Extendable and retractable endoscope cap

Abstract

The tissue treatment device includes a handle with an actuator, a control cable, and a cap. The cap includes a mounting structure that is detachably coupled in an operable configuration onto the distal end of the insertion device. The cap includes a portion movably coupled to the structure, which is for movement between a retracted position in which the distal end of the portion is received over the distal end of the device and an extended position in which the distal end of the portion is extended distally beyond the distal end of the device. The portion includes a wall defining an internal channel, which, when the portion is in the extended position, surrounds a space adjacent to the distal end of the device. The portion is coupled to the distal end of the cable, and the actuation of the actuator causes the portion to move between the extended and retracted positions.

Description

Technical Field

[0001] The present disclosure relates to an endoscopic device, and more particularly to a cap for attachment to the distal end of an endoscope.

Background Art

[0002] Physicians are increasingly performing a wide variety of interventional and therapeutic endoscopic gastrointestinal (GI) procedures that require observing and / or treating tissue proximate to the distal end of an endoscope. Some of these procedures involve a cap that is coupled to the distal end of the endoscope so as to extend distally away from the distal end of the endoscope, providing, for example, a space into which tissue can be drawn for treatment, or a space that can be used to observe tissue outside the cap under certain conditions.

Summary of the Invention

[0003] The present disclosure relates to a device for treating tissue. The device includes a handle including a first actuator, a first control cable extending distally from the proximal end coupled to the first actuator, and a cap. The cap includes an attachment structure configured to be removably coupled in an operable configuration on the distal end of an insertion device. The insertion device is configured to be inserted into a target site within a living body.

[0004] The cap further includes an extension movably coupled to the attachment structure, the extension being between a retracted position where the distal end of the extension is received over the distal end of the insertion device and an extended position where the distal end of the extension extends distally beyond the distal end of the insertion device. The extension includes a wall defining an internal channel, and when the extension is in the extended position, the wall is configured to surround a space proximate to the distal end of the insertion device. The extension is coupled to the distal end of the first control cable, and actuation of the first actuator is configured to move the extension between the extended position and the retracted position.

[0005] In one embodiment, the extension portion is slidably received on a mounting structure, and the extension portion moves linearly along the mounting structure between an extended position and a retracted position.

[0006] In one embodiment, a first control cable is configured to be attached along the length of the insertion device so as to extend from the cap to the handle, and the handle is configured to remain outside the body accessible to the user during use.

[0007] In one embodiment, the mounting structure includes a screw thread and an extension that engages with the screw thread, wherein rotation of the extension in a first direction around the mounting structure moves the extension distally to the mounting structure, and rotation of the extension in a second direction opposite to the first direction around the mounting structure moves the extension proximal to the mounting structure.

[0008] In one embodiment, a first control cable is configured to be inserted through an internal channel of the insertion device to the distal end of the insertion device, and the first control cable enters the extension through an opening on the radial inner surface of the wall of the extension and is attached to the extension, and the movement of the first actuator moves the first control cable relative to the mounting structure, rotates the extension around the mounting structure, and moves the extension proximal and distal relative to the distal end of the insertion device, and the handle is configured to remain outside the body accessible to the user during use.

[0009] In one embodiment, the handle further includes at least one feedback structure configured to interact with a first actuator, so that the user receives feedback corresponding to the operation of the first actuator corresponding to the amount of movement of the extension relative to the mounting structure.

[0010] In one embodiment, a first actuator is slidably mounted on the body of a handle, and a feedback structure includes a series of bumps on the body of the handle that, when contacted by the first actuator, provide the user with tactile or audible feedback.

[0011] In one embodiment, the first actuator is coupled to a first control cable and includes a wheel rotatably mounted on a handle, such that the rotation of the wheel causes the first control cable to rotate.

[0012] In one embodiment, the device further includes a hemostatic clip detachably attached to an extension and a second control cable extending from the hemostatic clip to a second actuator on a handle, wherein when the extension is moved to the extended position, operating the second actuator moves the second control cable, deploying the hemostatic clip from the extension to clip any tissue drawn into the channel of the extension.

[0013] In one embodiment, the first control cable includes a coil that is rigid in the longitudinal direction and flexible in the axial direction. In one embodiment, the mounting structure includes a first portion having a first outer diameter and a second portion extending distally from the first portion and having a second outer diameter reduced from the first outer diameter of the first portion, wherein the extension has an inner diameter corresponding to the second outer diameter of the second portion and an outer diameter substantially equal to the first outer diameter of the first portion.

[0014] In one embodiment, the hemostatic clip includes a first jaw and a second jaw biased toward a closed configuration, the extension portion being radially rigid enough to maintain the hemostatic clip in an open configuration with the first jaw and the second jaw spaced apart from each other, and the channel of the extension portion remaining open to receive the tissue to be clipped when in the extended position.

[0015] In addition, this disclosure relates to a method for treating tissue. The method includes: attaching a cap mounting structure to the distal end of an endoscope in a retracted position where the distal end of the cap is retracted toward the distal end of the endoscope; advancing the endoscope into the body to a target site adjacent to the tissue to be treated; operating a first actuator, which remains outside the body accessible to the user during use, to extend the extension of the cap distally relative to the mounting structure such that the extension protrudes distally from the distal end of the endoscope, with the internal channel of the extension defining an internal space close to the distal end of the endoscope; and operating the first actuator to retract the extension to the retracted position after treating the tissue accessed through the internal channel of the extension.

[0016] In one embodiment, operating the first actuator to extend the extension portion of the cap distal to the mounting structure includes sliding the first actuator axially relative to the body of the handle to which the first actuator is attached.

[0017] In one embodiment, operating the first actuator to extend the extension portion of the cap distal to the mounting structure includes rotating the first actuator around the body of the handle to which the first actuator is attached.

[0018] In one embodiment, the cap includes a hemostatic clip that is removably received on the cap. The method further includes drawing tissue into an internal channel of the extension and operating a second actuator that remains outside the living body and accessible to the user during use to deploy the hemostatic clip from the extension and clip the tissue drawn into the internal channel of the extension.

[0019] In one embodiment, the operation of the first actuator causes the extension portion to move linearly on the mounting structure. In one embodiment, the method further includes operating a first actuator in a first direction to rotate an extension on a thread of an attachment structure and advance the extension distally with respect to the attachment structure, and operating the first actuator in a second direction opposite the first direction to linearly rotate the extension on the thread of the attachment structure and retract the extension proximally with respect to the attachment structure.

Brief Description of the Drawings

[0020] [Figure 1A] FIG. 8 shows a side view of an endoscope with a cap according to an exemplary embodiment attached thereto in a retracted state. [Figure 1B] FIG. 11 shows a side view of an endoscope with the cap of FIG. 1A attached thereto in an extended state. [Figure 2A] FIG. 14 shows a perspective view of the caps of FIGS. 1A and 1B in a retracted state. [Figure 2B] FIG. 17 shows a partial perspective view of the caps of FIGS. 1A and 1B in an extended state. [Figure 3] FIG. 20 shows a cross-sectional view of the caps of FIGS. 1A and 1B in a retracted state. [Figure 4] FIG. 23 shows a side view of a handle and an actuator for use with the system of FIGS. 1-3. [Figure 5] FIG. 26 shows a perspective view of a cap according to a further embodiment. [Figure 6] FIG. 29 shows a perspective view of a system according to yet another embodiment.

Modes for Carrying Out the Invention

[0021] The present disclosure can be further understood by reference to the following description and the accompanying drawings, in which like elements are referred to by the same reference numerals. The present disclosure relates to a cap that can be selectively coupled to the distal end of an endoscope or other insertion device to create a controllable space distal to the distal end of the endoscope. The controllable space can be used, for example, to create a region with improved visibility distal to the endoscope, to provide a space into which tissue can be drawn so that the tissue can be treated in any of a variety of procedures, or to create a space between the distal end of the scope and the tissue to be observed, treated, sampled, or otherwise interacted with.

[0022] In an exemplary embodiment, this cap, which is used in combination with an over-the-scope hemostatic clip, will be described. However, those skilled in the art will understand that the caps according to these embodiments can be employed in any number of applications related or unrelated to hemostatic clips. Further, as will be understood by those skilled in the art, the terms distal and proximal are employed in this application to indicate the directions of proximal (towards the user) and distal (away from the user).

[0023] As will be understood by those skilled in the art, the adapters according to the embodiments described herein can be used in a wide range of applications, including the deployment of ligating bands, procedures where the user may desire to observe tissue closely (i.e., with the adapter retracted in the proximal direction of the endoscope) at one point and create a space controlled distal to the distal end of the endoscope at another point. For example, in certain situations, a physician may desire to create a space between the visual system of the endoscope and the tissue being examined, or the physician may desire to clear the area in front of the endoscope (e.g., by aspirating debris from the space within the adapter) to improve visibility. In some cases, the physician may be inserting the endoscope into the space between tissue layers, and the tissue layers may collapse onto the endoscope leaving no space for visualization. Extending the adapter distally from the endoscope can create the separation from the tissue necessary to enable observation.

[0024] Such procedures may involve, for example, the injection of fluid into the organ wall between tissue layers to separate the tissue layers of the organ. The physician may then make an incision in the organ wall and insert an endoscope into the space between the tissue layers (for example, to check whether the lesion has infiltrated deeper layers of tissue). This observation may be enhanced by extending an adapter from the distal end of the endoscope, as described below, to create a desired amount of space between the lens of the endoscope and the tissue. Thus, there are many procedures that can be enhanced through the use of the adapters described below, and the description of the hemostatic clip is merely illustrative.

[0025] As shown in Figures 1 to 4, a clipping system 100 for treating tissue defects and / or perforations according to an exemplary embodiment includes an adapter 110 mounted on the distal end 108 of an endoscope 106. The adapter 110 includes a proximal attachment portion 113 configured to be detachably attached (e.g., by friction fitting) to the distal portion of the endoscope 106, and a nesting distal portion 114 movably attached to the proximal attachment portion 113.

[0026] As those skilled in the art will understand, a cap coupled to an endoscope so as to extend distally from the distal end of the endoscope may reduce the field of view of the endoscope and may make it more difficult to maneuver the endoscope through the body lumen to a target site (for example, by making it more difficult to navigate tight bends). The adapter of the embodiments described herein is movable relative to the endoscope and moves between a retracted configuration and an extended configuration. This allows the user to retract the adapter to the retracted position if they wish to see a wider or unobstructed field of view, or if they wish to improve the maneuverability of the endoscope by eliminating all or part of the distal projection of the adapter beyond the distal end of the endoscope.

[0027] For example, in this embodiment, the adapter 110 is movable relative to the distal end 108 of the endoscope 106 to which the adapter 110 is attached via extension members 112 (e.g., axially slidable along the endoscope 106), and each of the extension members 112 extends from the distal end coupled to the adapter 110 to the proximal end coupled to the actuator 130 on the handle 132 along the outside of the endoscope 106. If the adapter 110 is configured to deploy, for example, an over-the-scope hemostatic clip 102, as described below, one or more of the extension members 112 may be configured as hollow members (e.g., coils that are rigid in the longitudinal direction and flexible in the axial direction) within which control wires are slidably received to actuate the clip 102 in any known way. That is, as will be understood by those skilled in the art, each of the control wires 103 may extend distally beyond the distal end of the corresponding extension member 112 and be releasably coupled to the clip 102, so that the clip may be deployed in any known manner on the target tissue drawn into the adapter 110.

[0028] The proximal end of the extension member 112 is coupled to an actuator 130 slidably mounted on the body 136 of the handle 132. The body 136 of the handle 132 includes a series of feedback bumps 134 that provide tactile and / or audible feedback to the user as the actuator 130 is advanced distally, so that each time the user encounters a bump 134, they know how far distally the adapter 110 has been advanced from its initial position (e.g., the fully retracted position where the distal end of the adapter 110 is aligned with the distal end of the endoscope 106). In this embodiment, the handle 132 includes a finger loop 138, and the actuator 130 includes a pair of finger loops 140.

[0029] However, those skilled in the art will understand that the handle 132 may be configured in any way that allows the operator to move the actuator 130 relative to the body 136 of the handle 132 as needed to achieve the desired movement of the adapter 110. Furthermore, those skilled in the art will understand that the actuator 130 may include a locking mechanism so as to lock the position of the actuator 130 relative to the body 136 of the handle 132, thereby locking the position of the adapter 110 relative to the distal end 108 of the endoscope 106.

[0030] As those skilled in the art will understand, system 100 may be used in combination with any over-the-clip 102, and therefore the operation of clip 102 will not be described in detail except with respect to the movement of adapter 110 between retracted and extended configurations. That is, those skilled in the art will understand that once adapter 110 is in the extended configuration, the operation of clip 102 is substantially the same as the operation that would have always been performed on a conventional system including an adapter that remains fixed in an extended position distal to the endoscope.

[0031] In this embodiment, the nesting distal portion 114 of the adapter 110 is slidably received on the proximal attachment portion 113 to move proximal and distally between a retracted configuration and an extended configuration (or to any desired partial extended configuration). Specifically, in this embodiment, the proximal attachment portion 113 includes a first portion 120 having a first outer diameter 120D and a second portion 122 extending distally from the first portion 120 and having an outer diameter 122D that is reduced relative to the outer diameter of the first portion 120. The nesting distal portion 114 in this embodiment has an inner diameter corresponding to the outer diameter of the second portion 122 and an outer diameter substantially equal to the outer diameter of the first portion 120. As will be understood by those skilled in the art, this is not essential, but it ensures that the cross-sectional area of ​​the adapter 110 is minimized to reduce interference with surrounding tissue when the endoscope 106 is inserted into the target site.

[0032] The proximal mounting portion 113 of the adapter 110 in this embodiment is a hollow member sized and shaped to frictionally fit onto the distal end of the endoscope 106, and is sufficiently rigid in the radial direction so that when the clip 102 is received by the nesting distal portion 114, the jaws of the clip are separated from each other, and even when the nesting distal portion 114 extends distally from its retracted configuration, the central channel 124 of the nesting distal portion 114 remains open, allowing it to receive target tissue and minimizing the reduction of the endoscope's field of view by the nesting distal portion 114.

[0033] When in use, the adapter 110 is mounted on the endoscope 106 by sliding the first portion 120 over the distal end 108 of the endoscope 106 until the distal end of the nesting distal portion 114 is flush with the distal end 108 of the endoscope 106. The extension member 112 is then pulled proximal along the endoscope 106 and optionally fixed to the endoscope. The adapter 110 is then maintained in a retracted configuration as the endoscope 106 is navigated to a target site in the body (for example, through a body lumen accessed via a pre-existing bodily opening). Those skilled in the art will understand that this allows the user to maintain all the advantages of the endoscope 106's maneuverability and field of view while inserting the endoscope 106 into a target site.

[0034] Upon reaching the target site, the user may keep the adapter in a retracted configuration to observe the target tissue, and once the user has identified a desired location to deploy the clip 102, the user may move the extension member 112 distally so that the extension member 112 pushes the nesting distal portion 114 distally over the second portion 122 of the proximal attachment portion 113, causing the nesting distal portion 114 to slide over the second portion 122 to the extended configuration. Those skilled in the art will understand that the maximum distal extension of the nesting distal portion 114 may be defined by the limits of the movement of the extension member 112, or by the shoulders of the second portion 122 positioned to abut against the corresponding shoulders of the nesting distal portion 114, or by any other known mechanism.

[0035] When the nesting distal section 114 is in the desired position (e.g., fully extended to the extended configuration or extended to any desired intermediate position), the user can pull the target tissue into the central channel 124 (e.g., by suction applied through the working channel of the endoscope 106) and clip the tissue by deploying the clip 102 from the adapter 110. The user can then retract the nesting distal section 114 into the retracted configuration by operating the actuator 130 on the handle 132, retract the extension member 112 proximal, and remove the endoscope 106 from the body.

[0036] As shown in Figure 5, the adapter 210 according to a further embodiment includes an inner member 212 from which a helical protrusion 214 protrudes. An outer cap 216 mounted on the inner member 212 includes a helical groove 218 that slidably receives the protrusion 214, such that rotation of the cap 216 on the protrusion 214 can cause the cap 216 to advance distally and retract proximally on the inner member 212. Those skilled in the art will understand that, based on the pitch of the protrusion 214 and the helical groove 218, the distance the cap is distally extended or proximally retracted per rotation of the cap 216 is known, and therefore this screw mechanism allows the user to achieve any known amount of extension of the cap 216. Thus, the user only needs to rotate the cap 216 by a number of degrees corresponding to the desired amount of distal extension or proximal retraction of the cap 216. For example, the user may manually rotate the cap 216 to the desired extension before inserting the device into the body.

[0037] As shown in Figure 6, the system 250 includes a handle 252 and an adapter 260 similar to the adapter 210, which includes an inner member 262 having a helical protrusion 264 protruding therefrom. An outer cap 266 mounted on the inner member 262 includes a helical groove 268 which slidably receives the protrusion 264 so that the rotation of the cap 266 on the protrusion 264 can cause the cap 266 to advance distally and retract proximally on the inner member 262.

[0038] Those skilled in the art will understand that, based on the pitch of the raised portion 264 and the helical groove 268, the distance the cap is extended distally or retracted proximally per rotation of the cap 266 is known, and that this screw mechanism allows the user to achieve any known extension of the cap 266 in the same manner as described above with respect to Figure 5. The handle 252 of the system 250 includes an actuator 270 rotatably mounted on a spool 272 of the handle 252. The proximal end of the extension member 274 is coupled to a spool 272 slidably mounted on the body 276 of the handle 252 for operating the extension member 274 in substantially the same manner as described with respect to the previous embodiment. In this embodiment, the handle 252 includes a finger loop 278, and the spool 272 includes a pair of finger loops 280.

[0039] However, those skilled in the art will understand that the handle 252 may be configured in any way that allows the operator to move the spool 272 relative to the body 276 of the handle 252 as needed to achieve the desired movement of the adapter 260. Furthermore, those skilled in the art will understand that the spool 272 may include a locking mechanism so as to lock its position relative to the body 276 of the handle 252, thereby locking the position of the adapter 260 relative to the distal end 108 of the endoscope 106. In this embodiment, the actuator 270 is rotatably mounted on the spool 272 and coupled to a rotating wire 282 extending from its proximal end, coupled to the actuator 270, along the endoscope 106 to the adapter 260.

[0040] The rotating wire 282 extends into the cap 266, substantially aligned with the longitudinal axis L of the cap 266, and then bends to form a distal portion 285 that extends substantially perpendicular to the axis L to the distal end 284 of the rotating wire 282 coupled to the cap 266. Therefore, if the user wishes to adjust the position of the cap 266 relative to the inner member 262 and the distal end 108 of the endoscope 106, the user rotates the actuator 270 in a first direction A to extend the cap 266 distally relative to the inner member 262, and rotates it in a second direction B to pull the cap 266 proximal onto the inner member 262. In other words, as the actuator 270 rotates relative to the spool 272, the rotating wire 282 rotates around the endoscope 106, and the distal portion 285 of the rotating wire 282 rotates the cap 266 by pushing the cap 266 in direction A or pulling the cap 266 in direction B, so that the cap 266 moves over the raised portion 264 to advance the cap 266 (distally) or pull it (proximal) until it reaches a desired position on the cap 266.

[0041] It will be apparent to those skilled in the art that various modifications may be made to this disclosure without departing from the scope of this disclosure. Furthermore, those skilled in the art will understand that features in any of the various embodiments may be combined in any way that does not contradict the description and / or function of the embodiments.

Claims

1. A device for treating tissue, A handle including a first actuator, A first control cable extending distally from a proximal end coupled to the first actuator, A cap comprising a mounting structure configured to be movably and detachably coupled to the distal end of an implantable device, wherein the implantable device is configured to be inserted into a target site in a living organism, The cap further includes an extension portion movably coupled to the mounting structure, the extension portion for movement between a retracted position in which the distal end of the extension portion is received on the distal end of the insertion device and an extended position in which the distal end of the extension portion extends distally beyond the distal end of the insertion device, A device wherein the extension portion includes a wall defining an internal channel, and when the extension portion is in the extended position, the wall surrounds a space adjacent to the distal end of the insertion device, the extension portion is coupled to the distal end of the first control cable, and the operation of the first actuator moves the extension portion between the extended position and the retracted position.

2. The device according to claim 1, wherein the extension portion is slidably received on the mounting structure, and the extension portion moves linearly along the mounting structure between the extension position and the retracted position.

3. The first control cable is configured to be attached along the length of the insertion device so as to extend from the cap to the handle. The device according to claim 2, wherein the handle is configured to remain outside the biological body accessible to the user during use.

4. The aforementioned mounting structure includes a screw thread, The device according to any one of claims 1 to 3, wherein the extension portion includes a structure that engages with the screw threads, and rotation of the extension portion in a first direction around the mounting structure moves the extension portion distally to the mounting structure, and rotation of the extension portion in a second direction opposite to the first direction around the mounting structure moves the extension portion proximal to the mounting structure.

5. The first control cable is configured to be inserted through the internal channel of the insertion device to the distal end of the insertion device, The device according to claim 4, wherein the first control cable enters the extension through an opening in the radial inner surface of the wall of the extension and is attached to the extension, and the movement of the first actuator moves the first control cable relative to the mounting structure, rotates the extension around the mounting structure, and moves the extension proximal and distal relative to the distal end of the insertion device, and the handle is configured to remain outside the biological body accessible to the user during use.

6. The device according to any one of claims 1 to 5, wherein the handle further includes at least one feedback structure configured to interact with the first actuator, so that the user receives feedback corresponding to the operation of the first actuator corresponding to the amount of movement of the extension relative to the mounting structure.

7. The first actuator is slidably mounted on the body of the handle, The device according to claim 6, wherein the feedback structure includes a series of bumps on the body of the handle that, when contacted by the first actuator, provide the user with tactile or audible feedback.

8. The device according to claim 5, wherein the first actuator is coupled to the first control cable and includes a wheel rotatably mounted on the handle, the rotation of the wheel causing the first control cable to rotate.

9. A hemostatic clip is detachably attached to the extension portion, The device according to any one of claims 1 to 8, further comprising: a second control cable extending from the hemostatic clip to a second actuator on the handle, wherein when the extension portion is moved to the extended position, operating the second actuator moves the second control cable, causing the hemostatic clip to unfold from the extension portion and clip any tissue drawn into the channel of the extension portion.

10. The device according to any one of claims 1 to 9, wherein the first control cable includes a coil that is rigid in the longitudinal direction and flexible in the axial direction.

11. The device according to any one of claims 1 to 10, wherein the mounting structure includes a first portion having a first outer diameter and a second portion extending distally from the first portion and having a second outer diameter reduced from the first outer diameter of the first portion, and the extension portion has an inner diameter corresponding to the second outer diameter of the second portion and an outer diameter substantially equal to the first outer diameter of the first portion.

12. The hemostatic clip includes a first jaw and a second jaw that are biased toward a closure configuration. The device according to claim 9, wherein the extension is radially rigid enough to maintain the hemostatic clip in an open configuration with the first jaws and the second jaws spaced apart from each other, and when in the extended position, the channel of the extension remains open to receive the tissue to be clipped.

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