Endoscopic instruments and endoscopic treatment systems

Abstract

The present invention provides an endoscopic treatment instrument, etc., that allows for easy rotation of the tip, which is equipped with a treatment section, while maintaining a curved shape. [Solution] The endoscopic treatment instrument comprises a sheath having a lumen extending in the longitudinal direction, an operating part attached to the base end of the sheath, a wire having one end attached to the tip of the sheath and the other end attached to the operating part, the wire being able to move forward and backward in the longitudinal direction and rotate in the circumferential direction by operation of the operating part, and a ring member positioned in contact with the wire.

Description

Technical Field

[0001] The present invention relates to an endoscopic treatment instrument and an endoscopic treatment system. This application claims priority based on US Provisional Patent Application No. 63 / 375,987, which was provisionally filed in the United States on September 16, 2022, and the content thereof is incorporated herein by reference.

Background Art

[0002] Endoscopic retrograde cholangiopancreatography (ERCP) is used in procedures such as inserting a contrast agent, a guide wire, and various catheters from the duodenum into the bile duct to perform diagnosis within the bile duct, retrieving stones, and draining stenosis. In these procedures, an endoscope and a papillotome that can be inserted through the treatment instrument channel of the endoscope are used.

[0003] The papillotome used in these procedures maintains a state in which a knife (treatment portion, incision portion) for incising the sphincter of the papilla is in a state where it can be incised by curving the tip of the sheath. The papillotome described in Patent Document 1 has a rotation function for rotating the sheath around the central axis of the sheath, and by rotating the sheath, the tip provided with the knife can be moved.

Prior Art Documents

Patent Documents

[0004]

Patent Document 1

Summary of the Invention

Problems to be Solved by the Invention

[0005] However, it has been difficult for a papillotome having a rotation function as described in Patent Document 1 to maintain a state where the tip is curved and the knife is in a state where it can be incised while rotating the sheath. For example, when the sheath is rotated, the tip may not be able to maintain a curved state.

[0006] Based on the above circumstances, the present invention aims to provide an endoscopic treatment instrument and an endoscopic treatment system equipped with an endoscopic treatment instrument, which allow the tip portion equipped with the treatment section to be easily rotated while maintaining a curved state. [Means for solving the problem]

[0007] To solve the above problems, this invention proposes the following means. An endoscopic treatment instrument according to a first aspect of the present invention comprises a sheath which is a long member having a lumen extending in the longitudinal direction, a tip treatment section provided at the tip of the sheath, an operating section provided at the base end of the sheath, and a wire which is inserted through the lumen and attached to the tip treatment section and supported by the operating section so as to be able to move back and forth in the longitudinal direction, wherein the operating section has a locking mechanism that restricts the movement of the wire in the longitudinal direction. [Effects of the Invention]

[0008] The endoscopic treatment instrument and endoscopic treatment system of the present invention make it easy to rotate the tip while maintaining a curved state at the tip where the treatment section is provided. [Brief explanation of the drawing]

[0009] [Figure 1] This is an overall diagram of the endoscopic treatment system according to the first embodiment. [Figure 2] This is a diagram showing the papillotome of the endoscopic treatment system. [Figure 3] This is a diagram of the same papillotome. [Figure 4] This is a cross-sectional view of the tip of the sheath of the papillotome. [Figure 5] This is a front view of the tip of the sheath, seen from the tip side. [Figure 6] This is a cross-sectional view of the operating section of the papillotome. [Figure 7] This is a cross-sectional view of the base end of the sheath along the line C1-C1 in Figure 6. [Figure 8]It is a perspective view showing the first deformation part of the second body. [Figure 9] It is a figure showing the same first deformation part and the first connecting part before deformation. [Figure 10] It is a figure showing the same first deformation part and the first connecting part after deformation. [Figure 11] It is a figure showing the same papillotomy forceps inserted into the endoscope. [Figure 12] It is a figure showing the alignment process. [Figure 13] It is a figure showing the incision process. [Figure 14] It is a figure showing the operation part of the papillotomy forceps according to the second embodiment. [Figure 15] It is a figure showing the first deformation part and the first connecting part before deformation. [Figure 16] It is a figure showing the same first deformation part and the first connecting part after deformation. [Figure 17] It is a figure showing the operation part of the papillotomy forceps according to the third embodiment. [Figure 18] It is a figure showing another aspect of the O-ring. [Figure 19] It is a figure showing the operation part of the papillotomy forceps according to the fourth embodiment. [Figure 20] It is a figure showing the operation part of the papillotomy forceps according to the fifth embodiment. [Figure 21] It is a figure for explaining the action of the lever of the operation part. [Figure 22] It is a figure for explaining the action of the lever.

BEST MODE FOR CARRYING OUT THE INVENTION

[0010] (First Embodiment) The first embodiment of the present invention will be described with reference to FIGS. 1 to 13. FIG. 1 is an overall view of the endoscope treatment system 300 according to this embodiment.

[0011] [Endoscope Treatment System 300] The endoscopic treatment system 300 comprises a papillotome 100 and an endoscope 200. The papillotome 100 is used by inserting it into the endoscope 200.

[0012] [Endoscope 200] The endoscope 200 is a known side-viewing flexible endoscope and comprises a long insertion section 210, an operating section 220 provided at the proximal end of the insertion section 210, and a universal cord 250 extending from the operating section 220. The endoscope 200 may also be a straight-viewing flexible endoscope.

[0013] The insertion section 210 has a rigid tip section 211 at its tip, a bendable curved section 212 provided on the base end side of the rigid tip section 211, and a flexible tube section 213 provided on the base end side of the curved section 212. A light guide 215 and an imaging unit 216 having a CCD are provided on the side of the rigid tip section 211 in an exposed state.

[0014] The insertion section 210 has a treatment instrument channel 230 formed therein for inserting endoscopic treatment instruments such as a papillotome 100. The tip 230a of the treatment instrument channel 230 opens on the side of the rigid tip 211. The base end of the treatment instrument channel 230 extends to the operating section 220.

[0015] A lifting base 214 is provided at the hardened tip portion 211 of the instrument channel 230. The base end of the lifting base 214 is rotatably supported by the hardened tip portion 211. A lifting base operating wire 217, fixed to the tip of the lifting base 214, extends towards the base end through the insertion portion 210.

[0016] The curved section 212 is configured to bend freely in the vertical and horizontal directions. The tip of the operating wire is fixed to the tip of the curved section 212. The operating wire extends through the insertion section 210 to the operating section 220.

[0017] The base end of the control unit 220 is provided with a knob 223 for operating the control wire and a switch 224 for operating the imaging unit 216, etc. The user can bend the curved section 212 in the desired direction by operating the knob 223.

[0018] The tip of the operating section 220 is provided with a forceps channel 222 that communicates with the treatment instrument channel 230. The user can insert the endoscopic treatment instrument 100 through the forceps channel 222. A forceps plug 225 is attached to the forceps channel 222 to prevent leakage of bodily fluids.

[0019] The universal code 250 connects the endoscope 200 to the image control device. The imaging signal captured by the imaging unit 216 is transmitted to the image control device via the universal code 250.

[0020] [Papillotome 100] Figures 2 and 3 show the papillotome 100. The papillotome (endoscopic treatment instrument, high-frequency treatment instrument) 100 comprises a tip treatment section 1, a sheath 2, a conductive wire 3, and an operating section 5. In the following description, in the longitudinal direction A of the papillotome 100, the side inserted into the patient's body is referred to as the "tip side (distal side) A1," and the side with the operating section 5 is referred to as the "proximal side (proximal side) A2."

[0021] Figure 4 is a cross-sectional view of the tip portion 20 of the sheath 2. The tip treatment section 1 is provided on the outer circumferential surface of the tip 20 of the sheath 2. The tip treatment section 1 has a first through hole 11 and a second through hole 12 that pass through the knife lumen 21. The first through hole 11 and the second through hole 12 are arranged in the longitudinal direction A. The first through hole 11 is located closer to the tip A1 than the second through hole 12. The second through hole 12 is located closer to the base A2 than the first through hole 11. The tip treatment section 1 is marked with a marker 15 that has a different color or pattern from the rest of the sheath 2.

[0022] The marker 15 is formed in a line shape extending in the longitudinal direction A and is provided in a part of the circumferential direction C where the first through hole 11 and the second through hole 12 are located (the part that constitutes the incision 6 described later). The tip of the marker 15 is positioned at the tip of the sheath 2, and the base of the marker 15 is positioned near the second through hole 12. The width of the marker 15 in the circumferential direction C is less than or equal to half the circumference of the outer circumference of the sheath 2.

[0023] Sheath 2 is a long member having a lumen extending along the longitudinal direction A. Sheath 2 has an outer diameter that allows insertion into the treatment instrument channel 230. Sheath 2 is, for example, a flexible sheath made of resin.

[0024] Figure 5 is a front view of the tip portion 20 of the sheath 2 as seen from the tip side A1. Sheath 2 is a multi-lumen tube having multiple lumens. The multiple lumens include a knife lumen 21 through which a conductive wire 3 is inserted, a contrast lumen 22 through which contrast agent, etc. is inserted, and a guidewire lumen 23 through which a guidewire is inserted.

[0025] Figure 6 is a cross-sectional view of the operating section 5. The knife lumen 21 is the lumen through which the conductive wire 3 is inserted. The knife lumen 21 extends from the tip opening (first through hole 11 and second through hole 12) provided in the tip treatment section 1 to the base end opening 21b which communicates with the operating section 5. The contrast lumen (fluid delivery lumen) 22 is a lumen through which contrast agents, water delivery fluids, or air delivery fluids are inserted. The contrast lumen 22 extends from the tip opening 22a formed at the tip of the tip section 20 to the base opening 22b which communicates with the operating section 5.

[0026] Figure 7 is a cross-sectional view of the base end 26 of the sheath 2 along the line C1-C1 in Figure 6. The guide wire lumen 23 is the lumen through which the guide wire is inserted. The guide wire lumen 23 extends from the tip opening 23a formed at the tip of the tip portion 20 to the base end opening 23b provided on the outer circumferential surface of the base end portion 26 of the sheath 2.

[0027] The conductive wire 3 has a conductive core wire coated with an insulating film made of a suitable synthetic resin. The conductive wire 3 is inserted through the knife lumen 21 of the sheath 2. The conductive wire 3 is supported by the operating part 5 so as to be able to move back and forth in the longitudinal direction A and rotate in the circumferential direction C.

[0028] The tip of the conductive wire 3 protrudes from the knife lumen 21 to the outside of the sheath 2 through the second through hole 12, extends along the longitudinal direction A of the sheath 2 to the tip side A1, and enters the knife lumen 21 through the first through hole 11 at the tip side A1. The tip 3a of the conductive wire 3 is fixed inside the knife lumen 21. The portion of the conductive wire 3 that can be exposed to the outside of the sheath 2 through the first through hole 11 and the second through hole 12 is not coated with an insulating film, and the core wire is exposed, forming a wire-shaped cutting portion 6 that can cut tissue. The cutting portion 6 is an example of an electrode.

[0029] As shown in Figure 6, the base end of the conductive wire 3 is attached to a power supply connector 55 provided on the slider 54 of the operating unit 5. When the conductive wire 3 is pulled toward the base end A2, as shown in Figure 3, the tip treatment section 1 curves inward, and the incision section 6 becomes taut. Since the part marked with the marker 15 curves inward, the operator can easily grasp the direction in which the tip 20 of the sheath 2 curves.

[0030] As shown in Figure 6, the operating unit 5 is provided at the base end of the sheath 2. The base end of the sheath 2 is rotatably attached to the operating unit 5 in the circumferential direction C. The operating unit 5 comprises a first body 51, a second body 52, a handle 53, a slider 54, and a power supply connector 55.

[0031] The first body 51 is attached to the base end of the sheath 2 and is formed in a shape that extends in the longitudinal direction A. The first body 51 has a base end protrusion 510, a first tube 511, a second tube 512, and a contrast port 56.

[0032] The first tube 511 is inserted through the inside of the first body 51, and its tip is in communication with the knife lumen 21. The conductive wire 3 is inserted through the first tube 511.

[0033] The second tube 512 is inserted through the inside of the first body 51, and its tip communicates with the contrast lumen 22. The base end of the second tube 512 communicates with the opening of the contrast port 56. Fluids such as contrast agent injected from the contrast port 56 are discharged through the second tube 512 and the contrast lumen 22, and then through the tip opening 22a formed at the tip of the tip portion 20.

[0034] Figure 8 is a perspective view showing the first deformed portion 57 of the second body 52. The second body 52 is attached to the base end projection 510 of the first body 51. The second body 52 is rotatably attached to the first body 51 in the circumferential direction C. The second body 52 has a through hole 52h that penetrates along the longitudinal direction A. The conductive wire 3 is inserted through the through hole 52h. In addition, the base end of the second body 52 is provided with a first deformation portion 57 that is connected to the handle 53.

[0035] Figure 9 shows the first deformed portion 57 and the first connecting portion 58 before deformation. The first deformable portion 57 is an elastically deformable member and is formed in a substantially wedge-shaped convex portion. The first deformable portion 57 has a tapered portion 57a, a retainer 57b, and a through hole 57h. The tapered portion 57a ​​is formed in a rectangular prism shape with the top and bottom surfaces being the same trapezoidal shape. The width of the tapered portion 57a ​​decreases from the tip side A1 to the base side A2. The retainer 57b is provided at the base end of the tapered portion 57a ​​and prevents the first deformable portion 57 from separating from the handle 53. The through hole 57h penetrates the first deformable portion 57 along the longitudinal direction A. The conductive wire 3 is inserted through the through hole 57h.

[0036] As shown in Figure 8, the handle 53 is connected to the second body 52 so as not to rotate in the circumferential direction C. When the handle 53 is rotated in the circumferential direction C, the second body 52 rotates together with the handle 53 relative to the first body 51. The tip of the handle 53 is provided with a first connecting portion 58 which is connected to the first deformed portion 57 of the second body 52.

[0037] The first connecting portion 58 is formed in a roughly wedge-shaped recess, and the first deformed portion 57 is positioned on the inside in the radial direction R. The inner surface 58a of the first connecting portion 58 is formed in a mortar shape, which is a rectangular prism-shaped recess with the top and bottom surfaces being the same trapezoidal shape, and the width decreases from the tip side A1 to the base side A2.

[0038] Figure 10 shows the first deformed portion 57 and the first connecting portion 58 after deformation. By bringing the second body 52 and the handle 53 closer together, the first deformable portion 57 engages with the inner surface 58a of the first connecting portion 58 and deforms inward in the radial direction R. As a result, the first deformable portion 57 contacts the conductive wire 3 from the outside in the radial direction R, restricting the forward and backward movement of the conductive wire 3 in the longitudinal direction A.

[0039] In other words, the first deformation portion 57, by engaging with the first connecting portion 58, functions as a locking mechanism that restricts the forward and backward movement of the conductive wire 3 in the longitudinal direction A. Here, a "locking mechanism" is a mechanism that can restrict the forward and backward movement of the conductive wire 3 in the longitudinal direction A without restricting the rotation of the conductive wire 3 in the circumferential direction C. Note that the locking mechanism may also restrict the rotation of the conductive wire 3 in the circumferential direction C.

[0040] A knob 531 is provided at the base end of the handle 53. The user can easily rotate the handle 53 in the circumferential direction C by grasping the knob 531 and rotating it in the circumferential direction C.

[0041] The slider 54 is mounted to the handle 53 so that it can move back and forth in the longitudinal direction A, but cannot rotate in the circumferential direction C.

[0042] The power supply connector 55 is fixed to the slider 54. The base end 3b of the conductive wire 3 is connected to the power supply connector 55. The power supply connector 55 can be connected to a high-frequency power supply unit (not shown) and is connected to the conductive wire 3. The power supply connector 55 can supply high-frequency current supplied from the high-frequency power supply unit to the conductive wire 3 and the cut portion 6.

[0043] By rotating the handle 53 in the circumferential direction C relative to the first body 51, the second body 52, the slider 54, and the power supply connector 55 all rotate. The conductive wire 3 rotates in the circumferential direction C relative to the first body 51. As a result, the tip treatment portion 1 provided at the tip portion 20 of the sheath 2 rotates. In other words, the conductive wire 3 also serves as a torque transmission member that transmits rotational torque in the circumferential direction C.

[0044] [Operation of Endoscopic Treatment System 300] Next, the operation and function of the endoscopic treatment system 300 according to this embodiment will be described with reference to Figures 11 to 13. Specifically, the procedure for treating bile duct BD by endoscopic retrograde cholangiopancreatography (ERCP) will be described.

[0045] <Step S1: Endoscope insertion process> In step S1, the surgeon inserts the insertion section 210 of the endoscope 200 into the patient's lumen through a natural opening such as the mouth. The surgeon operates the control section 220 as needed to bend the bending section 212. The surgeon then inserts the rigid tip 211 of the endoscope 200 to the vicinity of the duodenal papilla.

[0046] <Step S2: Endoscope alignment process> In step S2, the operator adjusts the position of the rigid tip 211 of the endoscope 200 so that the duodenal papilla is within the imaging range of the imaging unit 216 of the endoscope 200. The operator adjusts the position of the rigid tip 211 by appropriately combining advancing and retracting, bending and twisting operations of the endoscope 200.

[0047] <Step S3: Papillotome alignment process> Figure 11 shows a papillotome 100 inserted into an endoscope 200. Next, in step S3, the operator inserts the papillotome 100 into the instrument channel 230 through the forceps channel (proximal opening) 222 of the endoscope 200. The operator then extends the tip 20 of the sheath 2 through the tip opening 230a.

[0048] The surgeon pulls the conductive wire 3 by moving the slider 54 to the proximal end A2 relative to the handle 53, causing the tip 20 of the sheath 2 to curve. As a result, as shown in Figure 11, the incision portion 6, which is part of the conductive wire 3, becomes taut. Next, the surgeon brings the main body (first body 51 and second body 52) closer to the handle 53. As a result, the first deformable portion 57 deforms inward in the radial direction R, coming into contact with the conductive wire 3 and restricting the forward and backward movement of the conductive wire 3. While maintaining the curved state of the tip 20 of the sheath 2, the surgeon rotates the sheath 2 in the circumferential direction C, thereby moving the tip treatment portion 1. Alternatively, the surgeon may rotate the entire papillotome 100 in the circumferential direction C to move the tip treatment portion 1.

[0049] Figure 12 shows the alignment process. The operator may discharge fluid from the tip opening 22a via the contrast lumen (fluid delivery lumen) 22 to confirm whether the tip 20 of the sheath 2 is facing the nipple PA. If the operator can apply fluid to the nipple PA from the tip opening 22a, they can confirm that the tip 20 of the sheath 2 is positioned close to the nipple PA.

[0050] <Step S4: Incision Process> Figure 13 shows the incision process. In step S4, the surgeon supplies high-frequency current from the power connector 55 to the incision 6. The papillotome 100 is operated using the control section 5 to incise a portion of the papillary PA through the incision section 6.

[0051] <Step S5: Contrast Imaging Process> In step S5, the surgeon injects contrast medium into the bile duct BD from the papillotome 100. The surgeon then performs an X-ray to obtain an X-ray image showing the bile duct BD and other structures.

[0052] <Step S6: Guidewire insertion process> In step S6, the surgeon inserts a guidewire into the guidewire lumen 23 of the papillotome 100, causing the guidewire to protrude from the tip opening 23a, and inserts the guidewire into the bile duct BD. Next, the surgeon removes the papillotome 100 while leaving the guidewire in place in the bile duct BD. This leaves only the guidewire in the bile duct BD, creating an access route from the duodenum to the bile duct BD.

[0053] After establishing an access route, the surgeon can perform various procedures by guiding the tips of various instruments along the guidewire and introducing them into the bile duct (BD) via the access route.

[0054] According to the papillotome 100 of this embodiment, the tip portion 20 of the sheath 2, which is provided with the tip treatment portion 1, can be easily moved by rotating the sheath 2 in the circumferential direction C while maintaining the curved state of the tip portion 20. Therefore, the operator can perform the operation of rotating the sheath 2 in the circumferential direction C while maintaining the curved state of the tip portion 20 of the sheath 2 by themselves.

[0055] Although the first embodiment of the present invention has been described in detail above with reference to the drawings, the specific configuration is not limited to this embodiment, and design changes and the like are also included within the scope of the gist of the present invention. Furthermore, the components shown in the above-described embodiment and the following modifications can be combined as appropriate.

[0056] (Second embodiment) A papillotome 100B according to a second embodiment of the present invention will be described with reference to Figures 14 to 16. In the following description, components that are common to those already described will be denoted by the same reference numerals, and redundant descriptions will be omitted.

[0057] Figure 14 shows the operating section 5B of the papillotome 100B. The papillotome (endoscopic treatment instrument, high-frequency treatment instrument) 100B is used as an endoscopic treatment system together with the endoscope 200, similar to the papillotome 100 of the first embodiment. The papillotome 100B comprises a tip treatment section 1, a sheath 2, a conductive wire 3, and an operating section 5B.

[0058] The operating unit 5B comprises a first main body 51, a second main body 52B, a handle 53B, a slider 54, and a power supply connector 55.

[0059] The second body 52B is attached to the base end projection 510 of the first body 51. The second body 52B is rotatably attached to the first body 51 in the circumferential direction C. The second body 52B has a through hole 52h that penetrates along the longitudinal direction A. The conductive wire 3 is inserted through the through hole 52h. In addition, a second connecting portion 58B is provided at the base end of the second body 52.

[0060] The second connecting portion 58B is formed in a roughly wedge-shaped recess, and the second deformed portion 57B is positioned inside in the radial direction R. The inner surface 58Ba of the second connecting portion 58B is formed in a mortar shape, which is a rectangular prism-shaped recess with the top and bottom surfaces being the same trapezoidal shape, and its width increases from the tip side A1 to the base side A2.

[0061] The handle 53B is connected to the second body 52B so as not to rotate in the circumferential direction C. When the handle 53B is rotated in the circumferential direction C, the second body 52B rotates together with the handle 53B relative to the first body 51. The tip of the handle 53B is provided with a second deformation portion 57B which is connected to a second connecting portion 58B of the second body 52B.

[0062] Figure 15 shows the second deformed section 57B and the second connecting section 58B before deformation. The second deformable portion 57B is an elastically deformable member and is formed as a roughly wedge-shaped protrusion. The second deformable portion 57B has a tapered portion 57Ba and a through hole 57Bh. The tapered portion 57Ba is formed as a rectangular prism with the top and bottom surfaces being the same trapezoidal shape. The width of the tapered portion 57Ba increases from the tip side A1 to the base side A2. The through hole 57Bh penetrates the second deformable portion 57B along the longitudinal direction A. The conductive wire 3 is inserted through the through hole 57Bh.

[0063] Figure 16 shows the second deformed section 57B and the second connecting section 58B after deformation. By bringing the second body 52B and the handle 53B closer together, the second deformable portion 57B deforms inward in the radial direction R by engaging with the inner surface 58Ba of the second connecting portion 58B. As a result, the second deformable portion 57B comes into contact with the conductive wire 3 from the outside in the radial direction R, restricting the forward and backward movement of the conductive wire 3 in the longitudinal direction A.

[0064] According to the papillotome 100B of this embodiment, the tip portion 20 of the sheath 2, which is provided with the tip treatment portion 1, can be easily moved by rotating the sheath 2 in the circumferential direction C while maintaining the curved state of the tip portion 20. Therefore, the operator can perform the operation of rotating the sheath 2 in the circumferential direction C while maintaining the curved state of the tip portion 20 of the sheath 2 by themselves.

[0065] Although a second embodiment of the present invention has been described in detail above 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 gist of the present invention. Furthermore, the components shown in the above-described embodiment and the following modifications can be combined as appropriate.

[0066] (Third embodiment) A papillotome 100C according to a third embodiment of the present invention will be described with reference to Figures 17 to 18. In the following description, components that are common to those already described will be denoted by the same reference numerals, and redundant descriptions will be omitted.

[0067] Figure 17 shows the operating section 5C of the papillotome 100C. The papillotome (endoscopic treatment instrument, high-frequency treatment instrument) 100C is used as an endoscopic treatment system together with the endoscope 200, similar to the papillotome 100 of the first embodiment. The papillotome 100C comprises a tip treatment section 1, a sheath 2, a conductive wire 3, and an operating section 5C.

[0068] The operating unit 5C comprises a first main body 51, a second main body 52C, a handle 53C, a slider 54, and a power supply connector 55.

[0069] The second body 52C is attached to the base end of the first body 51. The second body 52C has a through hole 52h that runs through it along the longitudinal direction A. The conductive wire 3 is inserted through the through hole 52h.

[0070] The through hole 52h of the second body 52C houses an O-ring (ring member) 59. The conductive wire 3 is inserted through the O-ring 59 and is in contact with the O-ring 59. Therefore, compared to the first embodiment, the sliding resistance of the conductive wire 3 in the longitudinal direction A is high. As a result, even when the operator releases their hand from the slider 54, the conductive wire 3 is less likely to advance in the longitudinal direction A, and the tip portion 20 of the sheath 2 is more likely to maintain its curved state.

[0071] Figure 18 shows another embodiment of the O-ring 59. The second body 52C may house multiple O-rings 59, as shown in Figure 18. This increases the sliding resistance of the conductive wire 3 in the longitudinal direction A.

[0072] The handle 53C is connected to the second body 52C in such a way that it cannot rotate in the circumferential direction C and cannot move forward or backward in the longitudinal direction A. When the handle 53C is rotated in the circumferential direction C, the second body 52C rotates together with the handle 53C relative to the first body 51.

[0073] According to the papillotome 100C of this embodiment, the tip 20 of the sheath 2, which is provided with the tip treatment section 1, can be easily moved by rotating the sheath 2 in the circumferential direction C while maintaining the curved state of the tip 20. The operator can maintain the curved state of the tip 20 without performing any special operations. Therefore, the operator can perform the operation of rotating the sheath 2 in the circumferential direction C while maintaining the curved state of the tip 20 of the sheath 2 by themselves.

[0074] Although a third embodiment of the present invention has been described in detail above 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 gist of the present invention. Furthermore, the components shown in the above-described embodiment and the following modifications can be combined as appropriate.

[0075] (Fourth embodiment) A papillotome 100D according to the fourth embodiment of the present invention will be described with reference to Figure 19. In the following description, components that are common to those already described will be denoted by the same reference numerals, and redundant descriptions will be omitted.

[0076] Figure 19 shows the operating section 5D of the Papillotome 100D. The papillotome (endoscopic treatment instrument, high-frequency treatment instrument) 100D is used as an endoscopic treatment system together with the endoscope 200, similar to the papillotome 100 of the first embodiment. The papillotome 100D comprises a tip treatment section 1, a sheath 2, a conductive wire 3, and an operating section 5D.

[0077] The operating unit 5D comprises a first body 51, a second body 52, a handle 53, a slider 54D, and a power supply connector 55.

[0078] The slider 54D is mounted to the handle 53 so as to be able to move back and forth in the longitudinal direction A, but not to be able to rotate in the circumferential direction C. The slider 54D has a screw 57D.

[0079] The screw (first pressing member) 57D can fix the position of the slider 54D relative to the handle 53.

[0080] The operator pulls the conductive wire 3 by moving the slider 54D to the base end A2 relative to the handle 53, thereby curving the tip 20 of the sheath 2. With the tip 20 of the sheath 2 curved, the operator tightens the screw 57D to fix the position of the slider 54D relative to the handle 53. As a result, even if the operator releases their hand from the slider 54D, the conductive wire 3 does not advance in the longitudinal direction A, and the tip 20 of the sheath 2 can maintain its curved state.

[0081] According to the papillotome 100D of this embodiment, the tip portion 20 of the sheath 2, which is provided with the tip treatment portion 1, can be easily moved by rotating the sheath 2 in the circumferential direction C while maintaining a curved state.

[0082] Although the fourth embodiment of the present invention has been described in detail above with reference to the drawings, the specific configuration is not limited to this embodiment, and design changes and the like are also included within the scope of the gist of the present invention. Furthermore, the components shown in the above-described embodiment and the following modifications can be combined as appropriate.

[0083] (Fifth embodiment) A papillotome 100E according to the fifth embodiment of the present invention will be described with reference to Figures 20 to 22. In the following description, components that are common to those already described will be denoted by the same reference numerals, and redundant descriptions will be omitted.

[0084] Figure 20 shows the operating section 5E of the papillotome 100E. The papillotome (endoscopic treatment instrument, high-frequency treatment instrument) 100E is used as an endoscopic treatment system together with the endoscope 200, similar to the papillotome 100 of the first embodiment. The papillotome 100E comprises a tip treatment section 1, a sheath 2, a conductive wire 3, and an operating section 5E.

[0085] The operating unit 5E comprises a first main body 51, a second main body 52E, a handle 53E, a slider 54, and a power supply connector 55.

[0086] The second body 52E is attached to the base end of the first body 51. The second body 52E has a through hole 52h that runs through it along the longitudinal direction A. The conductive wire 3 is inserted through the through hole 52h. A lever 57E is also provided at the base end of the second body 52E.

[0087] Figures 21 and 22 illustrate the operation of lever 57E. The lever (second pressing member) 57E is attached to the second body 52E so as to be rotatable about a rotation axis 57Er. The lever 57E has a pressing portion 57Eb that can contact the conductive wire 3. By rotating the lever 57E to position the pressing portion 57Eb to press against the conductive wire 3, the position of the conductive wire 3 relative to the second body 52 can be fixed.

[0088] The operator pulls the conductive wire 3 by moving the slider 54 to the proximal end A2 relative to the handle 53, thereby curving the tip 20 of the sheath 2. With the tip 20 of the sheath 2 curved, the operator fixes the position of the conductive wire 3 relative to the second body 52 by positioning the pressing part 57Eb to press against the conductive wire 3. As a result, even if the operator releases their hand from the slider 54, the conductive wire 3 does not advance in the longitudinal direction A, and the curved state of the tip 20 of the sheath 2 can be maintained.

[0089] The handle 53E is connected to the second body 52E in such a way that it cannot rotate in the circumferential direction C and cannot move forward or backward in the longitudinal direction A. When the handle 53E is rotated in the circumferential direction C, the second body 52E rotates together with the handle 53E relative to the first body 51.

[0090] According to the papillotome 100E of this embodiment, the tip portion 20 of the sheath 2, which is provided with the tip treatment portion 1, can be easily moved by rotating the sheath 2 in the circumferential direction C while maintaining a curved state.

[0091] Although the fifth embodiment of the present invention has been described in detail above with reference to the drawings, the specific configuration is not limited to this embodiment, and design changes and the like are also included within the scope of the gist of the present invention. Furthermore, the components shown in the above-described embodiment and the following modifications can be combined as appropriate. [Industrial applicability]

[0092] This invention can be applied to endoscopic treatment instruments and the like that which have a rotating function. [Explanation of symbols]

[0093] 300 Endoscopic Treatment Systems 200 Endoscopes 100, 100B, 100C, 100D, 100E Papillotomes (endoscopic treatment instruments, high-frequency treatment instruments) 1. Advanced Treatment Section 11 First through hole 12 Second through hole 15 Markers 2 sheaths 20 Tip 21 knife lumens 21b Proximal opening 22. Contrast lumen (fluid delivery lumen) 22a Tip opening 22b Proximal opening 23 guide wire lumens 23a Tip opening 23b Proximal opening 26 Proximal end 3 Conductive wires 5,5B,5C,5D,5E Operation section 51 First Main Body 511 First Tube 512 Second tube 52,52B,52C,52E Second body 52h through hole 53, 53B, 53C, 53E handle 531 Snacks 54, 54D Slider 55 Power supply connector 56 Contrast Imaging Port 57 First deformation section 57B Second deformation section 57Bh through hole 57a, 57Ba tapered section 57D Screw (First pressing member) 57E Lever (Second pressing member) 57Eb Pressing part 57Er Rotation axis 57h through hole 58 First connection part 58a Inside surface 58B Second connection part 58Ba Inner surface 59 O-ring (ring component) 6. Incision site

Claims

1. A sheath having lumens extending in the longitudinal direction, An operating part attached to the base end of the sheath, A wire having one end attached to the tip of the sheath and the other end attached to the operating part, wherein the wire is capable of moving forward and backward in the longitudinal direction and rotating in the circumferential direction by operation of the operating part, A ring member positioned in contact with the aforementioned wire, Equipped with, Endoscopic instruments.

2. The tip of the sheath has a first through-hole and a second through-hole that communicate with the lumen, The wire is inserted through the first and second through holes and exposed to the outside of the sheath. The endoscopic treatment instrument according to claim 1.

3. By operating the aforementioned operating unit, the wire is rotated in the circumferential direction, thereby rotating the tip of the sheath in the circumferential direction. The endoscopic treatment instrument according to claim 1.

4. By operating the aforementioned operating unit, the wire is pulled in the longitudinal direction, causing the tip of the sheath to bend. The endoscopic treatment instrument according to claim 1.

5. The aforementioned operating unit is The main body attached to the base end of the sheath, A handle is connected to the main body so as to be rotatable in the circumferential direction, A slider is connected to the handle so as to be able to move back and forth in the longitudinal direction, It has, The wire is connected to a connector provided on the slider. The endoscopic treatment instrument according to claim 1.

6. The slider is mounted to the handle so as to be able to move back and forth in the longitudinal direction and not to be able to rotate in the circumferential direction. The endoscopic treatment instrument according to claim 5.

7. The ring member is provided on the main body, To generate sliding resistance to the forward and backward movement of the wire in the longitudinal direction, The endoscopic treatment instrument according to claim 5.

8. A marker is provided on a part of the circumferential direction of the sheath, in the portion where the first through hole and the second through hole are provided. The endoscopic treatment instrument according to claim 2.

9. The endoscopic treatment instrument according to claim 1, Endoscope and, Equipped with, Endoscopic treatment system.

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