Next, the surgeon performs the guidewire placement step.

[0083] 9 is a diagram showing a guidewire placement step of the treatment tool insertion method. In the guidewire placement step, the surgeon removes the endoscopic device 100 from the biliary pancreatic duct B while leaving the guidewire GW in the biliary pancreatic duct B. As a result, only the guidewire GW is placed in the biliary pancreatic duct B.

[0084] (Stent placement process) Next, the surgeon performs the stent placement step.

[0085] 10 is a diagram showing a stent placement step of the treatment tool insertion method. In the stent placement step, the surgeon inserts the stent delivery device 400 into the biliary pancreatic duct B along the guidewire GW.

[0086] The surgeon operates the stent delivery device 400 to move the stent delivery device 400 along the guidewire GW toward the liver, and moves the portion of the stent delivery device 400 in which the stent 430 is housed to the vicinity of the stenosis.

[0087] The surgeon operates the stent delivery device 400 to expose the stent 430 housed in the stent delivery device 400, and places the stent 430 in the biliary pancreatic duct B.

[0088] Although the procedure of placing the stent 430 has been shown as an example of the operation of the endoscope system 300, treatment using the endoscope system 300 is not limited to the procedure of placing the stent 430. For example, the endoscope system 300 can also be used for procedures using a stone retrieval / lithotripsy basket or stone retrieval balloon using the placed guidewire GW.

[0089] The endoscopic device 100 of this embodiment comprises a sheath 1 extending in a longitudinal direction A, a treatment instrument opening 2 that communicates with a treatment instrument lumen 20 that passes through the sheath 1 in the longitudinal direction A and that allows a treatment instrument (e.g., a guide wire GW) that passes through the treatment instrument lumen 20 to protrude and retract into the distal end side A1 of the sheath 1, and a suction opening 3 that communicates with a suction lumen 30 that passes through the sheath 1 in the longitudinal direction A.

[0090] The treatment instrument opening 2 and the suction opening 3 are provided in an insertion region IR that is located inside the biliary pancreatic duct B when the sheath 1 is inserted into the biliary pancreatic duct B. The suction opening 3 is capable of suctioning the inner wall of the biliary pancreatic duct B.

[0091] According to the endoscopic device 100 of this embodiment, an endoscopic device 100 with improved insertability when inserting a treatment tool into the biliary pancreatic duct B can be provided.

[0092] Although one embodiment of the present invention has been described above in detail with reference to the drawings, the specific configuration is not limited to this embodiment, and design modifications and the like are also included within the scope of the present invention. Furthermore, the components shown in the above embodiment and modifications can be configured by appropriately combining them.

[0093] (Variation 1) Fig. 11 is a perspective view showing a treatment section 110A which is a modified example of the treatment section 110. Fig. 12 is a cross-sectional view taken along line XII-XII in Fig. 11.

[0094] The treatment section 110A is provided with a treatment tool opening 2 provided on the distal end surface 1t of the sheath 1 and a suction opening 3A provided on the outer peripheral surface of the sheath 1.

[0095] In this modification, three suction openings 3A are provided in the treatment section 110A. The three suction openings 3A are arranged at equal intervals in the circumferential direction C of the central axis O1 of the sheath 1. The three suction openings 3A do not have to be arranged at equal intervals in the circumferential direction C in a strict sense.

[0096] 12, the suction opening 3A is provided in the insertion region IR. Since the suction opening 3A is open facing the outer side R2, when the treatment section 110A is inserted into the biliary-pancreatic duct B in the sheath insertion step and the inner wall of the biliary-pancreatic duct B is aspirated by the suction opening 3A in the suction step, the inner wall of the biliary-pancreatic duct B can be stably aspirated and adsorbed.

[0097] (Variation 2) Fig. 13 is a perspective view showing a treatment section 110B which is a modified example of the treatment section 110. Fig. 14 is a cross-sectional view taken along line XIV-XIV in Fig. 13.

[0098] In the treatment section 110B, the central axis of the suction lumen 30B communicating with the suction opening 3B provided in the distal end surface 1t of the sheath 1 coincides with the central axis O1 of the sheath 1. The central axis of the suction lumen 30B does not have to strictly coincide with the central axis O1.

[0099] The treatment instrument opening 2 is provided in an inner sheath 21 through which the suction lumen 30B is inserted in the longitudinal direction A. A treatment instrument lumen 20 communicating with the treatment instrument opening 2 is inserted through the inner sheath 21 in the longitudinal direction A.

[0100] The inner sheath 21 extends, for example, from the distal end 1a of the sheath 1 to the proximal end 1b.

[0101] The treatment section 110B of this modification is composed of a sheath 1 and an inner sheath 21 that passes through the sheath 1. That is, the treatment section 110B is composed of a double sheath extending in the longitudinal direction A.

[0102] At the distal end surface it of the sheath 1, the suction opening 3B is an opening formed between the inner peripheral edge of the suction lumen 30B and the outer peripheral edge of the inner sheath .

[0103] In the treatment section 110B, the inner sheath 21 may be provided so as to be able to protrude and retract from the suction opening 3B.

[0104] FIG. 15 is an overall view showing an endoscopic device 100B which is a modified example of the endoscopic device 100. As shown in FIG.

[0105] The endoscopic device 100B includes a sheath 1, a manipulation wire 4, and a manipulation section 8. The above-mentioned treatment section 110B is provided at the distal end of the endoscopic device 100B.

[0106] The operation wire 4 is a metal wire, and is connected to the proximal end of the inner sheath 21. The proximal end of the operation wire 4 is fixed to the slider 83.

[0107] The slider 83 is attached to the operation unit body 81 so as to be movable along the longitudinal direction A.

[0108] The proximal end of the operation wire 4 is fixed to the slider 83, so that when the operator advances or retreats the slider 83 relative to the operation portion main body 81, the operation wire 4 advances or retreats.

[0109] Furthermore, since the inner sheath 21 is connected to the tip of the operation wire 4, the surgeon can advance and retract the inner sheath 21 by advancing and retracting the operation wire 4, thereby protruding and retracting it from the suction opening 3B.

[0110] (Variation 3) Fig. 16 is a perspective view showing a treatment section 110C which is a modified example of the treatment section 110. Fig. 17 is a cross-sectional view taken along line XVII-XVII in Fig. 16.

[0111] In the treatment section 110C, the central axis of the suction lumen 30C communicating with the suction opening 3C provided in the distal end surface 1t of the sheath 1 coincides with the central axis O1 of the sheath 1. The central axis of the suction lumen 30C does not have to strictly coincide with the central axis O1.

[0112] The treatment tool opening 2C is provided in an inner sheath 21C through which the suction lumen 30C is inserted in the longitudinal direction A.

[0113] The inner sheath 21C includes a tube 22 that is inserted through the suction lumen 30C in the longitudinal direction A, a protrusion 23 provided at the tip of the tube 22, and a tapered portion 24 that extends from the protrusion 23 toward the tip side A1.

[0114] A treatment instrument opening 2C through which the guide wire GW can be protruded and retracted is provided on the distal end surface 2t of the inner sheath 21 C. A treatment instrument lumen 20C communicating with the treatment instrument opening 2C is inserted in the longitudinal direction A through the inner sheath 21 C.

[0115] The tube 22 is a long member that passes through the suction lumen 30C. The tube 22 extends, for example, from the distal end 1a of the sheath 1 to the proximal end 1b.

[0116] The treatment section 110C of this modification is composed of a sheath 1 and a tube 22 that passes through the sheath 1. That is, the treatment section 110C is composed of a double sheath that extends in the longitudinal direction A.

[0117] 16 and 17, the protrusion 23 is a cylindrical member whose central axis extends in the longitudinal direction A. The protrusion 23 does not have to be strictly cylindrical.

[0118] The outer diameter of the protruding portion 23 is larger than the diameter of the suction opening 3 C. That is, the protruding portion 23 protrudes outward R2 in the radial direction R of the sheath 1 beyond the suction opening 3 C.

[0119] The protrusion 23 is disposed on the distal side A1 of the suction opening 3C. The protrusion 23 has an outer diameter larger than the diameter of the suction opening 3C, and therefore is not disposed inside the suction lumen 30C.

[0120] The tapered portion 24 is a truncated cone-shaped member whose diameter decreases toward the tip side A1 and whose central axis extends in the longitudinal direction A. The tapered portion 24 does not have to be strictly truncated cone-shaped.

[0121] The inner sheath 21C is configured by connecting a tube 22, a protruding portion 23, and a tapered portion 24 in this order from the base end side A2.

[0122] The treatment tool lumen 20C is inserted in the longitudinal direction A through the tube 22, the protruding portion 23, and the tapered portion 24.

[0123] At the distal end surface it of the sheath 1, the suction opening 3C is an opening formed between the inner peripheral edge of the suction lumen 30C and the outer peripheral surface of the tube 22.

[0124] 17, the protrusion 23 covers the suction opening 3C from the tip side A1. The protrusion 23 is disposed at a distance from the suction opening 3C on the tip side A1.

[0125] In the longitudinal direction A, a gap (suction space 3S) of a predetermined size is formed between the suction opening 3C and the protrusion .

[0126] The suction space 3S is formed around the entire circumference of the treatment section 110C in the circumferential direction C. The suction space 3S is a space that communicates with the suction lumen 30C. Therefore, when the suction lumen 30C becomes negative pressure, the suction space 3S also becomes negative pressure.

[0127] As shown in FIG. 17, the treatment instrument opening 2C, the suction opening 3C and the suction space 3S are provided in the insertion region IR.

[0128] In the above-mentioned sheath insertion process, the tip of the sheath 1 (here, the insertion area IR of the treatment section 110C) is inserted into the inside of the biliary-pancreatic duct B, and when the suction lumen 30C is made negative pressure in the above-mentioned suction process, the suction opening 3C suctions the inner wall of the biliary-pancreatic duct B through the suction space 3S.

[0129] The inner sheath 21C is provided so as to be able to advance and retreat relative to the sheath 1 by the operation wire 4 and the slider 83, for example, in the same manner as the above-described inner sheath 21.

[0130] The surgeon can change the distance in the longitudinal direction A between the protrusion 23 and the suction opening 3C by moving the inner sheath 21C forward or backward relative to the sheath 1.

[0131] By changing the distance in the longitudinal direction A between the protrusion 23 and the suction opening 3C, the size in the longitudinal direction A of the suction space 3S formed between the protrusion 23 and the suction opening 3C is changed.

[0132] The surgeon can change the area of ​​the suction port that sucks the inner wall of the biliary pancreatic duct B in the treatment section 110C by moving the inner sheath 21C forward and backward to change the size of the suction space 3S.

[0133] For example, if the suction force applied to the inner wall of the biliary pancreatic duct B is excessive, there is a possibility that the inner wall of the biliary pancreatic duct B will be invaded. Invasion of the inner wall of the biliary pancreatic duct B means that the biological tissue in the inner wall of the biliary pancreatic duct B will be damaged.

[0134] Furthermore, if the suction force for sucking the inner wall of the biliary pancreatic duct B is insufficient, the papilla PA cannot be sufficiently pulled, and it may be difficult to insert the guidewire GW through the opening PA1.

[0135] The surgeon can change the suction force for sucking the inner wall of the biliary-pancreatic duct B by moving the inner sheath 21C back and forth to change the area of ​​the suction port in the treatment section 110C, and can suck the inner wall of the biliary-pancreatic duct B with a suction force that takes into account the degree of invasion of the inner wall of the biliary-pancreatic duct B and the suction force caused by suction.

[0136] Furthermore, since the tapered portion 24 of the inner sheath 21C has a reduced diameter on the distal end side A1, the surgeon can easily insert the inner sheath 21C into the biliary pancreatic duct B from the opening PA1 in the sheath insertion step described above. [Explanation of symbols]

[0137] 300 Endoscopy System 100, 100B Endoscopic devices 1 sheath 1t Sheath tip surface 2, 2C Treatment tool opening 20, 20C Treatment tool lumen 21, 21C inner sheath 22 tubes 23 Protrusion 3, 3A, 3B, 3C Suction opening 30, 30B, 30C Suction Lumen 3S suction space GW Guidewire A Longitudinal direction A1 Tip side A2 proximal side R Radial direction R1 Inside R2 outside IR insertion area O1 Sheath central axis C circumferential direction B bile pancreatic duct PA nipple PA1 Nipple opening

Claims

1. a longitudinally extending sheath; a treatment instrument opening communicating with a treatment instrument lumen inserted through the sheath in the longitudinal direction and allowing a treatment instrument inserted through the treatment instrument lumen to protrude and retract toward a distal end side of the sheath in the longitudinal direction; a suction opening communicating with a suction lumen passing through the sheath in the longitudinal direction; Equipped with the treatment instrument opening and the suction opening are provided in an insertion region that is disposed inside the biliary pancreatic duct when the sheath is inserted into the biliary pancreatic duct; The suction opening is capable of suctioning the inner wall of the biliary pancreatic duct. Endoscopic devices.

2. The suction opening is provided on the outer side of the treatment instrument opening in the radial direction of the sheath. The endoscopic device according to claim 1 .

3. The suction opening is provided on the distal end surface of the sheath. The endoscopic device according to claim 2 .

4. The suction opening is provided on the outer peripheral surface of the sheath. The endoscopic device according to claim 2 .

5. a plurality of said suction openings; The plurality of suction openings are provided at equal intervals in a circumferential direction of the central axis of the sheath. The endoscopic device according to any one of claims 1 to 4.

6. an inner sheath that passes through the suction lumen; The treatment instrument opening communicates with the treatment instrument lumen that passes through the inner sheath in the longitudinal direction. The endoscopic device according to claim 1 or 2.

7. an inner sheath including a tube that passes through the suction lumen and a protrusion that is provided on the distal end side of the suction opening and protrudes outward in a radial direction of the sheath beyond the suction opening; the treatment instrument opening communicates with the treatment instrument lumen that passes through the inner sheath in the longitudinal direction, the suction opening sucks the inner wall of the biliary pancreatic duct through a suction space formed between the suction opening and the protrusion in the longitudinal direction. The endoscopic device according to claim 1 or 2.

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