Suturing member

Abstract

Provided is a suturing member capable of promoting hemostasis of a mucosa defective part and healing of the mucosa defective part. This suturing member 100A, which is used for suturing a mucosa defective part of a digestive tract wall, includes: an annular wire material 110 branched into two from an annular wire material base end 120 and connected with an annular wire material tip 130 opposing the annular wire material base end 120 to form an annular shape; and a cylindrical member 500 externally fitted to the annular wire material 110 so as to be slidable in a direction of the annular wire material tip 130 from the annular wire material base end 120. The annular wire material 110 forms a loop part 200 on the tip side of the cylindrical member 500, and has a wire material (for example, a crosslinking wire material 300) disposed above the mucosa defective part when the substantially central part of the loop part 200 is disposed so as to overlap the substantially central part of the mucosa defective part. The cylindrical member 500 is externally fitted to the annular wire material 110 and a wire material (for example, a crosslinking wire material 300) disposed above the mucosa defective part.

Description

Stitching member

[0001] The present invention relates to a suture member used for suturing a mucosal defect in a digestive tract wall.

[0002] BACKGROUND ART Conventionally, endoscopic submucosal dissection (ESD) and endoscopic mucosal resection (EMR) have been known as techniques for resecting lesions occurring in the walls of the digestive tract, such as the large intestine, esophagus, and stomach.

[0003] In ESD and EMR, mucosal tissue, etc., where a lesion has occurred in the gastrointestinal wall is excised, leaving a mucosal defect, which is a scar (wound) from the excision of the lesion. For example, in ESD, a mucosal defect occurs after the entire lesion, including the submucosal layer, is excised. A mucosal defect caused by ESD is a hole formed in a part of the gastrointestinal wall (the site where the lesion was located), and the bottom of the mucosal defect (bottom of the mucosal defect) reaches the submucosa or the vicinity of the muscular layer. If bleeding from the mucosal defect is observed, a wound closure procedure is performed to close the opening of the mucosal defect (mucosal defect opening).

[0004] A procedure called purse string suture is known as one type of wound closure technique. In purse string suture, for example, as described in Patent Document 1, a retention snare having a substantially circular loop for ligating internal tissue is used, and the retention snare is positioned to surround the mucosal defect, and multiple points of the retention snare are fixed to the mucosa at the edge of the mucosal defect (peripheral mucosa) with endoscopic clips or the like, and the retention snare is pulled and squeezed to close the opening of the mucosal defect like the opening of a purse string.

[0005] JP 2015-192725 A

[0006] In conventional purse string suture, a retention snare 900 having a substantially circular loop is used, as shown in Figures 16A and 16B. First, as shown in Figure 16A, the retention snare 900 is fixed to the peripheral mucosa with a plurality of endoscopic clips C. Then, as shown in Figure 16B, a tubular member 910 is slid to squeeze the loop of the retention snare 900 and reduce its diameter, thereby suturing the mucosal defect D.

[0007] However, although the opening of the mucosal defect is closed at this time, a void (pocket) is formed inside the mucosal defect D, as shown in Figure 16B. In other words, the opening of the mucosal defect is closed like squeezing the opening of a purse, but a cavity is formed at the bottom surface Db of the mucosal defect like the bag part of a purse. As a result, it is not possible to apply pressure to the bottom surface Db of the mucosal defect, which is the source of bleeding, to stop bleeding, which is a problem in that hemostasis cannot be achieved sufficiently. Furthermore, because the bottom surface Db of the mucosal defect is not in a tightly closed state due to the formation of the cavity, tissue healing is difficult to progress, which causes a problem in that healing of the mucosal defect D is delayed.

[0008] The present invention has been made in view of the above problems, and has as its object to provide a suture member that enables hemostasis in a mucosal defect and promotion of healing of the mucosal defect.

[0009] In order to achieve the above-mentioned object, the suture device of the present invention is a suture device used to suture a mucosal defect in a digestive tract wall, and is configured to include an annular wire that branches into two from a base end of the annular wire and is connected to a tip end of the annular wire facing the base end of the annular wire to form a ring, and a tubular member that can slide from the base end of the annular wire in the direction of the tip end of the annular wire, wherein the annular wire forms a loop portion distal to the tubular member, and when the loop portion is positioned so that approximately the center of the loop portion overlaps approximately the center of the mucosal defect, the tubular member has a wire that is positioned above the mucosal defect, and the tubular member is fitted over the annular wire and the wire that is positioned above the mucosal defect.

[0010] According to the above configuration, when suturing a mucosal defect, the wire of the suturing member is positioned above the mucosal defect, so that a portion of the annular wire that is positioned so as to hang over the peripheral mucosa can be fixed to the peripheral mucosa with an endoscopic clip or the like, and the wire that is positioned so as to hang over the mucosal defect can be inserted inside the mucosal defect and fixed to the bottom surface of the mucosal defect (submucosal layer or muscular layer) with an endoscopic clip or the like.

[0011] When the tubular member is slid toward the distal end of the annular wire while the loop is secured with an endoscopic clip or the like, the diameter of the loop contracts and the secured positions converge to the approximate center of the loop, closing the opening of the mucosal defect and lifting the bottom of the mucosal defect toward the opening, thereby reducing the space inside the mucosal defect. This allows bleeding from the bottom of the mucosal defect to be stopped and promotes healing of the mucosal defect.

[0012] In the suture member according to the present invention, in the above configuration, the wire placed above the mucosal defect may comprise a bridging wire that connects two different points of the annular wire in the loop portion.

[0013] According to the above configuration, the crosslinked wire that crosses the inside of the loop portion can be positioned above the mucosal defect.

[0014] In the suture member according to the present invention, in the above configuration, one end of the bridging wire may be connected to the base end of the annular wire, and the other end of the bridging wire may be connected to the tip end of the annular wire.

[0015] According to the above configuration, the bridging wire is arranged so that the extending direction of the bridging wire coincides with the sliding direction of the tubular member, so that after being fixed with an endoscopic clip or the like, the tubular member can be smoothly slid toward the tip end of the annular wire.

[0016] In the sewing member according to the present invention, in the above configuration, the crosslinking wire may be curved.

[0017] According to the above configuration, the crosslinking wire can be lengthened to provide slack in the crosslinking wire, preventing deformation of the loop portion due to tension in the crosslinking wire and making the loop surface of the loop portion a flat surface that can be easily placed near the mucosal defect. Furthermore, lengthening the crosslinking wire makes it easier to insert the crosslinking wire into the mucosal defect and to fix the crosslinking wire to the bottom of the mucosal defect with an endoscopic clip or the like.

[0018] In the above-described configuration of the crimping member according to the present invention, the length of the bridging wire may be substantially the same as the length of the annular wire from the base end of the annular wire to the tip end of the annular wire.

[0019] According to the above configuration, when the base end of the annular wire and the annular wire are pulled in opposite directions to form a shape that brings them close to each other, the bridging wire is not loose. Therefore, when the tubular member is slid toward the tip end of the annular wire after being fixed with an endoscopic clip or the like, loosening of the annular wire and the bridging wire is prevented, and the tubular member can be slid smoothly toward the tip end of the annular wire.

[0020] In the sewing member according to the present invention, in the above configuration, the bridging wire may be included within the loop surface of the loop portion and curved in a substantially S-shape.

[0021] According to the above configuration, the cross-linking wire is reliably made long enough to allow slack, making it easier for the cross-linking wire to reach the bottom surface of the mucosal defect, making it easier to fix the cross-linking wire to the bottom surface of the mucosal defect using an endoscopic clip or the like.

[0022] In the sewing member according to the present invention, in the above configuration, the bridging wire may be curved so as to protrude from the loop surface of the loop portion.

[0023] According to the above configuration, the crosslinking wire is reliably made long enough to allow slack, making it easier for the crosslinking wire to reach the bottom surface of the mucosal defect, and therefore it becomes easy to fix the crosslinking wire to the bottom surface of the mucosal defect with an endoscopic clip, etc. Furthermore, when the suture member is placed in the vicinity of the mucosal defect, the crosslinking wire is positioned so as to protrude above the mucosal defect, making it easy to fix the crosslinking wire with an endoscopic clip, etc.

[0024] In the suture member according to the present invention, in the above configuration, the wires constituting the annular wire may be set to have an intersection at the loop portion where they cross, and the wire placed above the mucosal defect may be formed from a part of the wires constituting the annular wire.

[0025] According to the above configuration, when the approximate center of the loop portion is positioned so as to overlap the approximate center of the mucosal defect, a portion of the annular wire having an intersection portion can be positioned above the mucosal defect.

[0026] In the suture member of the present invention, in the above configuration, the annular wire may be formed to have a concave curved portion that is curved inward at the loop portion, and the wire placed above the mucosal defect may be formed from a part of the wire that makes up the annular wire.

[0027] According to the above configuration, when the approximate center of the loop portion is positioned so as to overlap the approximate center of the mucosal defect, the concave curved portion, which is part of the annular wire, can be positioned above the mucosal defect.

[0028] In the above-described configuration, the suture member according to the present invention may further include a connecting loop portion formed in an annular shape on the proximal side of the tubular member.

[0029] According to the above configuration, when the tubular member is slid toward the tip of the annular wire after being fixed with an endoscopic clip or the like, the annular connecting loop portion can be grasped by the suture device, allowing the tubular member to be slid smoothly.

[0030] In the sewing member according to the present invention, in the above configuration, the connecting loop portion may be formed by the annular wire.

[0031] According to the above configuration, the connecting loop portion can be formed from a part of the annular wire, and the connecting loop portion can be provided with a simple configuration.

[0032] In the sewing member according to the present invention, in the above configuration, the connecting loop portion may be formed by an annular connecting member attached to the annular wire.

[0033] According to the above configuration, the connecting loop portion can be formed by an annular connecting member that can be gripped during sewing, without being limited by the structure of the annular wire rod.

[0034] FIG. 1 is a perspective view showing a suturing member in a first embodiment of the present invention. FIG. 2 is a plan view showing an example of an expanded diameter state of a loop portion of the suturing member in a first embodiment of the present invention. FIG. 3 is a plan view showing an example of a contracted diameter state of a loop portion of the suturing member in a first embodiment of the present invention. FIG. 4 is a side view showing a suturing device used when suturing the suturing member in a first embodiment of the present invention. FIG. 5 is a plan view showing a state immediately before the suturing member in a first embodiment of the present invention is connected to the suturing device. FIG. 6 is a side view showing a state immediately before the suturing member in a first embodiment of the present invention is connected to the distal end of the suturing device. FIG. 7 is a side view showing a state when the suturing member in a first embodiment of the present invention is connected to the distal end of the suturing device. FIG. 8 is a plan view showing a state when the distal end member of the suturing device is abutted against the suturing member in a first embodiment of the present invention. FIG. 9 is a side view showing a state when the distal end member of the suturing device is abutted against the suturing member in a first embodiment of the present invention. FIG. 10 is a plan view showing a state when the suturing member in a first embodiment of the present invention has been contracted in diameter by the suturing device. FIG. 11 is a side view showing a state when the suturing member in a first embodiment of the present invention has been contracted in diameter by the suturing device. FIG. 1 is a plan view for explaining another example of the operation of reducing the diameter of the suturing member in the first embodiment of the present invention by the suturing device. FIG. 2 is a view showing a state in which the suturing member in the first embodiment of the present invention is fixed in the vicinity of a mucosal defect, as viewed from above the mucosal defect. FIG. 3 is a view showing a state in which the suturing member in the first embodiment of the present invention is fixed in the vicinity of a mucosal defect, as viewed from a side of the mucosal defect. FIG. 4 is a view showing a state in which the suturing member in the first embodiment of the present invention has been reduced in diameter to suture the mucosal defect, as viewed from above the mucosal defect. FIG. 5 is a view showing a state in which the suturing member in the first embodiment of the present invention has been reduced in diameter to suture the mucosal defect, as viewed from a side of the mucosal defect. FIG. 6 is a perspective view of a suturing member in a second embodiment of the present invention. FIG. 7 is a plan view of a suturing member in the second embodiment of the present invention. FIG. 8 is a side view of a suturing member in the second embodiment of the present invention. FIG. 9 is a perspective view of a suturing member in a third embodiment of the present invention. FIG. 10 is a view schematically showing the shape of a loop portion of a suturing member included in the present invention, showing a first example having a bridging wire crossing the inside of the loop portion.

[0023] FIG. 1 is a diagram schematically showing the shape of a loop portion of a suturing member included in the present invention, showing a second example having a crosslinked wire rod crossing the inside of the loop portion.

[0024] FIG. 1 is a diagram schematically showing the shape of a loop portion of a suturing member included in the present invention, showing a third example having a crosslinked wire rod crossing the inside of the loop portion.

[0025] FIG. 1 is a diagram schematically showing the shape of a loop portion of a suturing member included in the present invention, showing a first example in which the wire rod constituting the loop portion has an intersection.

[0026] FIG. 1 is a diagram schematically showing the shape of a loop portion of a suturing member included in the present invention, showing a second example in which the wire rod constituting the loop portion has an intersection.

[0027] FIG. 2 is a diagram schematically showing the shape of a loop portion of a suturing member included in the present invention, showing a third example in which the wire rod constituting the loop portion has an intersection.

[0028] FIG. 2 is a diagram schematically showing the shape of a loop portion of a suturing member included in the present invention, showing a first example in which the wire rod constituting the loop portion has a concave curved portion. 1 is a diagram schematically illustrating the shape of a loop portion of a suture member included in the present invention, and is a diagram illustrating a second example in which the wire constituting the loop portion has a concavely curved portion. 2 is a diagram for explaining the problem to be solved by the present invention, and is a diagram of a mucosal defect viewed from above, showing a state in which a retention snare is fixed near a mucosal defect. 3 is a diagram for explaining the problem to be solved by the present invention, and is a diagram of a mucosal defect viewed from the side, showing a state in which a void (pocket) has been formed inside the sutured mucosal defect.

[0035] The suturing member according to the present invention will be described below with reference to the drawings. The suturing member according to the present invention is used to suture mucosal defects caused by, for example, resecting a lesion in the wall of the digestive tract, such as the large intestine, esophagus, or stomach. In this specification, the inside of the patient's body is referred to as the distal side or tip side, and the side closest to the user is referred to as the proximal side or base side, based on the device (suturing device) used to suturing the suturing member inside the body and the user of the endoscope. The drawings referred to in this specification are not necessarily to an accurate scale relative to the actual dimensions, and some parts are exaggerated or simplified to schematically illustrate the configuration according to the present invention.

[0036] First Embodiment First, the configuration of a suturing member 100A according to a first embodiment of the present invention will be described with reference to Figures 1 to 3. Figure 1 is a perspective view showing the suturing member 100A according to the first embodiment of the present invention. Figure 2 is a plan view showing an example of an expanded diameter state of the loop portion 200 of the suturing member 100A according to the first embodiment of the present invention. Figure 3 is a plan view showing an example of a contracted diameter state of the loop portion 200 of the suturing member 100A according to the first embodiment of the present invention.

[0037] As shown in FIGS. 1 to 3, the crimping member 100A is generally configured to include an annular wire 110, a bridging wire 300, and a tubular member 500.

[0038] The annular wire 110 is formed by connecting wires to form an annular shape as a whole. The proximal (base end) portion of the annular wire 110 is designated as the annular wire base end 120, and the distal (tip end) portion of the annular wire 110 facing the annular wire base end 120 is designated as the annular wire tip end 130. The annular wire 110 is formed so that it branches into two strands from the annular wire base end 120 and is connected at the annular wire tip end 130. That is, the annular wire 110 has two opposing wires 110a, 110b between the annular wire base end 120 and the annular wire tip end 130. Examples of materials that can be used for the annular wire 110 include synthetic polymer materials such as polyamide, polyester, and polypropylene, natural fibers such as cotton and silk, and metals.

[0039] The bridging wire 300 is a wire disposed inside the annular wire 110. In the crimped member 100A of the first embodiment, one end 310 of the bridging wire 300 is connected to the annular wire base end 120, and the other end 320 of the bridging wire 300 is connected to the annular wire tip end 130. That is, the bridging wire 300 is bridged between the annular wire base end 120 and the annular wire tip end 130. When the bridging wire 300 is provided so as to connect the annular wire base end 120 and the annular wire tip end 130 in this manner, the extending direction of the bridging wire 300 can be aligned with the sliding direction of the tubular member 500, thereby enabling the tubular member 500 to smoothly slide toward the annular wire tip end 130. The material of the bridging wire 300 is not particularly limited, and the same material as that of the annular wire 110 described above can be used.

[0040] The crosslinking wire 300 may be formed in a substantially straight line or curved shape between the annular wire proximal end 120 and the annular wire distal end 130. In the suturing member 100A of the first embodiment, the crosslinking wire 300 is disposed so as to be contained within the plane formed by the annular wire 110, and is pre-shaped so as to be curved in a substantially S-shape. By forming the crosslinking wire 300 in this curved shape, deformation of the loop portion 200 due to the tension of the crosslinking wire 300 can be prevented, and the loop surface LP (see FIG. 5B ) of the loop portion 200 can be made into a flat surface that can be easily positioned near the mucosal defect D. Furthermore, by lengthening the crosslinking wire 300, it becomes easier to insert the crosslinking wire 300 into the mucosal defect D.

[0041] The length of the curved cross-linking wire 300 is not particularly limited, but in this example, it is approximately the same as the length from the annular wire base end 120 to the annular wire tip end 130 of the annular wire 110. In other words, the opposing wires 110a, 110b and the cross-linking wire 300 have approximately the same length. As a result, when the annular wire base end 120 and the annular wire tip end 130 are pulled in opposite directions to form shapes that bring them closer to each other, the cross-linking wire 300 is in a non-slack state. Therefore, when the tubular member 500 is slid toward the annular wire tip end 130, the annular wire 110 and the cross-linking wire 300 are prevented from becoming loose, and the tubular member 500 can be smoothly slid.

[0042] The method of connecting the annular wire 110 and the crosslinking wire 300 when fabricating the sewn member 100A is not particularly limited. For example, a single wire may be bent appropriately to form the crosslinking wire 300, the wire 110a, and the wire 110b in a single stroke. Specifically, as shown in FIGS. 1 to 3 , the crosslinking wire 300 may be bent from one end 310 to the other end 320 to form the wires 110a and 110b into an annular shape, and then the wires may be fixed to each other at the annular wire base end 120 and the annular wire tip end 130 by adhesive bonding, fusion bonding, or the like. Alternatively, the annular wire 110 and the crosslinking wire 300 may be prepared separately, and the one end 310 and the other end 320 of the crosslinking wire 300 may be fixed to the annular wire base end 120 and the annular wire tip end 130 by adhesive bonding, fusion bonding, or the like. Furthermore, a ring-shaped wire may be prepared that constitutes one of the two wires 110a, 110b and the bridging wire 300, and both ends of the other of the two wires 110a, 110b may be fixed to the base end 120 and tip end 130 of the ring-shaped wire by adhesive bonding, fusion bonding, or the like.

[0043] The tubular member 500 is a cylindrical member having a lumen 500a that opens at a proximal end surface (base end surface) 500b and a distal end surface (tip end surface) 500c. The tubular member 500 is fitted onto the annular wire 110 so as to be slidable between the annular wire proximal end 120 and the annular wire distal end 130. At this time, as shown by the dotted lines in FIG. 1 , the lumen 500a of the tubular member 500 is inserted with the two wires 110a, 110b that make up the annular wire 110, as well as the bridging wire 300. The material of the tubular member 500 is not particularly limited, but is preferably elastic, and examples thereof include fluorine-based resin and silicone rubber.

[0044] When the tubular member 500 is fitted onto the annular wire 110 and the bridging wire 300, an annular loop portion 200 is formed on the distal side (tip side) of the tubular member 500. The loop portion 200 is a ring formed by the annular wire 110 extending from near the distal end surface 500c of the tubular member 500 to the distal side (tip side) of the tubular member 500, and is bent to form a substantially perfect circle.

[0045] Before suturing the mucosal defect D (see Figures 10A and 10B described below), the tubular member 500 is positioned on the proximal side (base end side) of the suturing member 100A, as shown in Figure 2. At this time, the loop portion 200 formed on the distal side (tip end side) of the tubular member 500 forms a large loop. When the tubular member 500 is slid from the annular wire proximal end 120 toward the annular wire distal end 130 from this state, the loop portion 200 is squeezed and gradually reduces in diameter, as shown in Figure 3.

[0046] Furthermore, when the tubular member 500 is fitted over the annular wire 110 and the bridging wire 300, an annular connecting loop portion 400 is formed on the proximal side (base end side) of the tubular member 500. The connecting loop portion 400 is a loop formed by the annular wire 110 extending from near the proximal end surface 500b of the tubular member 500 to the proximal side (base end side) of the tubular member 500. As will be described later, the suturing device 2 grasps the connecting loop portion 400 with its connecting hook 21 to connect it to the suturing member 100A.

[0047] The size of the suture member 100A may be appropriately determined according to the size of the mucosal defect D to be sutured. For example, it is preferable to set the diameter of the loop portion 200 larger than the diameter of the opening (mucosal defect opening) of the mucosal defect D to be sutured, so that when the loop portion 200 is positioned so that the approximate center of the mucosal defect D overlaps the approximate center of the loop portion 200, the loop portion 200 will surround the periphery of the mucosal defect opening. As an example, the diameter of the loop portion 200 of the tubular member 500 is approximately 2 to 40 mm, and the wire diameters of the annular wire 110 and the bridging wire 300 are approximately 0.2 to 0.6 mm. Furthermore, the tubular member 500 is preferably configured so that the two wires 110a, 110b and the bridging wire 300 constituting the annular wire 110 are press-fitted into the tubular member 500, and the inner diameter of the lumen 500a of the tubular member 500 is approximately 0.5 to 1.5 mm.

[0048] As described above, the suture member 100A in the first embodiment has a configuration in which the tubular member 500 is fitted onto the annular wire 110 and the bridging wire 300. The loop portion 200 formed on the distal side (tip side) of the tubular member 500 has the annular wire 110 that forms a substantially circular outline in a plan view, and the bridging wire 300 that is bridged across the inside of the loop portion 200, and when the tubular member 500 is slid in the direction from the annular wire base end 120 toward the annular wire tip end 130, the loop portion 200 can be squeezed to reduce its diameter.

[0049] Next, the crimping device 2 used for the crimping member 100A in the first embodiment of the present invention will be described with reference to Fig. 4. Fig. 4 is a side view showing the crimping device 2 used when crimping the crimping member 100A in the first embodiment of the present invention.

[0050] As shown in FIG. 4, the suture device 2 includes a connecting hook 21, a sheath 22, a drive wire 23, a locking mechanism 2A having a base side locking member 25 and a sheath side locking member 26, and an operating unit 2B having a base portion 27 and a slider portion 28.

[0051] The sheath 22 is made of a flexible hollow tube. Although a simple tube made of resin or the like may be used as the sheath 22, a coil tube is used in this embodiment. As the coil tube, for example, a flat wire coil tube formed by spirally winding a long flat plate made of a metal such as stainless steel may be used. However, a round wire coil tube or an internally flat coil tube may also be used. Furthermore, a wire tube may also be used as the sheath 22. The wire tube is a tube made of hollow stranded wires formed by spirally twisting multiple wires (cables) made of a metal such as stainless steel.

[0052] A substantially cylindrical tip member 24 made of, for example, resin is fixed integrally to the distal end (tip) of the coil tube of the sheath 22, and the distal end surface of the tip member 24 serves as an abutment portion that can abut against the proximal end surface (base end surface) 500b of the tubular member 500 of the suture member 100A described above. However, from the standpoint of reducing costs and the number of parts, the tip member 24 may not be provided, in which case the distal end surface of the coil tube serves as the abutment portion that abuts against the proximal end surface (base end surface) 500b of the tubular member 500 of the suture member 100A.

[0053] The drive wire 23 is made of a flexible wire, and in this embodiment, a wire rope is used. The wire rope is a rope made of stranded wires formed by helically twisting multiple wires (cables) made of metal such as stainless steel. However, the drive wire 23 may also be made of a single wire.

[0054] A connecting hook 21 is integrally attached to the distal end (tip) of the drive wire 23. The connecting hook 21 is made of an elastic body having a pair of arms 21a arranged to open from each other in a roughly V-shape (roughly V-shaped) toward the tip, and claws 21b formed by bending the tips of the arms 21a inward. The base ends of the arms 21a are integrated into a roughly U-shape and connected to the distal end (tip) of the drive wire 23. The connecting hook 21 can be made of a metal such as stainless steel.

[0055] The connecting hook 21 protrudes from the distal end of the sheath 22 and opens its legs in a generally V-shape due to its own elasticity when the drive wire 23 is slid so as to push the drive wire 23 distally relative to the sheath 22 (i.e., the sheath 22 is slid proximally relative to the drive wire 23). Conversely, when the drive wire 23 is slid so as to retract the drive wire 23 proximally relative to the sheath 22 (i.e., the sheath 22 is slid distally relative to the drive wire 23), the connecting hook 21 is accommodated inside the sheath 22 and closes its legs.

[0056] In the suture device 2 of this embodiment, by holding the drive wire 23 in a fixed position and operating the sheath 22 to push out or retract, the pair of arms 21a of the connecting hook 21 can be freely opened and closed (gripping or releasing) while keeping the position of the connecting hook 21 constant.

[0057] The proximal end (base end) of the sheath 22 through which the drive wire 23 is inserted is connected and fixed to the distal end (tip end) of the base portion 27 via a luer lock mechanism having a base side locking member 25 and a sheath side locking member 26.

[0058] A slider portion 28 is slidably attached to the base portion 27. The proximal end of the drive wire 23 passes through the through-holes of the sheath-side locking member 26 and the base-side locking member 25, reaches the slider portion 28, and is removably fixed to the slider portion 28 via a lock screw 29.

[0059] By sliding the slider portion 28 distally relative to the base portion 27, the connecting hook 21 provided at the distal end of the drive wire 23 is pushed out from the distal end of the sheath 22 and opens in a generally V-shape due to its own elasticity. Conversely, by sliding the slider portion 28 proximally relative to the base portion 27, the connecting hook 21 provided at the distal end of the drive wire 23 is recessed from the distal end of the sheath 22 and is housed inside the sheath 22.

[0060] 5A to 9, the operation of reducing the diameter of the loop portion 200 of the crimping member 100A using the above-described crimping device 2 will be described. FIG. 5A is a plan view showing the state immediately before connecting the crimping member 100A to the crimping device 2 in the first embodiment of the present invention. FIG. 5B is a side view showing the state immediately before connecting the crimping member 100A to the crimping device 2 in the first embodiment of the present invention. FIG. 6A is a plan view showing the state in which the crimping member 100A in the first embodiment of the present invention is connected to the distal end of the crimping device 2. FIG. 6B is a side view showing the state in which the crimping member 100A in the first embodiment of the present invention is connected to the distal end of the crimping device 2. FIG. 7A is a plan view showing the state in which the distal end of the sheath 22 of the crimping device 2 is abutted against the crimping member 100A in the first embodiment of the present invention. FIG. 7B is a side view showing the state in which the distal end of the sheath 22 of the crimping device 2 is abutted against the crimping member 100A in the first embodiment of the present invention. Fig. 8A is a plan view showing a state in which the diameter of the crimping member 100A in the first embodiment of the present invention has been reduced by the crimping device 2. Fig. 8B is a side view showing a state in which the diameter of the crimping member 100A in the first embodiment of the present invention has been reduced by the crimping device 2. Fig. 9 is a plan view for explaining another example of the operation of reducing the diameter of the crimping member 100A in the first embodiment of the present invention by the crimping device 2.

[0061] When connecting the suturing member 100A to the distal end of the sheath 22 of the suturing device 2, the base portion 27 is slid proximally relative to the slider portion 28 to retract the sheath 22 relative to the drive wire 23, causing the connecting hook 21 at the distal end of the drive wire 23 to protrude from the distal end of the sheath 22 and open in a generally V-shape due to its own elasticity, as shown in Figures 5A and 5B. The bridging wire 300 of the suturing member 100A is disposed so as to be contained within the loop surface LP of the loop portion 200, and when viewed from the side as in Figure 5B, for example, it is hidden behind the wire 110b located on the near side of the drawing.

[0062] From this state, when the base portion 27 is slid distally relative to the slider portion 28, the sheath 22 is pushed out relative to the drive wire 23, and the connecting hook 21 at the distal end of the drive wire 23 gradually closes as it enters the sheath 22. The connecting hook 21 is positioned so that it can grasp the connecting loop portion 400 of the suturing member 100A, and is then housed within the sheath 22 and completely closed. As a result, the connecting loop portion 400 of the suturing member 100A can be grasped by being pinched by the connecting hook 21, as shown in Figures 6A and 6B.

[0063] When the connecting loop portion 400 of the suturing member 100A is grasped by the connecting hook 21 and the base portion 27 is slid distally relative to the slider portion 28, the sheath 22 is pushed out relative to the drive wire 23, and as shown in Figures 7A and 7B, the distal end surface of the tip member 24 provided at the distal end of the sheath 22 of the suturing device 2 abuts against the proximal end surface (base end surface) 500b of the tubular member 500 of the suturing member 100A.

[0064] From this state, the base portion 27 is slid further distally relative to the slider portion 28, and the sheath 22 is slid distally relative to the drive wire 23, thereby pushing out the tubular member 500 by the sheath 22. As a result, as shown in Figures 8A and 8B, the tubular member 500 can be slid in the direction from the annular wire proximal end 120 to the annular wire distal end 130, and the loop portion 200 can be squeezed to reduce its diameter.

[0065] When disconnecting the suturing member 100A from the distal end of the sheath 22, the base portion 27 is slid proximally relative to the slider portion 28, and the sheath 22 is slid proximally relative to the drive wire 23, causing the connecting hook 21 to protrude from the distal end of the sheath 22 and open the legs. This releases the connection of the suturing member 100A by the connecting hook 21, and the suturing member 100A can be removed from the suturing device 2.

[0066] 9, while the wire near the proximal end surface (base end surface) 500b of the tubular member 500 of the suture member 100A is grasped from the side by the connecting hook 21, the sheath 22 may be slid distally relative to the driving wire 23, causing the tubular member 500 to slide from the annular wire proximal end 120 toward the annular wire distal end 130. This action makes it possible to push out the tubular member 500 strongly and tightly fasten the loop portion 200, which is particularly effective in the finishing stage of the suture process.

[0067] A method for suturing a mucosal defect D using a suturing member 100A will be described with reference to Figures 10A and 10B and Figures 11A and 11B. Figure 10A is a diagram showing a state in which a suturing member 100A according to a first embodiment of the present invention has been fixed in the vicinity of a mucosal defect D, as viewed from above the mucosal defect D. Figure 10B is a diagram showing a state in which a suturing member 100A according to a first embodiment of the present invention has been fixed in the vicinity of a mucosal defect D, as viewed from a side of the mucosal defect D. Figure 11A is a diagram showing a state in which the suturing member 100A according to the first embodiment of the present invention has been contracted to suture the mucosal defect D, as viewed from above the mucosal defect D. Figure 11B is a diagram showing a state in which the suturing member 100A according to the first embodiment of the present invention has been contracted to suture the mucosal defect D, as viewed from a side of the mucosal defect D. 10A and 10B, and 11A and 11B, the suture device 2 is not shown. Also, in Fig. 10B and 11B, a cross section of the mucosal defect D is shown.

[0068] As an example, the following describes a case in which a mucosal defect D, which occurs after a lesion in the digestive tract wall is excised using a high-frequency scalpel or the like by ESD, is sutured using the suture member 100A. When suturing the mucosal defect D, first, the suture member 100A is attached to the distal end of the suture device 2 and positioned near the mucosal defect D via a treatment tool guide tube of an endoscope (not shown).

[0069] The endoscope used here may be a single-channel endoscope having a single instrument guide tube, or a multi-channel endoscope having two or more instrument guide tubes. When a single-channel endoscope is used, for example, the suturing member 100A is transported and placed near the mucosal defect D using the suturing device 2, and then the device inserted into the instrument guide tube of the endoscope is replaced with a known clipping device or the like to fix the suturing member 100A with the clip. After fixation is complete, the device is replaced with the suturing device 2 to perform the suturing procedure. On the other hand, when a multi-channel endoscope is used, the distal end of the suturing device 2 to which the suturing member 100A is attached is inserted through a first instrument guide tube, and then a known clipping device or the like is inserted through a second instrument guide tube to fix the suturing member 100A with the clip. After fixation is complete, the suturing procedure can be performed by operating the suturing device 2 inserted through the first instrument guide tube.

[0070] Next, a plurality of endoscopic clips C (hereinafter referred to as "clips C") are used to fix the suture member 100A placed near the mucosal defect D. As with the clip device, known clips C can also be used.

[0071] The loop portion 200 of the suture member 100A is provided with an annular wire 110 that forms a substantially circular outline in plan view, and a bridging wire 300 that spans across the inside of the loop portion 200. When fixation is performed with the clip C, for example, the loop portion 200 is positioned so that the approximate center of the opening of the mucosal defect overlaps with the approximate center of the loop portion 200, and the annular wire 110 surrounds the periphery of the opening of the mucosal defect. At this time, the bridging wire 300 on the inside of the loop portion 200 is positioned so as to cross the opening of the mucosal defect.

[0072] In this state, the annular wire 110 is clamped between the clips C and pressed against the peripheral mucosa, thereby grasping (closing) the clips C. This allows the annular wire 110 to be fixed to the peripheral mucosa by the clips C. The number and positions of the clips C used to fix the annular wire 110 to the mucosa can be selected as appropriate.

[0073] The crosslinking wire 300, which is disposed inside the loop portion 200, is inserted into the mucosal defect D through the opening in the mucosal defect while being clamped by the clips C, and is then pressed against the bottom surface Db (submucosal layer or muscular layer) of the mucosal defect to grasp (close) the clips C. This allows the crosslinking wire 300 to be fixed to the bottom surface Db of the mucosal defect with the clips C. In particular, when the crosslinking wire 300 has a substantially S-shaped curve as shown in the figure, the crosslinking wire 300 can be made longer to provide some slack, making it easier for the crosslinking wire 300 to reach the bottom surface Db of the mucosal defect, facilitating the task of fixing the crosslinking wire 300 to the bottom surface Db of the mucosal defect. The number and positions of the clips C used to fix the crosslinking wire 300 to the bottom surface Db of the mucosal defect may be selected as appropriate.

[0074] 10A and 10B, the annular wire 110 constituting the loop portion 200 can be fixed to the peripheral mucosa, and the cross-linking wire 300 constituting the loop portion 200 can be fixed to the bottom surface Db of the mucosal defect. As an example, Figures 10A and 10B show a state in which the annular wire 110 is fixed to the peripheral mucosa using four clips C, and the cross-linking wire 300 is fixed to the bottom surface Db of the mucosal defect using two clips C.

[0075] The clips C attached at predetermined positions on the peripheral mucosa and the bottom surface Db of the mucosal defect grip and fix the peripheral mucosa and the bottom surface Db of the mucosal defect. Meanwhile, the annular wire 110 and the bridging wire 300 gripped by the clips C are positioned so as not to deviate from the fixed positions of the clips C, but are allowed to move (slide) along the longitudinal direction.

[0076] Next, a suturing treatment is performed using the suturing member 100A fixed by the clip C to the mucosa near the mucosal defect D. Here, the loop portion 200 of the suturing member 100A is contracted in diameter to suture the mucosal defect D. Specifically, as described with reference to FIGS. 5A to 9 , the suturing device 2 is used to slide the tubular member 500 of the suturing member 100A, thereby squeezing the loop portion 200 to contract its diameter.

[0077] When the tubular member 500 of the suture member 100A is gradually slid from the annular wire proximal end 120 toward the annular wire distal end 130, the annular wire 110 and the bridging wire 300 of the loop portion 200 are drawn into the lumen 500a of the tubular member 500, gradually reducing the diameter of the loop portion 200. At this time, with each clip C fixed to the peripheral mucosa or the bottom surface Db of the mucosal defect, the annular wire 110 and the bridging wire 300 move (slide) along the longitudinal direction, reducing the diameter of the loop portion 200. As a result, the peripheral mucosa or the bottom surface Db of the mucosal defect, where each clip C is fixed, moves toward the approximate center of the loop portion 200. As a result, the opening of the mucosal defect can be closed, and the bottom surface Db of the mucosal defect can be lifted toward the opening of the mucosal defect, as shown in FIGS. 11A and 11B .

[0078] In particular, the suture member 100A in the first embodiment of the present invention includes a bridging wire 300 inside the loop portion 200. The bridging wire 300 is positioned so as to hang above the mucosal defect D, and is inserted into the opening of the mucosal defect, whereby the bottom surface Db of the mucosal defect can be fixed with a clip C. Conventional purse-string suture techniques have the problem of forming a void (pocket) inside the mucosal defect D, as shown in FIG. 16B . On the other hand, when the mucosal defect D is sutured using the suture member 100A in the first embodiment of the present invention, the bottom surface Db of the mucosal defect rises toward the opening of the mucosal defect, as shown in FIG. 11B . This reduces the void inside the mucosal defect D (or eliminates the void inside the mucosal defect D), allowing the bottom surface Db of the mucosal defect to be tightly adhered. This allows bleeding from the bottom surface Db of the mucosal defect to be stopped and the healing of the mucosal defect D to be promoted.

[0079] The tubular member 500 of the suturing member 100A is firmly pushed distally (toward the tip) and pressed in so as not to return to the proximal side (toward the base end), and then the suturing member 100A is detached from the suturing device 2, and the suturing device 2 of the suturing member 100A is removed from the body, thereby completing the suturing treatment of the mucosal defect D. If necessary, portions of the annular wire 110 and the bridging wire 300 extending proximally beyond the tubular member 500 of the suturing member 100A may be cut with a high-frequency knife or the like and recovered.

[0080] Second Embodiment Next, the configuration of a suturing member 100B according to a second embodiment of the present invention will be described with reference to Figures 12, 13A, and 13B. Figure 12 is a perspective view showing a suturing member 100B according to the second embodiment of the present invention. Figure 13A is a plan view showing a suturing member 100B according to the second embodiment of the present invention. Figure 13B is a side view showing a suturing member 100B according to the second embodiment of the present invention. In the following, components similar to those of the suturing member 100A according to the first embodiment described above will be assigned the same reference numerals, and their description will be omitted or simplified.

[0081] 12, 13A, and 13B, the suturing member 100B of the second embodiment, like the suturing member 100A of the first embodiment described above, has a configuration in which a tubular member 500 is fitted onto the outside of an annular wire 110 and a bridging wire 300. The loop portion 200 formed on the distal side (tip side) of the tubular member 500 has the annular wire 110 that forms a substantially circular outline in a plan view and the bridging wire 300 that is bridged across the inside of the loop portion 200, and when the tubular member 500 is slid in the direction from the annular wire base end 120 toward the annular wire tip end 130, the loop portion 200 can be squeezed to reduce its diameter.

[0082] In the sewn member 100A in the first embodiment described above, the bridging wire 300 is preformed so as to be curved in a substantially S-shape and is disposed so as to be included within the loop surface LP of the loop portion 200. In contrast, in the sewn member 100B in the second embodiment, the bridging wire 300 is preformed so as to be curved and protrude from the loop surface LP of the loop portion 200, as shown in Fig. 13B.

[0083] In this way, by forming the crosslinking wire 300 in a curved shape so as to protrude from the loop surface LP of the loop portion 200, the crosslinking wire 300 can be reliably lengthened. As a result, the crosslinking wire 300 can be provided with some slack, making it easier for the crosslinking wire 300 to reach the bottom surface Db of the mucosal defect, and thus facilitating fixing the crosslinking wire 300 to the bottom surface Db of the mucosal defect with the clip C. Furthermore, when the suturing member 100B is positioned near the mucosal defect D, the crosslinking wire 300 is positioned so as to protrude above the mucosal defect D, making it easy to fix the crosslinking wire 300 with the clip C. The length of the curved crosslinking wire 300 is not particularly limited, but, similar to the suturing member 100A in the first embodiment, it is approximately the same as the length from the annular wire base end 120 to the annular wire tip end 130 of the annular wire 110.

[0084] Third Embodiment Next, the configuration of a suturing member 100C according to a third embodiment of the present invention will be described with reference to Fig. 14. Fig. 14 is a perspective view showing the suturing member 100C according to the third embodiment of the present invention. In the following, the same components as those of the suturing members 100A and 100B according to the first and second embodiments described above will be denoted by the same reference numerals, and their description will be omitted or simplified.

[0085] 14, the suturing member 100C of the third embodiment, like the suturing member 100A of the first embodiment described above, has a configuration in which a tubular member 500 is fitted onto the outside of an annular wire 110 and a bridging wire 300. The loop portion 200 formed on the distal side (tip side) of the tubular member 500 has the annular wire 110 that forms a substantially circular outline in a plan view and the bridging wire 300 that is bridged across the inside of the loop portion 200, and when the tubular member 500 is slid in the direction from the annular wire base end 120 toward the annular wire tip end 130, the loop portion 200 can be squeezed to reduce its diameter.

[0086] While the bridging wire 300 of the sewn members 100A and 100B in the first and second embodiments described above is preformed into a curved shape, the bridging wire 300 of the sewn member 100C in the third embodiment has a substantially straight shape as shown in Fig. 14. However, the bridging wire 300 may be preformed into a substantially S-shape or so as to protrude from the loop surface LP, as in the first and second embodiments described above.

[0087] In the suture member 100A of the first embodiment described above, the loop formed by the annular wire 110 extending from near the proximal end surface 500b of the tubular member 500 toward the proximal side (base end side) of the tubular member 500 is used as the connecting loop portion 400 to be grasped by the connecting hook 21 of the suture device 2. In contrast, in the suture member 100C of the third embodiment, as shown in Fig. 14, an annular connecting member 600 is attached proximally (toward the base end) of the tubular member 500 which is fitted over the annular wire 110 and the bridging wire 300. A through-hole 610 is formed in the connecting member 600, and this through-hole 610 can be used as the connecting loop portion 400 to be grasped by the connecting hook 21 of the suture device 2.

[0088] By providing the annular connecting member 600 on the proximal side (base end side) of the suture member 100C in this manner, the annular connecting member 600 can be securely grasped by the connecting hook 21 of the suture device 2 when the tubular member 500 is slid from the annular wire proximal end 120 toward the annular wire distal end 130. The connecting member 600 may be made of a material (e.g., metal) different from that of the annular wire 110 and the bridging wire 300, and may be fixed by adhesive or the like to the proximal side (base end side) of the annular wire proximal end 120 where the annular wire 110 and the bridging wire 300 are connected.

[0089] The concept of the present invention and the suture member 100 encompassed by the present invention will be described below. Figures 15A to 15H are diagrams schematically illustrating the shape of the loop portion 200 of the suture member 100 encompassed by the present invention. Figures 15A to 15C are diagrams showing first to third examples in which a bridging wire 300 crosses the inside of the loop portion 200, Figures 15D to 15F are diagrams showing first to third examples in which the wire constituting the loop portion 200 has an intersection portion 700, and Figures 15G and 15H are diagrams showing first and second examples in which the wire constituting the loop portion 200 has a concavely curved portion 800.

[0090] Retention snares conventionally used in purse string suturing (e.g., retention snare 900 shown in Figures 16A and 16B) have a loop portion on the distal side (tip side), similar to the suture members 100A, 100B, and 100C in the first to third embodiments described above. However, the loop portion formed in conventional retention snares is substantially circular, and no wire is positioned inside a reference circle that characterizes the outer shape of the loop portion (a reference circle that includes the loop portion). The reference circle that includes the loop portion here refers to a circle that characterizes the outer shape (outline) of the loop portion, and is the smallest including circle or smallest circumscribing circle of the loop portion.

[0091] On the other hand, the suturing member 100 according to the present invention is configured to have a wire positioned inside a reference circle (a reference circle encompassing the loop portion 200) that characterizes the outer shape of the loop portion 200. With this configuration, when the suturing member 100 is positioned so that the approximate center of the loop portion 200 (the center of the reference circle) overlaps the approximate center of the mucosal defect D, the wire can be positioned above the mucosal defect D, and the annular wire 110 that forms the loop portion 200 can be secured to the peripheral mucosa with a clip, while the wire positioned above the mucosal defect D can be inserted into the mucosal defect D and secured to the bottom surface Db of the mucosal defect with a clip. The present invention encompasses suturing members 100 of any shape that are configured so that the wire is positioned inside a reference circle (a reference circle encompassing the loop portion 200) that characterizes the outer shape of the loop portion 200.

[0092] The suture member 100 according to the present invention may have a substantially straight or curved bridging wire 300 provided so as to cross the inside of the loop portion 200. For example, in all of the suture members 100 shown in Figures 15A to 15C, the bridging wire 300 is provided so as to connect two different points on the annular wire 110 that forms the loop portion 200, and the bridging wire 300 is positioned inside a reference circle R that encompasses the loop portion 200. When suturing a mucosal defect D, the bridging wire 300 is positioned above the mucosal defect D.

[0093] The crimping member 100 shown in Fig. 15A is provided with a bridging wire 300 so that it coincides with the sliding direction of the tubular member 500. Representative examples of the crimping member 100 shown in Fig. 15A are the crimping members 100A, 100B, and 100C in the first to third embodiments described above. Furthermore, the crimping member 100 shown in Figs. 15B and 15C is provided with a bridging wire 300 that extends diagonally or perpendicularly to the sliding direction of the tubular member 500. Note that a plurality of bridging wires 300 may be provided.

[0094] Furthermore, the suture member 100 according to the present invention may be configured to have an intersection 700 where the annular wire 110 constituting the loop portion 200 intersects. At the intersection 700, the annular wire 110 constituting the loop portion 200 is overlapped or twisted. For example, in all of the suture members 100 shown in Figures 15D to 15F, the annular wire 110 constituting the loop portion 200 has an intersection 700, and as the wire overlaps or twists due to the intersection 700, the wire is positioned inside a reference circle R that encompasses the loop portion 200. When suturing a mucosal defect D, a portion of the wire constituting the annular wire 110 is positioned above the mucosal defect D. The position and number of intersections 700 are not particularly limited.

[0095] Furthermore, the suture member 100 according to the present invention may be configured so that the annular wire 110 constituting the loop portion 200 has a concavely curved portion 800 that is curved so as to be recessed inward of the loop portion 200. For example, the suture members 100 shown in Figures 15G and 15H both have a concavely curved portion 800 that is recessed inward of the loop portion 200, and the inward recess caused by the concavely curved portion 800 results in the wire being positioned inside a reference circle R that encompasses the loop portion 200. When suturing a mucosal defect D, a portion of the wire constituting the annular wire 110 is positioned above the mucosal defect D. The position and number of concavely curved portions 800 are not particularly limited.

[0096] The operation of the suture member 100 according to the present invention will now be described.

[0097] The suturing member 100 according to the present invention is used to suture a mucosal defect D in a digestive tract wall, and, like the suturing members 100A, 100B, and 100C in the first to third embodiments described above, is configured to include an annular wire 110 that branches into two at a proximal end 120 and is connected to a distal end 130 facing the proximal end 120 to form a ring, and a tubular member 500 that is slidable from the proximal end 120 toward the distal end 130. The annular wire 110 forms a loop portion 200 distal to the tubular member 500. Furthermore, when the suturing member 100 is positioned so that the approximate center of the loop portion 200 overlaps the approximate center of the mucosal defect D, the tubular member 500 is fitted over the annular wire 110 and the wire positioned above the mucosal defect D.

[0098] According to the above configuration, when suturing the mucosal defect D, the wire of the suturing member 100 is positioned above the mucosal defect D, so that a portion of the annular wire 110 that is positioned so as to hang over the peripheral mucosa can be fixed to the peripheral mucosa with an endoscopic clip (clip C) or the like, and the wire that is positioned so as to hang over the mucosal defect D can be inserted into the mucosal defect D with clip C or the like and fixed to the bottom surface Db (submucosa or muscular layer) of the mucosal defect D, which is the bottom of the mucosal defect D.

[0099] When the tubular member 500 is slid toward the distal end 130 of the annular wire in this fixed state, the loop portion 200 is squeezed and reduced in diameter, and the positions fixed by the clip C or the like are gathered at approximately the center of the loop portion 200, closing the opening of the mucosal defect and lifting the bottom surface Db of the mucosal defect toward the opening, thereby reducing the space inside the mucosal defect D. This makes it possible to stop bleeding from the bottom surface Db of the mucosal defect and promote healing of the mucosal defect D.

[0100] The suture member 100 according to the present invention may be provided with a bridging wire 300 that connects two different points of the annular wire 110 in the loop portion 200 as a wire that is placed above the mucosal defect D, like the suture members 100A, 100B, and 100C in the first to third embodiments described above.

[0101] According to the above configuration, the crosslinking wire 300 that crosses the inside of the loop portion 200 can be positioned above the mucosal defect D.

[0102] The sewn member 100 according to the present invention may have one end 310 of the bridging wire 300 connected to the annular wire base end 120 and the other end 320 of the bridging wire 300 connected to the annular wire tip end 130, like the sewn member 100A, 100B, and 100C in the first to third embodiments described above.

[0103] According to the above configuration, the bridging wire 300 is arranged so that the extension direction of the bridging wire 300 and the sliding direction of the tubular member 500 coincide with each other, so that after being fixed with a clip C or the like, the tubular member 500 can be smoothly slid in the direction of the annular wire tip 130.

[0104] The crimping member 100 according to the present invention may have a curved bridging wire 300, as in the crimping members 100A and 100B in the first and second embodiments described above.

[0105] According to the above configuration, the crosslinking wire 300 can be lengthened to provide slack to the crosslinking wire 300, preventing deformation of the loop portion 200 due to the tension of the crosslinking wire 300 and making the loop surface LP of the loop portion 200 a flat surface that can be easily placed near the mucosal defect D. Furthermore, lengthening the crosslinking wire 300 makes it easier to insert the crosslinking wire 300 into the mucosal defect D and to fix the crosslinking wire 300 to the bottom surface Db of the mucosal defect with a clip C or the like.

[0106] The sewn member 100 of the present invention may have a length of the bridging wire 300 that is approximately the same as the length from the annular wire base end 120 to the annular wire tip end 130 of the annular wire 110, as in the sewn member 100A and 100B in the first and second embodiments described above.

[0107] According to the above configuration, when the base end 120 of the annular wire and the tip end 130 of the annular wire are pulled in opposite directions to bring them closer to each other, the bridging wire 300 is not loose. Therefore, when the tubular member 500 is slid toward the tip end 130 of the annular wire after being fixed with a clip C or the like, loosening of the annular wire 110 and the bridging wire 300 is prevented, and the tubular member 500 can be smoothly slid toward the tip end 130 of the annular wire.

[0108] The sewn member 100 according to the present invention may have the bridging wire 300 included within the loop surface LP of the loop portion 200 and curved in an approximately S-shape, as in the sewn member 100A in the first embodiment described above.

[0109] According to the above configuration, the bridging wire 300 is reliably made long and has slack, making it easier for the bridging wire 300 to reach the bottom surface Db of the mucosal defect, and therefore it becomes easy to fix the bridging wire 300 to the bottom surface Db of the mucosal defect with a clip C or the like.

[0110] The sewn member 100 according to the present invention may be curved so that the bridging wire 300 protrudes from the loop surface LP of the loop portion 200, like the sewn member 100B in the second embodiment described above.

[0111] According to the above configuration, the cross-linking wire 300 is reliably made long enough to allow slack, making it easier for the cross-linking wire 300 to reach the bottom surface Db of the mucosal defect, and therefore it becomes easy to fix the cross-linking wire 300 to the bottom surface Db of the mucosal defect with a clip C or the like. Furthermore, when the suture member 100B is placed near the mucosal defect D, the cross-linking wire 300 is positioned so as to protrude above the mucosal defect D, making it easy to fix the cross-linking wire 300 with a clip C or the like.

[0112] As shown in Figures 15D to 15F, the suture member 100 according to the present invention is configured such that the loop portion 200 has an intersection 700 where the wires constituting the annular wire 110 intersect, and the wire placed above the mucosal defect D may be formed from a portion of the wires constituting the annular wire 110.

[0113] According to the above configuration, when the approximate center of the loop portion 200 is positioned so as to overlap the approximate center of the mucosal defect D, a portion of the annular wire 110 having the intersection portion 700 can be positioned above the mucosal defect D.

[0114] In the suture member 100 according to the present invention, as shown in Figures 15G and 15H, for example, the annular wire 110 is formed so as to have a concave curved portion 800 that is curved inward at the loop portion 200, and the wire placed above the mucosal defect D may be formed from a portion of the wire that constitutes the annular wire 110.

[0115] According to the above configuration, when the approximate center of the loop portion 200 is positioned so as to overlap the approximate center of the mucosal defect D, the concave curved portion 800, which is part of the annular wire 110, can be positioned above the mucosal defect D.

[0116] The suturing member 100 according to the present invention may be provided with a connecting loop portion 400 formed in a ring shape on the proximal side of the tubular member 500, like the suturing members 100A, 100B, and 100C in the first to third embodiments described above.

[0117] According to the above configuration, when the tubular member 500 is slid toward the annular wire tip 130 after being fixed with a clip C or the like, the annular connecting loop portion 400 can be grasped by the sewing device 2, allowing the tubular member 500 to slide smoothly.

[0118] In the sewn member 100 according to the present invention, the connecting loop portion 400 may be configured by the annular wire 110, as in the sewn members 100A and 100B in the first and second embodiments described above.

[0119] According to the above-described configuration, the connecting loop portion 400 can be formed from a part of the annular wire 110, and the connecting loop portion 400 can be provided with a simple configuration.

[0120] The sewn member 100 according to the present invention may have a connecting loop portion 400 formed by a ring-shaped connecting member 600 attached to the ring-shaped wire 110, as in the sewn member 100C in the third embodiment described above.

[0121] According to the above-described configuration, the connecting loop portion 400 can be formed by the annular connecting member 600 that can be gripped during sewing, without being limited by the structure of the annular wire 110 .

[0122] The above-described embodiments are provided to facilitate understanding of the present invention and are not intended to limit the present invention. The components disclosed in the above-described embodiments are intended to encompass all design modifications and equivalents that fall within the technical scope of the present invention. Furthermore, configurations obtained by appropriately combining the components described in each embodiment are also encompassed by the present invention.

[0123] 2 Suturing device 2A Locking mechanism 2B Operating section 21 Connecting hook 21a Arm section 21b Claw section 22 Sheath 23 Driving wire 24 Tip member 25 Base side locking member 26 Sheath side locking member 27 Base section 28 Slider section 29 Lock screw 100, 100A, 100B, 100C Suturing member 110 Annular wire 110a, 110b Wire 120 Annular wire base end 130 Annular wire tip 200 Loop section 300 Bridging wire 310 One end 320 Other end 400 Connecting loop section 500 Cylindrical member 500a Lumen 500b Proximal end surface (base end surface) 500c Distal end surface (tip surface) 600 Connecting member 610: Through-hole 700: Intersecting portion 800: Concave curved portion 900: Detention snare 910: Cylindrical member C: Clip (endoscopic clip) D: Mucosal defect Db: Bottom surface of mucosal defect LP: Loop surface R: Reference circle

Claims

1. A suturing device used for suturing a mucosal defect in a digestive tract wall, comprising: an annular wire that branches into two from a base end of the annular wire and is connected to a tip end of the annular wire facing the base end of the annular wire to form a ring; and a tubular member that can slide from the base end of the annular wire in the direction of the tip of the annular wire, wherein the annular wire forms a loop portion further distal than the tubular member, and when the loop portion is positioned so that an approximate center of the loop portion overlaps with an approximate center of the mucosal defect, the suturing device has a wire that is positioned above the mucosal defect, and the tubular member is fitted over the annular wire and the wire that is positioned above the mucosal defect.

2. The suture member according to claim 1, characterized in that the wire placed above the mucosal defect comprises a bridging wire connecting two different points of the annular wire in the loop portion.

3. A sewing member as described in claim 2, characterized in that one end of the bridging wire is connected to the base end of the annular wire, and the other end of the bridging wire is connected to the tip end of the annular wire.

4. The sewing member according to claim 2, wherein the crosslinked wire is curved.

5. The sewing member according to claim 4, characterized in that the length of the bridging wire is approximately the same as the length of the annular wire from the base end of the annular wire to the tip end of the annular wire.

6. The sewing member according to claim 4, characterized in that the bridging wire is included within the loop surface of the loop portion and is curved in a substantially S-shape.

7. The sewing member according to claim 4, wherein the bridging wire is curved so as to protrude from the loop surface of the loop portion.

8. The suture member according to claim 1, characterized in that in the loop portion, the wire material constituting the annular wire is formed to have an intersecting portion, and the wire material arranged above the mucosal defect is formed by a part of the wire material constituting the annular wire.

9. The suture member according to claim 1, characterized in that the annular wire is formed so as to have a concave curved portion that is curved inwardly at the loop portion, and the wire placed above the mucosal defect is constituted by a portion of the wire that constitutes the annular wire.

10. A suture member as claimed in any one of claims 1 to 9, characterized in that it is provided with a connecting loop portion formed in an annular shape on the proximal side of the tubular member.

11. The sewing member according to claim 10, wherein the connecting loop portion is formed from the annular wire.

12. The sewing member according to claim 10, wherein said connecting loop portion is formed by an annular connecting member attached to said annular wire.

Images