Insertion tool and method for using insertion tool

Abstract

An insertion tool according to one embodiment of the present invention comprises: a tube that can be inserted into the large intestine; a plurality of divider parts that are provided to the outer periphery of the tube and contact the inner surface of the large intestine; and drainage structures positioned between the divider parts. A method for using an insertion tool according to a first embodiment of the present invention comprises: an insertion step in which an insertion tool having a tube, a plurality of divider parts provided to the outer periphery of the tube, and drainage structures positioned between the divider parts is inserted into the large intestine, the plurality of divider parts are brought into contact with the inner surface of the large intestine, and the interior of the large intestine is partitioned into a plurality of partition regions; a drainage step in which, when bleeding occurs from the inner surface of the large intestine, the blood in the corresponding partition region is drained by the corresponding drainage structure; and a partition identification step in which the partition region in which the bleeding has occurred is identified.

Description

Insertion tool and how to use it

[0001] The present invention relates to an insert and a method for using the insert.

[0002] A large number of colonic diverticula (hereinafter simply referred to as diverticula) may develop on the inner surface of the large intestine. Colonic diverticula (hereinafter simply referred to as diverticula) are generally benign diseases, but they may bleed due to inflammation or localized stress. Furthermore, if the diverticula repeatedly bleed, endoscopic hemostatic treatment is required. Patent Document 1 discloses an example of a method for hemostatic treatment.

[0003] US Patent Application Publication No. 923 / 248949

[0004] In the case of colonic diverticulum bleeding, the surface of the bleeding point may become covered with a blood clot (a semi-solidified scab) some time after the occurrence of the bleeding, temporarily stopping the bleeding. In this case, even if the inside of the colon where bleeding was confirmed is observed with an endoscope, it is difficult to identify which diverticulum the bleeding came from, and there is a problem that permanent treatment for the diverticulum from which the bleeding occurred cannot be performed.

[0005] The present invention has been made in view of the above-mentioned problems, and has as its object to provide an insertion tool for identifying the location of a bleeding point in the large intestine, and a method for using the same.

[0006] In order to solve the above problems, the present invention proposes the following means: An insertion tool according to a first aspect of the present invention comprises a tube that can be inserted into the large intestine, a plurality of partitions that are provided on the outer periphery of the tube and come into contact with the inner surface of the large intestine, and drainage structures that are located between the partitions.

[0007] A method of using an insertion tool according to a first aspect of the present invention includes an insertion step of inserting an insertion tool having a tube, a plurality of partitions provided on the outer periphery of the tube, and drainage structures located between the partitions into the large intestine, and bringing the plurality of partitions into contact with the inner surface of the large intestine to partition the interior of the large intestine into a plurality of compartmented regions; a drainage step of draining blood from the compartmented regions using the drainage structures when bleeding occurs from the inner surface of the large intestine; and a compartment identification step of identifying the compartmented region where the bleeding occurred.

[0008] According to the above aspect, it is possible to provide an insertion tool for identifying the position of a bleeding point in the large intestine, and a method for using the insertion tool to identify the position of a bleeding point.

[0009] FIG. 1 is a schematic diagram of an insertion tool of a first embodiment. FIG. 2 is a schematic diagram showing a state in which the insertion tool of the first embodiment is placed in the large intestine. FIG. 3 is a flowchart showing a main flow of a method of using the insertion tool of the first embodiment. FIG. 4 is a schematic diagram of an endoscope used in the method of use of the first embodiment. FIG. 5 is a schematic diagram showing an insertion step in the method of use of the first embodiment. FIG. 6 is a schematic diagram showing an insertion step of a modified method of use of the first embodiment. FIG. 7 is a schematic diagram showing a drainage step in the method of use of the first embodiment. FIG. 8 is a schematic diagram showing a removal step in the method of use of the first embodiment. FIG. 9 is a flowchart showing a main flow of a method of use of a modified method of use of the first embodiment. FIG. 10 is a schematic diagram showing a state in which the insertion tool of a modified first embodiment is placed in the large intestine. FIG. 11 is a flowchart showing a main flow of a treatment step of a second embodiment. FIG. 12 is a schematic diagram of a treatment tool used in the treatment step of the second embodiment. FIG. 13 is a schematic diagram showing a closing step in the treatment step of the second embodiment. FIG. 14 is a schematic diagram showing a first suction step in the treatment steps of the second embodiment. FIG. 15 is a schematic diagram showing a first liquid injection step in the treatment steps of the second embodiment. FIG. 16 is a schematic diagram showing a second suction step in the treatment steps of the second embodiment. FIG. 17 is a schematic diagram showing a second liquid injection step in the treatment steps of the second embodiment. FIG. 18 is a schematic diagram showing how the second liquid is aspirated in the treatment steps of the second embodiment. FIG. 19 is a flowchart showing a main flow of the treatment steps of the third embodiment. FIG. 20 is a schematic diagram showing a holder attachment step and a depressurization step in the third embodiment. FIG. 21 is a schematic diagram showing a holder attachment step and a depressurization step in Modification 1 of the third embodiment. FIG. 22 is a schematic diagram showing a holder attachment step and a depressurization step in Modification 2 of the third embodiment. FIG. 23 is a schematic diagram showing a holder attachment step and a depressurization step in Modification 3 of the third embodiment. FIG. 24 is a schematic diagram showing a holder attachment step and a depressurization step in Modification 4 of the third embodiment. FIG. 25 is a schematic diagram showing a holder attaching step and a decompression step of a fifth modified example of the third embodiment.FIG. 26 is a flowchart showing a main flow of the bleeding point locating method of the fourth embodiment. FIG. 27 is a schematic diagram showing a first gel spraying step in the bleeding point locating method of the fourth embodiment. FIG. 28 is a schematic diagram showing a gel recovery step in the bleeding point locating method of the fourth embodiment. FIG. 29 is a schematic diagram showing a second gel spraying step in the bleeding point locating method of the fourth embodiment. FIG. 30 is a schematic diagram showing a bleeding point confirmation step in the bleeding point locating method of the fourth embodiment. FIG. 31 is a flowchart showing a main flow of the bleeding point locating method of the fifth embodiment. FIG. 32 is a schematic diagram showing a closing step in the bleeding point locating method of the fifth embodiment. FIG. 33 is a schematic diagram showing a medicinal solution spraying step in the bleeding point locating method of the fifth embodiment. FIG. 34 is a schematic diagram showing the closing step in Modification 1 of the fifth embodiment. FIG. 35 is a schematic diagram showing the medicinal solution spraying step in Modification 1 of the fifth embodiment. FIG. 36 is a schematic diagram showing the closing step in Modification 2 of the fifth embodiment.

[0010] Hereinafter, each embodiment of the present invention will be described with reference to the accompanying drawings. In all drawings, even if the embodiments are different, the same or corresponding components are designated by the same reference numerals, and common descriptions will be omitted.

[0011] <First embodiment> (Insertion tool) Fig. 1 is a schematic diagram of an insertion tool 1 of a first embodiment. Fig. 2 is a schematic diagram showing the insertion tool 1 of the first embodiment placed in the large intestine C. The insertion tool 1 of this embodiment is used by being inserted into the large intestine C of a patient. Furthermore, the insertion tool 1 is placed in the large intestine C of the patient for a certain period of time.

[0012] As shown in FIG. 1, the insertion device 1 includes a long tube 10, a balloon 11 provided at the distal end 10a of the tube 10, a plurality of partitions 12 provided on the outer periphery of the tube 10, and a suction section 15 provided at the proximal end 10b of the tube.

[0013] The tube 10 can be inserted into the large intestine C. The tube 10 is made of a flexible material such as silicone resin or elastomer resin. The tube 10 is, for example, slightly longer than the length of the large intestine C, and the total length of the tube 10 is, for example, about 1.5 m to 2 m.

[0014] The tube 10 is hollow and has a distal end 10a, a proximal end 10b, and a plurality of drainage holes (drainage structures) 16. A hollow portion 10h of the tube 10 opens at the distal end 10a, the proximal end 10b, and the plurality of drainage holes 16.

[0015] The distal end 10a of the tube 10 is provided with an openable / closable distal end valve 11c and a balloon 11. The means for opening and closing the distal end valve 11c is not particularly limited. The distal end valve 11c is opened and closed, for example, via a wire passed through the tube 10. Note that the distal end valve 11c may be omitted, and instead a separate conduit system may be provided inside the tube 10 that supplies air to the balloon 11 and maintains the pressure of the balloon 11 to maintain the inflation of the balloon 11.

[0016] The plurality of drainage holes 16 connect the outside of the tube 10 with the hollow portion 10h. The plurality of drainage holes 16 are arranged in a row in the longitudinal direction of the tube 10. The number of drainage holes 16 is, for example, one less than the number of partition portions 12. At least one drainage hole 16 is provided between the plurality of partition portions 12.

[0017] The drain holes 16 connect the outside of the tube 10 to the hollow portion 10h. Each of the drain holes 16 is provided with a valve portion 16c. The valve portion 16c allows liquid to flow into the hollow portion 10h from the outside of the tube 10. The valve portion 16c also restricts the outflow of fluid from the hollow portion 10h to the outside.

[0018] The surface of the tube 10 is formed with uneven portions 14a. The uneven portions 14a are provided at least between a plurality of the partitions 12. The uneven portions 14a are, for example, regions where the surface of the tube 10 is roughened. The uneven portions 14a can hold liquid between the convex portions or inside the concave portions. The uneven portions 14a may be a porous body such as a sponge fixed to the surface of the tube 10. In this case, the uneven portions 14a can hold liquid within the pores of the porous body. This allows the uneven portions 14a to hold adhered blood.

[0019] The balloon 11 is made of an easily stretchable material such as silicone resin or elastomer resin. The balloon 11 covers the opening at the distal end 10a of the tube 10. The balloon 11 expands by sending air from the proximal end 10b of the tube 10 into the hollow portion 10h of the tube 10 with the distal end valve portion 11c open.

[0020] 2, the balloon 11 is expanded with the insertion tool 1 placed in the large intestine C, and comes into contact with the inner surface of the large intestine C. This fixes the balloon 11 within the large intestine C. The balloon 11 also has the function of dividing the interior of the large intestine C. In other words, the balloon 11 is one form of a partition.

[0021] The plurality of partitions 12 are flexible pleated sections made of a material such as silicone resin or elastomer resin, and are preferably made of a material that is easily visible in images captured by computed tomography (CT) (computed tomography images, hereinafter referred to as CT images).

[0022] The partition portion 12 in this embodiment has a disk shape extending from the outer periphery of the tube 10 to the outside in the radial direction of the tube 10. Note that the shape of the partition portion 12 in this embodiment is an example, and the shape of the partition portion 12 is not limited to this embodiment.

[0023] 2 , when the insertion tool 1 is placed in the large intestine C, the multiple dividers 12 come into contact with the inner surface of the large intestine C. As a result, the multiple dividers 12 each come into contact with the inner surface of the large intestine C. As a result, the dividers 12 divide the inside of the large intestine C into multiple divided regions A.

[0024] As shown in FIG. 1 , the surface of the divider 12 has an uneven portion 14b formed thereon, similar to the surface of the tube 10. The uneven portion 14b is provided on both sides of the divider 12. Therefore, the divider 12 is provided on the surface facing the partitioned area A. The uneven portion 14b of the divider 12 has a configuration similar to the uneven portion 14a provided on the surface of the tube 10, for example. That is, the uneven portion 14b may be a region where the surface of the divider 12 is roughened, or may be a porous body such as a sponge fixed to the surface of the divider 12. The uneven portion 14b can retain blood that has adhered thereto.

[0025] In the present embodiment, the uneven portions 14 a, 14 b are provided on the surfaces of both the tube 10 and the partitions 12. However, it is sufficient that the uneven portions 14 a, 14 b are provided on the surface of at least one of the tube 10 or the partitions 12.

[0026] The suction unit 15 includes a drainage bag 15a and a negative pressure device 15b. The drainage bag 15a is supported by the negative pressure device 15b. The suction unit 15 is detachably attached to the proximal end 10b of the tube 10.

[0027] The drainage bag 15a is a container that can expand and contract, for example, in an accordion-like shape. The drainage bag 15a may be bag-shaped. The base end 10b of the tube 10 is inserted into the drainage bag 15a. That is, the drainage bag 15a covers the opening of the base end 10b of the tube 10. The interior of the drainage bag 15a and the hollow portion 10h are in communication with each other. The interior of the suction portion 15 is sealed from the outside space.

[0028] The negative pressure device 15b supports the drainage bag 15a. The negative pressure device 15b can expand the internal volume of the drainage bag 15a. By expanding the internal volume of the drainage bag 15a, the inside of the drainage bag 15a and the hollow portion 10h of the tube 10 can be maintained at negative pressure.

[0029] The insertion tool 1 of this embodiment is primarily used in hospitals. The insertion tool 1 is used for patients hospitalized with colonic diverticular bleeding. As shown in FIG. 2 , numerous diverticula D are formed in the patient's large intestine C. The diverticula D are formed so as to expand from the inner surface of the large intestine C toward the outside of the large intestine C. The inner surface of the diverticula D is recessed relative to the inner surface of the large intestine C. Therefore, bleeding from the inner surface of the diverticula D is difficult to observe with an endoscope placed in the large intestine C, making it difficult to find the bleeding point B on the inner surface of the diverticula D. Furthermore, bleeding from the bleeding point B may temporarily stop when it is covered with a blood clot. In this case, it becomes even more difficult to identify the culprit diverticulum Da from which bleeding occurred. In the following description, the diverticula D from which bleeding occurred will be referred to as the culprit diverticulum Da.

[0030] (Method of Using the Insertion Tool (Method of Searching for a Responsible Diverticulum)) Fig. 3 is a flowchart showing the main steps of the method of using the insertion tool 1 of this embodiment (method of searching for a responsible diverticulum). As shown in Fig. 3, the method of using the insertion tool 1 of this embodiment includes an insertion step S10, a drainage step S20, a removal step S30, a compartment identification step S40, and a treatment step S50. In the method of use of this embodiment, the insertion step S10, drainage step S20, removal step S30, compartment identification step S40, and treatment step S50 are performed in this order.

[0031] 4 is a schematic diagram of an endoscope 90 used in the insertion step S10 of this embodiment. The endoscope 90 is a known flexible endoscope, and includes an insertion section 92 that is inserted into the body from its tip, and an operation section 97 attached to the proximal end of the insertion section 92.

[0032] The insertion section 92 has an imaging section 93, a bending section 94, and a flexible section 95. The imaging section 93, the bending section 94, and the flexible section 95 are arranged in this order from the tip to the base end of the insertion section 92. The tip of the insertion section 92 is provided with a tip opening 96a, a suction hole 96b, and a discharge hole 96c.

[0033] The insertion portion 92 is provided with a channel 96 that extends along the length of the insertion portion 92 and opens at a distal end opening 96a. The insertion tool 1 is inserted into the channel 96.

[0034] The imaging unit 93 is equipped with an imaging element such as a CCD or CMOS, and is capable of capturing an image of the site to be treated. The imaging unit 93 can capture an image of the insertion tool 1 when the insertion tool 1 is protruding from the distal end opening 96 a of the channel 96.

[0035] The bending portion 94 bends in accordance with the operator's operation of the operating portion 97. The flexible portion 95 is a flexible tubular portion.

[0036] The operation unit 97 is connected to the flexible section 95. The operation unit 97 has an input unit 99 and a proximal end opening 96d of the channel 96. The input unit 99 has an angle knob 99a, an air / water supply button 99b, and a suction button 99c. The angle knob 99a accepts operation input for bending the bending section 94. The air / water supply button 99b is a push button through which an operation to supply air and water from the distal end opening 96a is input. The suction button 99c is a push button through which a suction operation from the distal end opening 96a is input, and pressing the suction button 99c starts suction within the channel.

[0037] 5 is a schematic diagram showing the insertion step S10 of this embodiment. The insertion step S10 is a step of inserting the insertion tool 1 into the large intestine C. By going through the insertion step S10, the insertion tool 1 brings the multiple dividers 12 into contact with the inner surface of the large intestine C, thereby dividing the inside of the large intestine C into multiple divided regions A.

[0038] The insertion step S10 is performed on a patient hospitalized with colonic diverticulum bleeding. Before performing the insertion step S10, the surgeon first inserts a colonoscope into the patient's colon C and observes the inner surface of the colon C. If a culprit diverticulum Da is identified through observation using the endoscope 90, the surgeon performs treatment on the culprit diverticulum Da. Furthermore, if the culprit diverticulum Da cannot be identified through observation using the endoscope 90, the surgeon inserts the insertion tool 1 into the large intestine C using the endoscope 90. That is, the insertion step S10 of this embodiment is performed using the endoscope 90.

[0039] In the insertion step S10, the surgeon first inserts the endoscope 90 into the large intestine C. In the insertion step S10 of this embodiment, the tip of the insertion section 92 of the endoscope 90 is inserted up to the ascending colon C1. In this embodiment, it is preferable to insert the insertion tool 1 immediately after observing the inner surface of the large intestine C with the endoscope 90. In this case, the insertion tool 1 can be inserted using the endoscope 90 that has already been inserted into the large intestine C, thereby reducing the burden on the patient.

[0040] In the insertion step S10, the surgeon then passes the insertion tool 1 through the channel 96 of the endoscope 90. The insertion tool 1 is inserted into the channel 96 from the distal end 10a of the tube 10, on which the balloon 11 is provided. The surgeon uses the imaging unit 93 provided at the distal end of the insertion section 92 of the endoscope 90 to confirm that the balloon 11 has reached the vicinity of the lower end of the ascending colon C1. After confirming that the balloon 11 has reached the lower end of the ascending colon C1, the surgeon opens the distal valve section 11c and supplies air from the proximal end 10b of the tube 10 into the hollow section 10h of the tube 10 to inflate the balloon 11. Note that when supplying air, the suction section 15 (see FIG. 1) attached to the proximal end 10b of the tube 10 is removed, and an air supply pump (not shown) is connected instead. By inflating the balloon 11, the surface of the balloon 11 is pressed against the inner surface of the large intestine C, and the distal end of the insertion tool 1 is fixed to the inner surface of the large intestine C.

[0041] In the insertion step S10, the surgeon then gradually withdraws the insertion section 92 of the endoscope 90 from the large intestine C. As described above, the tip of the insertion tool 1 is fixed to the inner surface of the large intestine C, and therefore, as the endoscope 90 is withdrawn from the large intestine C, the insertion tool 1 is gradually withdrawn from the tip opening 96a of the endoscope 90. The partition sections 12 of the insertion tool 1 are folded and housed inside the channel 96. As the insertion tool 1 is gradually withdrawn from the tip opening 96a, the multiple partition sections 12 protrude one after another from the tip opening 96a, and expand radially outward of the tube 10 due to their own restoring force, coming into contact with the inner surface of the large intestine C.

[0042] After the insertion step S10 is completed, a partition shaping step may be performed to adjust the posture of the partition 12 placed in the large intestine C. In this step, the surgeon supplies air to the partitioned area A through the drainage hole 16 to increase the pressure in the partitioned area A. The increased pressure in the partitioned area A adjusts the posture of the pleated partition 12 in a direction perpendicular to the longitudinal direction of the tube 10. When the partition shaping step is performed, the drainage hole 16 may not be provided with a valve 16c, or the valve 16c may be one that can be controlled to open and close. Air may also be supplied to the partitioned area A through a pipeline separate from the drainage hole 16.

[0043] In this embodiment, the case where the insertion step S10 is performed using the endoscope 90 has been described, but the insertion step S10 may be performed without using the endoscope 90. In this case, the insertion step S10 may be performed while observing the insertion tool 1 under X-ray fluoroscopy, for example.

[0044] FIG. 6 is a schematic diagram showing an insertion step of a modified example. If the tube 10B is thick and it is difficult to insert the insertion tool 1B through the channel 96 of the endoscope 90, the insertion step S10 shown in FIG. 6 may be employed. The insertion tool 1B may be inserted while being placed over the outside of the endoscope 90 as an overtube. That is, the endoscope 90 is temporarily removed from the body, and the tube 10B of the insertion tool 1B is placed over the endoscope 90 in the overtube format, which is then reinserted into the body. After inserting the insertion tool 1B to the very end, the balloon 11 is inflated to fix the tip position, and the endoscope is then removed with the insertion tool 1B remaining in place.

[0045] (Drainage Step) Figure 7 is a schematic diagram showing the drainage step S20 of this embodiment. The patient remains hospitalized with the insertion tool 1 indwelling in the large intestine C. The drainage step S20 is a step that is performed when bleeding occurs from the inner surface of the large intestine (more specifically, the culprit diverticulum Da) with the insertion tool 1 indwelling in the large intestine C. With the insertion tool 1 indwelling in the large intestine C, a suction part 15 is attached to the base end 10b of the tube 10, and a negative pressure is applied to the hollow part 10h of the tube 10 by the suction part 15.

[0046] When bleeding occurs from the responsible diverticulum Da, the compartment A separated by the partition 12 is filled with blood. Some of the blood in the compartment A flows into the hollow portion 10h of the tube 10 through the drainage hole 16, flows to the base end 10b of the tube 10, and is stored in the drainage bag 15a. That is, in the drainage step S20, the blood in the compartment A is drained through the drainage hole 16, which is a drainage structure provided in the tube 10 and opens into the compartment A. The accumulation of blood in the drainage bag 15a signals that rebleeding has occurred on the inner surface of the large intestine C.

[0047] 8 is a schematic diagram showing the removal step S30 of this embodiment. The removal step S30 is a step that is performed when rebleeding is confirmed on the inner surface of the large intestine C. The removal step S30 is a step of removing the insertion tool 1 from the large intestine C.

[0048] In the removal step S30, the surgeon first removes the suction portion 15 from the proximal end portion 10b of the tube 10 to open the opening of the proximal end portion 10b. Then, the surgeon opens the distal end valve portion 11c to release the air inside the balloon 11 through the tube 10. This causes the balloon 11 to deflate.

[0049] In the removal step S30, the surgeon then pulls out the insertion tool 1 from the patient's anus and removes it from the large intestine C. The removal step S30 may be performed by attaching a tubular member to the anus and inserting the insertion tool 1 into the tubular portion, thereby protecting the patient's anus. Alternatively, the surgeon may perform the removal step S30 using the same procedure as in the insertion step S10. That is, the removal step S30 may be a step of retrieving the insertion tool 1 by pulling it into the channel 96 from the distal end opening 96a of the endoscope 90.

[0050] (Compartment Identifying Step) The compartment identifying step S40 is a step of observing the removed insertion tool 1 and identifying the compartment area A where bleeding has occurred from the blood trace L. In the insertion tool 1 of this embodiment, uneven portions 14a, 14b are provided on the surfaces of the tube 10 and the partition section 12, respectively. The uneven portions 14a, 14b that are placed in the area where bleeding has occurred retain blood even after the insertion tool 1 is pulled out, leaving the blood trace L on their surfaces.

[0051] In the example shown in Fig. 8, traces of blood L remain in the partitioned area A between the first and second partitions 12 from the distal end side of the insertion tool 1. From this, it is possible to identify the partitioned area A in which the responsible diverticulum Da where the bleeding occurred is located.

[0052] It is also possible to record the location of each divided area A within the large intestine C in advance by capturing an X-ray image with the insertion tool 1 placed inside the large intestine C. In this case, by comparing the position of the trace L with the X-ray image, it is possible to confirm where within the large intestine C the divided area A in which the culprit diverticulum Da is located is located.

[0053] (Treatment Step S50) The treatment step S50 is a step for identifying and treating the culprit diverticulum Da. In the treatment step S50, the surgeon first inserts the endoscope 90 into the large intestine C. Next, the surgeon sequentially observes the multiple diverticula D located in the partitioned area A identified in the partition identification step S40. This allows the surgeon to identify which of the multiple diverticula D has caused the bleeding, and then treats this diverticulum (culprit diverticulum Da).

[0054] (Summary of First Embodiment) The insertion device 1 of this embodiment comprises a tube 10 that can be inserted into the large intestine C, a plurality of partitions 12 that are provided on the outer periphery of the tube 10 and that come into contact with the inner surface of the large intestine C, and drainage structures (drainage holes 16) that are located between the partitions 12.

[0055] According to this configuration, by placing the insertion tool 1 in the large intestine C, even if bleeding occurs from the inner surface of the large intestine C, the blood can be prevented from spreading within the large intestine C and can be contained within the compartmentalized area A partitioned by the partition section 12. This makes it possible to identify the compartmentalized area A where bleeding has occurred by taking a CT image of the large intestine C where bleeding has occurred while the insertion tool 1 is placed, or by removing the insertion tool 1 from the large intestine C and observing the location of blood adhering to the insertion tool 1. Furthermore, according to this configuration, each of the compartmentalized areas A is provided with a drainage structure (drainage hole 16). Therefore, when a compartmentalized area A is filled with blood, some of the blood can be drained. This prevents blood from leaking into other compartmentalized areas A even when the amount of bleeding is large, making it easy to identify the compartmentalized area A where bleeding has occurred. The above-described method for identifying the compartmentalized area A having the bleeding point B is merely an example, and other methods may be used to identify the compartmentalized area A where bleeding has occurred. For example, the insertion tool may have a sensor in each compartment that responds to the detection of blood. In this case, the user of the insertion tool can identify the partitioned area A where bleeding has occurred based on the detection results of the sensor.

[0056] In the insertion tool 1 of this embodiment, each of the plurality of partitions 12 is in the form of a flexible pleat.

[0057] This configuration allows the divider 12 to be constructed with a simple structure, thereby reducing the cost of the insertion tool 1. Furthermore, compared to when the divider 12 is a balloon (see FIG. 10 ), there is no need to prepare an air supply path for inflating the balloon, thereby further reducing the cost of the insertion tool 1. Furthermore, compared to when the divider 12 is a balloon, the contact area with the inner surface of the large intestine C can be easily reduced, thereby preventing the divider 12 from blocking a diverticulum D formed on the inner surface of the large intestine C. Therefore, when bleeding occurs from the diverticulum D, blood can be reliably guided into the compartmented area A, filling the compartmented area A with blood. As a result, it is easy to identify the compartmented area A from which bleeding has occurred. In this embodiment, the divider 12 has been described as extending in a flat plate shape in a direction perpendicular to the longitudinal direction of the tube 10. However, the shape of the divider 12 is not limited to a flat plate shape, as long as it is pleated. For example, the divider 12 may have an umbrella shape that is inclined relative to the longitudinal direction of the tube 10.

[0058] In the insertion device 1 of this embodiment, the drainage structure is a drainage hole 16 that connects the outside of the tube 10 with the hollow portion 10h.

[0059] With this configuration, blood that accumulates in the partitioned area A can be drained to the outside of the large intestine C via the tube 10. This makes it possible to prevent blood from one partitioned area A from leaking into another partitioned area A. Furthermore, by causing blood that flows into the hollow portion 10h of the tube 10 to leak from the base end 10b of the tube 10, it is possible to immediately detect the occurrence of bleeding within the large intestine C. Furthermore, since it is easy to collect blood that leaks from the base end 10b of the tube 10, it is possible to prevent blood from staining bedding and clothing.

[0060] In the insertion device 1 of this embodiment, the drainage hole 16 is provided with a valve portion 16c that allows the inflow of liquid from the outside into the hollow portion 10h and restricts the outflow of fluid from the hollow portion 10h to the outside.

[0061] This configuration makes it possible to prevent blood that flows from the partitioned area A where the bleeding point B is located into the hollow portion 10h through the drainage holes 16 and is discharged through the hollow portion 10h from leaking out of other drainage holes 16. This prevents blood from flowing into the partitioned area A where no bleeding occurs.

[0062] In the insertion tool 1 of this embodiment, the proximal end portion 10b of the tube 10 is provided with a suction portion 15 that maintains a negative pressure in the hollow portion 10h.

[0063] This configuration makes it easier to guide blood accumulated in partitioned area A into hollow portion 10h by utilizing the negative pressure within hollow portion 10h. Furthermore, it also makes it easier to guide fluid in hollow portion 10h to suction portion 15, making it easier to collect blood in suction portion 15.

[0064] In the insertion tool 1 of this embodiment, the tube 10 or the partitions 12 have at least one surface provided with uneven portions 14a, 14b for retaining adhered blood.

[0065] According to this configuration, blood traces L tend to remain on the surface of the tube 10 or the partition 12 placed in the partitioned area A. As a result, even after the insertion tool 1 has been removed from the large intestine C, by checking the blood traces L, it becomes easier to identify in which partitioned area A bleeding has occurred.

[0066] The insertion device 1 of this embodiment preferably includes three or more partitions 12 .

[0067] According to this configuration, the interior of the large intestine C can be divided into four or more divided regions A. That is, the interior of the large intestine C can be divided into small regions, each of which can be made sufficiently small. This makes it easier to find the responsible diverticulum Da from among the diverticula D included in the identified divided region A after identifying the divided region A in which bleeding has occurred.

[0068] In the insertion device 1 of this embodiment, the multiple partitions 12 are preferably arranged at intervals of 10 cm or more and less than 30 cm.

[0069] According to this configuration, the interior of the large intestine C can be divided into smaller sections, and each divided area A can be made sufficiently small. As a result, after identifying the divided area A where bleeding has occurred, it becomes easier to find the culprit diverticulum Da from among the diverticula D included in the identified divided area A. Note that, although the present embodiment has been described with reference to a case where the multiple dividers 12 are arranged at equal intervals, the intervals between the dividers 12 may be uneven.

[0070] In the insertion tool 1 of this embodiment, at least one of the multiple dividers 12 is positioned to separate the ascending colon C1 and the descending colon C3. That is, it is preferable that at least one of the multiple dividers 12 is positioned in the transverse colon C2. It is generally known that diverticula D of the large intestine C are formed in a concentrated manner in the ascending colon C1 and the descending colon C3. For this reason, large intestinal diverticular bleeding often occurs in either the ascending colon C1 or the descending colon C3. By separating the ascending colon C1 and the descending colon C3 using the divider 12, it is possible to determine whether the bleeding point is in the ascending colon C1 or the descending colon C3, thereby significantly shortening the time required to search for the responsible diverticulum Da.

[0071] The method of using the insertion tool 1 of this embodiment includes an insertion step S10, a drainage step S20, and a compartment identification step S40. The insertion step S10 is a step of inserting the insertion tool 1, which has a tube 10, multiple dividers 12 provided on the outer periphery of the tube 10, and drainage structures (drainage holes 16) located between the dividers 12, into the large intestine C, and bringing the multiple dividers 12 into contact with the inner surface of the large intestine C to partition the interior of the large intestine C into multiple compartmented regions A. The drainage step S20 is a step of draining blood from the compartmented region A using the drainage structure (drainage holes 16) when bleeding occurs from the inner surface of the large intestine C. The compartment identification step S40 is a step of identifying the compartmented region A where bleeding has occurred.

[0072] According to this configuration, by placing the insertion tool 1 in the large intestine C in the insertion step S10, even if bleeding occurs from the inner surface of the large intestine, the blood can be prevented from spreading uncontrollably within the large intestine C and the blood can be contained within the partitioned area A partitioned by the partition section 12. This makes it possible to identify the partitioned area A where bleeding has occurred in the partition identifying step S40. Furthermore, according to this configuration, when bleeding occurs from the inner surface of the large intestine C, the blood can be drained from the partitioned area A where bleeding has occurred in the draining step S20. This makes it possible to prevent blood from leaking into other partitioned areas A even when the amount of bleeding is large, making it easy to identify the partitioned area A where bleeding has occurred.

[0073] The method of use of this embodiment further includes a removal step S30 that is performed after the drainage step S20 and before the compartment identification step S40. The removal step S30 is a step of removing the insertion tool 1 from the large intestine C. The compartment identification step S40 is a step of observing the removed insertion tool 1 and identifying the compartment A where bleeding has occurred from the position of blood adhesion.

[0074] According to this configuration, the compartment area A where blood has occurred can be identified by checking the traces of blood L adhering to the removed insertion tool 1. This eliminates the need to provide a sensor or the like in the insertion tool 1, making it possible to inexpensively manufacture the insertion tool 1. Furthermore, there is no need to use expensive equipment or devices in the compartment identification step S40, making it easier to introduce the insertion tool 1 into the treatment of colonic diverticular bleeding.

[0075] In the method of use of this embodiment, the insertion step S10 is performed by first inserting the endoscope 90 into the large intestine C, then positioning the tip portion 10a of the insertion tool 1 inside the large intestine C through the channel 96 of the endoscope 90, then inflating the balloon 11 provided on the tip portion 10a of the insertion tool 1 to fix the balloon 11 to the inner surface of the large intestine C, and then withdrawing the endoscope 90 from the large intestine C.

[0076] According to this configuration, the insertion tool 1 is inserted into the large intestine C by passing it through the channel 96 of the endoscope 90, and the insertion tool 1 can be positioned within the large intestine C while being viewed using the imaging unit 93 of the endoscope 90. This allows the insertion tool 1 to be positioned at an appropriate position within the large intestine C. Furthermore, by withdrawing the endoscope 90 after fixing the tip portion 10a of the insertion tool 1 in the large intestine C, the insertion tool 1 is pulled out from the channel 96 of the endoscope 90, making it easier to position the insertion tool 1 in an appropriate posture within the large intestine C.

[0077] <Modification of Method of Using Insertion Tool> Fig. 9 is a flowchart showing the main steps of a modification of the method of using the insertion tool 1 of this embodiment. As shown in Fig. 9, the method of use of this modification includes an insertion step S10, a drainage step S20, a compartment identification step S30A, a removal step S30, and a treatment step S50.

[0078] The method of use of this modified example differs from the above embodiment in the order in which the compartment identification step S30A is performed. In this modified example, the compartment identification step S30A is performed after the draining step S20 and before the removing step S30.

[0079] The compartment identification step S30A of this modified example is performed by observing a CT image of the large intestine C in which the insertion tool 1 is placed. As described above, the dividers 12 are formed of a material that easily shows up in CT images. When observing a CT image of a patient with bleeding from the inner surface of the large intestine C, multiple dividers 12 and blood pooling between any of the dividers 12 are confirmed (see FIG. 7 ). By capturing and examining the CT image, the surgeon can identify the compartment A in which bleeding has occurred.

[0080] According to the method of use of this modified example, the compartment identification step S30A is performed by observing a CT image of the large intestine C in which the insertion tool 1 is placed.

[0081] According to this configuration, the compartment area A where bleeding has occurred can be identified while the insertion tool 1 is left in place, and the burden on the patient associated with inserting and removing the insertion tool 1 can be reduced.

[0082] <Modified Insertion Device> Next, a modified insertion device 1A that can be used in place of the insertion device 1 of the above-described embodiment will be described. Fig. 10 is a schematic diagram showing the state in which the insertion device 1A of this modified embodiment is placed in the large intestine C. The insertion device 1A of this modified embodiment differs from the above-described embodiment mainly in the configuration of the partition section (partition balloon 12A).

[0083] As in the above-described embodiment, the insertion device 1A of this modified example includes a long tube 10A, a balloon 11 provided at the tip end of the tube 10A, a plurality of partition balloons (partition portions) 12A provided on the outer periphery of the tube 10A, and a detachable suction portion 15 (omitted in FIG. 10 ) provided at the base end of the tube 10A.

[0084] In the insertion tool 1A of this modification, the tube 10A is provided with a plurality of drainage holes 16 and a plurality of air supply holes 17A. In the tube 10A of this modification, two drainage holes 16 are provided between the partition balloons 12A.

[0085] Two air supply holes 17A are provided in the tube 10A. Each air supply hole 17A is provided with an on-off valve 17c. The means for opening and closing the on-off valve 17c is not particularly limited. For example, the on-off valve 17c may be opened and closed by a wire passed through the tube 10A.

[0086] The partition balloon 12A is provided on the outer periphery of the tube 10A. The partition balloon 12A covers the portion of the tube 10A where the air supply hole 17A is provided. In other words, the air supply hole 17A connects the inside of the partition balloon 12A with the hollow portion 10h of the tube 10A. The partition balloon 12A comes into contact with the inner surface of the large intestine C by expanding with air supplied through the air supply hole 17A. In this way, the partition balloon 12A can divide the inside of the large intestine C into multiple partitioned regions A, and if bleeding occurs in one of the partitioned regions A, it is possible to prevent blood from flowing into the other partitioned regions A.

[0087] The on-off valve 17c is opened when air is supplied to the partition balloon 12A from the hollow portion 10h of the tube 10A. Furthermore, by closing the on-off valve 17c, the pressure inside the partition balloon 12A is maintained and the balloon is kept in an expanded state. When the partition balloon 12A is to be deflated, the on-off valve 17c is opened and the air inside the partition balloon 12A is exhausted into the hollow portion 10h of the tube 10A through the air supply hole 17A.

[0088] In the insertion tool 1A of this modified example, each of the plurality of partition sections (partition balloons 12A) is balloon-shaped.

[0089] According to this configuration, the divider portion (divider balloon 12A) can be inflated by supplying air, so that its outer shape changes to match the size and shape of the large intestine C, enabling the partitioned area A to be more reliably partitioned. It also becomes possible to use a common insertion tool 1A regardless of the size of the patient's large intestine C. Furthermore, according to this modification, the divider balloon 12A can be fixed to the inner surface of the large intestine C by inflating it. This makes it possible to prevent the insertion tool 1A from moving inside the large intestine C. Additionally, since the diameter of the divider portion (divider balloon 12A) can be reduced by deflating it, it is possible to reduce the burden on the patient when inserting and removing the insertion tool 1A into and from the large intestine C.

[0090] Second Embodiment (Treatment Step (Treatment Method)) Next, a treatment step S150 of a second embodiment that can be performed instead of the treatment step S50 of the first embodiment described above will be described. Note that components that are the same as those in the above embodiment or its modified example will be assigned the same reference numerals, and descriptions thereof will be omitted.

[0091] The treatment step S150 of this embodiment is performed after the compartment identification step S40 described in the above embodiment, and is a step of treating the bleeding point B in the large intestine C.

[0092] 11 is a flowchart showing a main flow of the treatment step S150 of the second embodiment. The treatment step S150 (treatment method) of this embodiment includes a treatment tool insertion step S151, a closing step S152, a first suction step S153, a first liquid injection step S154, a second suction step S155, and a second liquid injection step S156. In the treatment step S150 of this embodiment, the treatment tool insertion step S151, the closing step S152, the first suction step S153, the first liquid injection step S154, the second suction step S155, and the second liquid injection step S156 are performed in this order.

[0093] The treatment step S150 of this embodiment is performed after the partitioned area A where bleeding has occurred is identified by the partition identification step S40 of the above-described embodiment. The treatment step S150 of this embodiment is a step of simultaneously treating multiple diverticula D that are candidates for the culprit diverticulum Da without identifying the culprit diverticulum Da from the multiple diverticula D in the identified partitioned area A.

[0094] 12 is a schematic diagram of a treatment tool 101 used in treatment step S150 of this embodiment. The treatment tool 101 includes a long tube 110, a first balloon (first closing member) 131, and a second balloon 132. The first balloon 131 and the second balloon 132 are attached to the outer periphery of the tube 110. The first balloon 131 is located closer to the distal end of the tube 110 than the second balloon (second closing member) 132. The first balloon 131 and the second balloon 132 are formed of a material such as silicone resin or elastomer resin.

[0095] The tube 110 is a multi-lumen tube having a main lumen with an inner diameter, and a first minor lumen 121 and a second minor lumen 122 formed within the wall of the main lumen.

[0096] The first sub-lumen 121 opens onto the outer peripheral surface of the tube 110 at a location where the first balloon 131 and the second balloon 132 are attached, and is in communication with the first balloon 131 and the second balloon 132. The first sub-lumen 121 extends to a first port 151 provided on the proximal side of the treatment tool 101. An air / water pump and a suction pump are connected to the first port 151. When a fluid is supplied to the first port 151, the first balloon 131 and the second balloon 132 can be inflated.

[0097] The second sub-lumen 122 communicates with an opening 160 provided on the outer circumferential surface of the tube between the first balloon 131 and the second balloon 132. The second sub-lumen 122 extends to a second port 152 provided on the proximal side of the treatment tool 101. A liquid pump and a suction pump are connected to the second port 152. The liquid pump is also connected to two tanks that respectively contain a first liquid L1 and a second liquid L2. The first liquid L1 and the second liquid L2 will be described later.

[0098] (Treatment Tool Insertion Step) The treatment tool insertion step S151 is a step of inserting the treatment tool 101 into the large intestine C. The treatment tool insertion step S151 is performed using, for example, the endoscope 90. In the treatment tool insertion step S151, the surgeon inserts the treatment tool 101 to a position where a plurality of diverticula D that are candidates for the responsible diverticulum Da are located between the first balloon 131 and the second balloon 132.

[0099] (Closing Step) Figure 13 is a schematic diagram showing the closing step S152. The closing step S152 is a step in which the partitioned area A is closed by the first balloon 131 and the second balloon 132. In the closing step S152, the surgeon supplies air to the first balloon 131 and the second balloon 132 to expand the first balloon 131 and the second balloon 132. As a result, the surfaces of the first balloon 131 and the second balloon 132 are pressed against the inner surface of the large intestine C, and the partitioned area A located between the first balloon 131 and the second balloon 132 is closed. In the following description, the space closed by the first balloon 131 and the second balloon 132 is referred to as a closed area Cs.

[0100] 14 is a schematic diagram showing the first suction step S153. The first suction step S153 is a step of suctioning gas from the closed area Cs through the opening 160. In the first suction step S153, the surgeon suctions gas from the closed area Cs to reduce the internal pressure of the closed area Cs.

[0101] By performing the first suction step S153, the large intestine C in the closed area Cs contracts. As a result, the inner surface of the large intestine C approaches and comes into contact with the tube 110. Furthermore, the gas in the diverticulum D is also aspirated. In the first suction step S153, not only the gas in the closed area Cs but also unnecessary body fluids (e.g., blood) in the closed area Cs may be aspirated as needed.

[0102] 15 is a schematic diagram showing the first liquid injection step S154. The first liquid injection step S154 is a step of injecting the first liquid L1 into the closed area Cs through the opening 160. The first liquid L1 is introduced into the closed area Cs, between the outer periphery of the tube 110 and the inner surface of the large intestine C. The first liquid L1 is also introduced into the diverticulum D that opens into the closed area Cs.

[0103] The first liquid L1 may be, for example, a drug containing a component that dissolves blood clots (a blood clot dissolving agent). More specifically, examples of the drug contained in the first liquid L1 include heparin, urokinase, and t-PA.

[0104] After injecting the first liquid L1, the surgeon waits a predetermined time until the effects of the first liquid L1 are fully manifested. After a sufficient amount of time has passed since the first liquid L1 came into contact with the bleeding point B of the culprit diverticulum Da, the blood clot covering the bleeding point B is removed. This exposes the bleeding point B. Furthermore, by exposing the bleeding point B, blood flows out from the bleeding point B and mixes with the first liquid L1.

[0105] 16 is a schematic diagram showing the second suction step S155. The second suction step S155 is a step of suctioning the liquid in the closed area Cs through the opening 160. In the second suction step S155, the first liquid L1 and blood mixed with the first liquid L1 are drained from the closed area Cs. Furthermore, the large intestine C in the closed area Cs contracts, and the inner surface approaches and comes into contact with the tube 110.

[0106] 17 is a schematic diagram showing the second liquid injection step S156. The second liquid injection step S156 is a step of injecting the second liquid L2 into the closed area Cs through the opening 160. The second liquid L2 is introduced into the closed area Cs, between the outer periphery of the tube 110 and the inner surface of the large intestine C. The second liquid L2 is also introduced into the diverticulum D that opens into the closed area Cs.

[0107] The second liquid L2 may be, for example, a drug that exerts a hemostatic effect. More specifically, the following drugs may be used as the second liquid L2: a bioabsorbable local hemostatic agent containing gelatin, cross-linked gelatin, or the like; a bioadhesive containing gelatin, cross-linked gelatin, or the like; a bioadhesive containing fibrinogen and thrombin that gels upon reaction; an injectable gel that gels inside the body. Any of these may be used, including those that gel upon reaction between collagen and a cross-linking agent, those that gel upon reaction with moisture in the body, and those that gel upon temperature change. A dressing material such as a hydrogel containing a urethane-based polymer or carboxymethylcellulose (CMC). The above are merely examples, and other liquid or viscous liquid biocompatible drugs that exert local hemostatic effects, bioadhesive properties, wound sealing effects, wound healing effects, etc. may be used.

[0108] After the second liquid L2 is injected, a predetermined time is waited until the effect of the second liquid L2 is fully manifested. In this embodiment, before the second liquid L2 is injected, the blood clot covering the bleeding point B is removed in the first liquid injection step S154, exposing the bleeding point B. Therefore, in the second liquid injection step S156, the second liquid L2 is more likely to come into direct contact with the bleeding point B. This ensures that the hemostatic component contained in the second liquid L2 acts on the bleeding point B, thereby stopping bleeding or making the bleeding point B less susceptible to bleeding.

[0109] After the second liquid injection step S156 is completed, the first balloon 131 and the second balloon 132 are deflated and the treatment tool 101 is removed from the body, thereby completing the treatment step S150 of this embodiment. If there is another region to be treated, the treatment tool 101 may be moved to the next region to be treated without being removed from the body. If there is no problem with flowing the used second liquid L2 into the large intestine C, it is not necessary to recover the second liquid L2 remaining in the closed region Cs. However, if it is desired to prevent the second liquid L2 from coming into contact with other regions in the large intestine C, it is preferable to recover the second liquid L2 by suction through the opening 160 before deflating the first balloon 131 and the second balloon 132, as shown in FIG. 18 .

[0110] (Summary of Second Embodiment) The treatment step S150 according to this embodiment includes a closing step S152, a first liquid injection step S154, and a second liquid injection step S156. The closing step S152 is a step of closing an area including a plurality of diverticula D to form a closed area Cs. The first liquid injection step S154 is a step of injecting a first liquid L1 into the closed area Cs. The second liquid injection step S156 is a step of injecting a second liquid L2 into the closed area Cs.

[0111] According to this configuration, after removing the clot at the bleeding point B with the first liquid L1 and exposing the bleeding point B, the second liquid L2 is injected into the closed area Cs, allowing the second liquid L2 to directly contact the exposed bleeding point B. This allows the second liquid L2 to directly act on the bleeding point B. Furthermore, according to this configuration, the medicinal solutions (the first liquid L1 and the second liquid L2) can be supplied simultaneously to multiple diverticula D present on the inner surface of the closed area Cs, allowing for simultaneous treatment. Therefore, the surgeon can treat multiple diverticula D present on the inner surface of the closed area Cs without identifying which of the multiple diverticula D in the divided area A identified in the compartment identification step S40 is the responsible diverticulum Da, thereby reducing the surgeon's burden. Furthermore, by performing simultaneous treatment, in addition to stopping the bleeding of the diverticula D, preventative treatment can also be performed on diverticula D that are not currently bleeding but are likely to bleed. Therefore, the treatment step S150 of this embodiment eliminates complexity for the patient and the surgeon, shortens the required time, and improves the treatment effect.

[0112] In the above embodiment, the first liquid L1 contains a component that dissolves blood clots. However, the first liquid L1 may be, for example, water. Even in this case, by sufficiently increasing the pressure when injecting the first liquid L1 into the closed area Cs, the flow of the first liquid L1 can wash away the surface of the bleeding point B, removing the blood clot and exposing the bleeding point B.

[0113] The treatment step S150 of this embodiment includes a first suction step S153 of suctioning gas from the closed area Cs after the closing step S152 and before the first liquid injection step S154.

[0114] According to this configuration, in the first suction step S153, the gas in the closed region Cs is sucked in to reduce the internal pressure, and therefore the gas present in a concave affected area such as a diverticulum D is also sucked in and removed. As a result, in the subsequent first liquid injection step S154, the first liquid L1 is suitably supplied to the interior of the entire affected area regardless of the position of the affected area. That is, depending on the patient's position during treatment, the first liquid L1 can be suitably supplied even to a concave affected area located vertically upward, without changing the patient's position.

[0115] Similarly, the treatment step S150 of this embodiment includes a second suction step S155 of suctioning gas from the closed area Cs after the first liquid injection step S154 and before the second liquid injection step S156.

[0116] According to this configuration, in the second suction step S155, the first liquid L1 present in a concave affected area such as a diverticulum D is also aspirated and removed. As a result, in the subsequent second liquid injection step S156, the second liquid L2 is suitably supplied to the entire affected area regardless of the location of the affected area. Furthermore, according to this configuration, blood clots detached or dissolved by the action of the first liquid L1 can be discharged from the closed area Cs in the second suction step S155. This makes it easier for the second liquid L2 to act on the bleeding point B.

[0117] Depending on the types of drugs contained in the first liquid L1 and the second liquid L2, the second suction step S155 may be omitted. That is, in the second liquid injection step S156, the second liquid L2 may be further injected into the closed area Cs filled with the first liquid L1.

[0118] Third Embodiment (Treatment Step (Treatment Method)) Next, a treatment step S250 of a third embodiment that can be performed instead of the treatment step S50 of the first embodiment will be described. Note that components that are the same as those in the above-described embodiment or its modified example will be assigned the same reference numerals, and descriptions thereof will be omitted.

[0119] The treatment step S250 of this embodiment is performed after the compartment identification step S40 described in the above embodiment, and is a step of treating the bleeding point B in the large intestine C.

[0120] 19 is a flowchart showing the main flow of the treatment step S250 of the third embodiment. The treatment step S250 (treatment method) of this embodiment includes an endoscope insertion step S251, a holder attachment step S252, a decompression step S253, and a diverticulum treatment step S254. In the treatment step S250, the endoscope insertion step S251, the holder attachment step S252, the decompression step S253, and the diverticulum treatment step S254 are performed in this order.

[0121] The treatment step S250 of this embodiment is performed after the compartment A where bleeding has occurred is identified by the compartment identification step S40 of the above-described embodiment. The treatment step S250 of this embodiment is a step of identifying a culprit diverticulum Da by checking whether or not bleeding is present in the multiple diverticula D in the identified compartment A, and then treating the identified culprit diverticulum Da.

[0122] The endoscope inserting step S251 is a step of inserting the endoscope 90 into the large intestine C. The holder attaching step S252, the decompression step S253, and the diverticulum treatment step S254 of this embodiment are performed using the endoscope 90.

[0123] 20 is a schematic diagram showing the holder attachment step S252 and the decompression step S253 of this embodiment. In the holder attachment step S252 of this embodiment, a stent 201 is used as a holder. The holder attachment step S252 is a step of attaching the stent 201 inside the large intestine C. The stent 201 is tubular. The stent 201 is made of a shape-memory mesh metal. The stent 201 can be folded to reduce the tube diameter.

[0124] In the holder attachment step S252, the surgeon first releases the folded stent 201 from the distal end opening 96a of the endoscope 90 into the large intestine C. The surgeon also places the stent 201 in the compartment A where multiple diverticula D, which are candidates for the culprit diverticulum Da, have been formed. The stent 201 expands in diameter within the large intestine C and comes into contact with the inner surface of the large intestine C. As a result, the stent 201 holds the inner surface of the large intestine C in the compartment A that includes the culprit diverticulum Da.

[0125] The decompression step S253 is a step in which gas within the large intestine C is sucked in through the suction hole 96b of the endoscope 90, thereby decompressing the inside of the large intestine C. When the inside of the large intestine C is decompressed, the large intestine C contracts, causing the inner surfaces to come into contact. However, the compartment area A in which the stent 201 is placed is prevented from contracting because the inner diameter is maintained by the stent 201. Furthermore, decompression of the inside of the large intestine C makes it easier for blood to flow out from the bleeding point B. This causes blood to spread around the culprit diverticulum Da, which has the bleeding point B.

[0126] The diverticulum treatment step S254 is a step in which the culprit diverticulum Da is identified and treated. As described above, by performing the decompression step S253, blood spreads around the culprit diverticulum Da. The surgeon uses the imaging unit 93 of the endoscope 90 to observe the inner surface of the large intestine C expanded by the stent 201, and identifies the culprit diverticulum Da by finding blood. Furthermore, the surgeon removes the stent 201 using the endoscope 90 to treat the culprit diverticulum Da.

[0127] (Summary of the third embodiment) The treatment step S250 (treatment method) of this embodiment includes a retainer attachment step S252 of attaching a retainer (stent 201) that holds the inner surface of the large intestine C, and a decompression step S253 of decompressing the inside of the large intestine C.

[0128] According to this configuration, it is possible to reduce the pressure inside the large intestine C while suppressing contractions of the large intestine C. This makes it possible to check for bleeding due to reduced pressure while making the inner surface of the large intestine C easier to see, and makes it possible to easily identify the bleeding point B.

[0129] In the treatment step S250 of this embodiment, the retaining tool is a stent 201 that maintains the inner diameter of the large intestine C. The stent 201 is attached to a certain region in the longitudinal direction of the large intestine C and can maintain the inner surface of the entire partitioned region A of the large intestine C, including multiple diverticula D. This makes it possible to simultaneously check for bleeding in multiple diverticula D.

[0130] <Modification 1 of Third Embodiment> Next, a holder attachment step and a decompression step of Modification 1 that can be employed in the treatment step of the third embodiment will be described.

[0131] 21 is a schematic diagram showing the holder attachment step and the decompression step of Modification 1 of the third embodiment. The holder attachment step and the decompression step of this modification are performed in order on a plurality of diverticula D that are candidates for the responsible diverticulum Da.

[0132] In the holder attachment step of this modified example, a cap member 201A is used as the holder. The cap member 201A is a cylindrical member attached to the distal end of the insertion section 92 of the endoscope 90. In the holder attachment step, the distal end surface of the cap member 201A is pressed against the outer periphery of one diverticulum D using the endoscope 90. By pressing the cap member 201A against the inner surface of the large intestine C around the diverticulum D, the inner surface of the large intestine C is held by the cap member 201A.

[0133] In the decompression step, the surgeon, while pressing the cap member 201A against the periphery of the diverticulum D, aspirates the gas inside the large intestine C through the suction hole 96b of the endoscope 90. This reduces the pressure inside the diverticulum D. If the diverticulum D, the periphery of which is held by the cap member 201A, has a bleeding point B, bleeding from this diverticulum D is confirmed. This identifies the culprit diverticulum Da. Furthermore, a diverticulum treatment step is performed on the culprit diverticulum Da using the endoscope 90.

[0134] <Modification 2 of Third Embodiment> Next, a holder attaching step and a decompression step of Modification 2 that can be employed in the third embodiment will be described.

[0135] 22 is a schematic diagram showing the holder attachment step and the decompression step of Modification 2 of the third embodiment. The holder attachment step and the decompression step of this modification are performed sequentially on a plurality of diverticula D that are candidates for the responsible diverticulum Da.

[0136] In the holder attachment step of this modified example, a diverticulum dilation device 201B is used as the holder. The diverticulum dilation device 201B passes through the channel 96 of the endoscope 90 and protrudes from the distal opening 96a. The diverticulum dilation device 201B has three legs 201b. The diverticulum dilation device 201B can be switched between a closed state in which the three legs 201b are bundled and parallel to one another, and an open state in which the tips of the three legs 201b are spaced apart.

[0137] In the holder attachment step of this modified example, the surgeon first inserts the diverticulum dilation device 201B in a closed state into the diverticulum D and then opens it inside the diverticulum D. This causes each of the three legs 201b to come into contact with the inner surface of the diverticulum D, and the inner surface of the diverticulum D is held by the diverticulum dilation device 201B. In other words, the holder attachment step is a step of attaching a holder (diverticulum dilation device 201B) that holds the inner surface of the large intestine C (the inner surface of the diverticulum D in this modified example).

[0138] In the decompression step, the surgeon aspirates the gas inside the large intestine C through the suction hole 96b of the endoscope 90 while the diverticulum dilation device 201B is inserted into the diverticulum D. This reduces the pressure inside the diverticulum D. If the diverticulum D into which the diverticulum dilation device 201B is inserted has a bleeding point B, bleeding from this diverticulum D is confirmed. This identifies the culprit diverticulum Da. Furthermore, a diverticulum treatment step is performed on the culprit diverticulum Da using the endoscope 90.

[0139] In this modification, a tripod-shaped diverticulum dilation device 201B having three legs 201b is shown as an example of a holder. However, the diverticulum dilation device 201B is not limited to the configuration of this modification as long as it has multiple legs 201b that can be opened and closed.

[0140] <Modification 3 of Third Embodiment> Next, a holder attaching step and a decompression step of Modification 3 that can be employed in the third embodiment will be described.

[0141] 23 is a schematic diagram showing the holder attachment step and the decompression step of Modification 3 of the third embodiment. The holder attachment step and the decompression step of this modification are performed sequentially on a plurality of diverticula D that are candidates for the responsible diverticulum Da.

[0142] In the holder attachment step of this modification, a spherical stent 201C is used as a holder. The spherical stent 201C is made of a shape-memory mesh metal. The spherical stent 201C has a spherical shape and can be folded to reduce its diameter.

[0143] In the holder attachment step of this modified example, the surgeon first places the folded spherical stent 201C into the diverticulum D through the distal end opening 96a of the endoscope 90. The spherical stent 201C expands in diameter inside the diverticulum D and comes into contact with the inner surface of the diverticulum D. In other words, the holder attachment step is a step of attaching a holder (spherical stent 201C) that holds the inner surface of the large intestine C (the inner surface of the diverticulum D in this modified example).

[0144] In the decompression step, the surgeon aspirates gas from the large intestine C through the suction hole 96b of the endoscope 90 while the spherical stent 201C is inserted into the diverticulum D. This reduces the pressure inside the diverticulum D. If the diverticulum D in which the spherical stent 201C is placed has a bleeding point B, bleeding from this diverticulum D is confirmed. This identifies the culprit diverticulum Da. Furthermore, a diverticulum treatment step is performed on the culprit diverticulum Da using the endoscope 90.

[0145] <Fourth Modification of Third Embodiment> Next, a holder attaching step and a decompression step of a fourth modification that can be employed in the third embodiment will be described.

[0146] 24 is a schematic diagram showing the holder attachment step and the decompression step of Modification 4 of Embodiment 3. The holder attachment step and the decompression step of this modification are performed sequentially on a plurality of diverticula D that are candidates for the responsible diverticulum Da.

[0147] In the holder attachment step of this modification, a coil 201D is used as the holder. The coil 201D is made of platinum wire 201d. For example, the coil 201D may be the same as a coil used for cerebral aneurysms.

[0148] In the holder attachment step of this modified example, the surgeon first protrudes delivery wire 90e from distal end opening 96a of endoscope 90, positions the tip of delivery wire 90e inside diverticulum D, and supplies wire 201d from the tip of delivery wire 90e into diverticulum D. As a result, wire 201d gathers into a spherical shape inside diverticulum D to form coil 201D. Coil 201D comes into contact with the inner surface of diverticulum D within diverticulum D. By going through the holder attachment step, the inner diameter of diverticulum D is maintained. In other words, the holder attachment step is a step of attaching a holder (coil 201D) that holds the inner surface of large intestine C (the inner surface of diverticulum D in this modified example).

[0149] In the decompression step, the surgeon aspirates gas from the large intestine C through the suction hole 96b of the endoscope 90 while the coil 201D is inserted into the diverticulum D. This reduces the pressure inside the diverticulum D. If the diverticulum D in which the coil 201D is placed has a bleeding point B, bleeding from this diverticulum D is confirmed. This identifies the culprit diverticulum Da. Furthermore, a diverticulum treatment step is performed on the culprit diverticulum Da using the endoscope 90.

[0150] <Fifth Modification of Third Embodiment> Next, a holder attaching step and a decompression step of a fifth modification that can be employed in the third embodiment will be described.

[0151] 25 is a schematic diagram showing the holder attachment step and the decompression step of Modification 5 of Embodiment 3. The holder attachment step and the decompression step of this modification are performed sequentially on a plurality of diverticula D that are candidates for the responsible diverticulum Da.

[0152] In the holder attachment step of this modified example, a porous balloon 201E is used as the holder. The porous balloon 201E is made of a material such as silicone resin or elastomer resin. The porous balloon 201E is donut-shaped and has a central hole 201e. A plurality of openings 201f are formed on the outer surface of the porous balloon 201E. The plurality of openings 201f and the central hole 201e are connected to each other by a tube portion 201g that passes through the interior of the porous balloon 201E.

[0153] In the retainer attachment step of this modified example, the surgeon first protrudes the delivery wire 90e from the distal end opening 96a of the endoscope 90 and positions the distal end inside the diverticulum D. Next, the surgeon supplies the porous balloon 201E from the distal end of the delivery wire 90e into the diverticulum D. This positions the porous balloon 201E inside the diverticulum D and causes it to expand. Furthermore, the outer surface of the porous balloon 201E comes into contact with the inner surface of the diverticulum D inside the diverticulum D. By going through the retainer attachment step, the inner diameter of the diverticulum D is maintained. In other words, the retainer attachment step is a step of attaching a retainer (porous balloon 201E) that holds the inner surface of the large intestine C (the inner surface of the diverticulum D in this modified example).

[0154] In the decompression step, with the perforated balloon 201E inserted into the diverticulum D, gas within the large intestine C is aspirated through the suction holes 96b of the endoscope 90. This reduces the pressure inside the diverticulum D. If the diverticulum D in which the perforated balloon 201E is placed has a bleeding point B, blood will reach the central hole 201e through the tubular portion 201g. By confirming that blood is flowing into the central hole 201e, the culprit diverticulum Da is identified. Furthermore, a diverticulum treatment step is performed on the culprit diverticulum Da using the endoscope 90.

[0155] <Fourth embodiment> (Bleeding point identifying method) Next, a bleeding point identifying method according to a fourth embodiment will be described. Note that components that are the same as those in the above-described embodiment or the modified examples thereof will be given the same reference numerals, and descriptions thereof will be omitted.

[0156] 26 is a flowchart showing the main flow of the bleeding point locating method of the fourth embodiment. The bleeding point locating method of this embodiment includes an endoscope insertion step S410, a diverticulum search step S420, a gel spraying step S430, a bleeding point confirmation step S440, and a gel recovery step S450. In the bleeding point locating method of this embodiment, the endoscope insertion step S410, the diverticulum search step S420, the gel spraying step S430, the bleeding point confirmation step S440, and the gel recovery step S450 are performed in this order. The bleeding point locating method of this embodiment is performed using an endoscope 90.

[0157] The endoscope insertion step S410 is a step of inserting the endoscope 90 into the large intestine C. In the endoscope insertion step S410 of this embodiment, the tip of the insertion section 92 of the endoscope 90 is placed at the lower end of the ascending colon C1 of the large intestine C.

[0158] The diverticulum searching step S420 is a step of searching for a diverticulum D while moving the tip of the endoscope 90 within the large intestine C. In the diverticulum searching step S420 of this embodiment, the diverticulum D is searched for by the imaging unit 93 while the tip of the endoscope 90 is moved backward within the large intestine C (i.e., moved in a direction closer to the anus).

[0159] The gel spraying step S430 is performed on the area where the diverticulum D was found in the diverticulum searching step S420. Generally, multiple diverticula D are formed in a concentrated area in the large intestine C. The gel spraying step S430 is performed on the area where multiple diverticula D are formed in a concentrated area in the large intestine C.

[0160] 27 is a schematic diagram showing the first gel spraying step S430. In the gel spraying step S430, gel G is released from the discharge hole 96c of the endoscope 90. In the gel spraying step S430, gel is sprayed onto an area including a plurality of diverticula D within the large intestine C. Here, the area onto which gel G is sprayed in the first gel spraying step S430 is referred to as a first spraying area S1. The first spraying area S1 is, for example, an area that can be observed by the imaging unit 93 without moving the endoscope 90.

[0161] The gel G is a highly viscous, transparent liquid. Therefore, the sprayed gel G covers the multiple diverticula D. Furthermore, the gel G spreads only within the first spraying region S1 in the large intestine C where it was sprayed, and is unlikely to spread to other areas.

[0162] In this embodiment, the gel G contains a drug (blood clot dissolving agent) that contains a component that dissolves blood clots. More specifically, examples of the drug that can be used in the gel G include heparin, urokinase, and t-PA.

[0163] In the gel spraying step S430, after spraying the gel G, a predetermined time is waited until the effects of the ingredients contained in the gel G are fully manifested. If any diverticulum D in the first spraying area S1 has a bleeding point B, the blood clot covering the bleeding point B is removed, and blood flows out from the bleeding point B.

[0164] The bleeding point confirmation step S440 is a step for confirming bleeding in the first spraying region S1. Because the gel G is transparent, when blood flows out from the bleeding point B, the gel G bleeds red near the bleeding point B. When the surgeon confirms the portion where the gel G bleeds red based on the image of the first spraying region S1 captured by the imaging unit 93 of the endoscope 90, the surgeon determines that the bleeding point B is located on the inner surface of the diverticulum D in the bleed portion.

[0165] In the bleeding point confirmation step S440, if a bleeding point B is confirmed in the first spray area S1 (bleeding point confirmation step S440: Yes), the surgeon identifies the responsible diverticulum Da having the bleeding point B and treats the responsible diverticulum Da using the endoscope 90.

[0166] In the bleeding point confirmation step S440, if a bleeding point B cannot be confirmed in the first spraying area S1 (bleeding point confirmation step S440: No), the surgeon determines that there is no bleeding point B in the first spraying area S1. In this case, the procedure proceeds to the gel recovery step S450.

[0167] 28 is a schematic diagram showing the gel recovery step S450. The gel recovery step S450 is a step of recovering the gel G sprayed from the suction hole 96b of the endoscope 90.

[0168] By performing the gel collection step, it is possible to prevent the sprayed area from becoming difficult to distinguish when performing the gel spraying step S430 multiple times. Even when performing the gel spraying step S430 multiple times, the gel collection step S450 may be omitted if the sprayed areas are sufficiently separated and there is no problem with the drug components contained in the gel G flowing into the large intestine C.

[0169] After the gel recovery step S450, the diverticulum search step S420, the gel spraying step S430, and the bleeding point confirmation step S440 are performed again in this order. In the second diverticulum search step S420, for example, the endoscope 90 is retracted to search for the diverticulum D.

[0170] 29 is a schematic diagram showing the second gel spraying step S430. In the second gel spraying step S430, gel G is sprayed over a second spraying area S2, which is an area where a diverticulum D found in the second diverticulum search step S420 is to be formed. Similar to the first spraying area S1, the second spraying area S2 is an area that can be observed by the imaging unit 93 without moving the endoscope 90.

[0171] 30 is a schematic diagram of the second bleeding point confirmation step S440. In the bleeding point confirmation step S440, the surgeon searches for a portion where the gel G is oozing red based on the image of the second spray area S2 captured by the imaging unit 93 of the endoscope 90. Furthermore, when the surgeon confirms a portion where the gel G is oozing red, the surgeon determines that a bleeding point B is present on the inner surface of the diverticulum D in the oozing portion.

[0172] As described above, if bleeding point B is confirmed in bleeding point confirmation step S440, treatment is performed on diverticulum D having bleeding point B. If bleeding point B is not confirmed in bleeding point confirmation step S440, the third gel recovery step S450, diverticulum search step S420, gel spraying step S430, and bleeding point confirmation step S440 are performed in this order.

[0173] (Summary of Fourth Embodiment) The bleeding point identification method of this embodiment includes a diverticulum search step S420, a gel spraying step S430, and a bleeding point confirmation step S440. The diverticulum search step S420 is a step of searching for a diverticulum D in the large intestine C using an endoscope 90. The gel spraying step S430 is a step of spraying a transparent gel G containing a blood clot dissolving agent over an area where the diverticulum D was found in the diverticulum search step S420. The bleeding point confirmation step S440 is a step of confirming bleeding in the spraying areas S1 and S2.

[0174] According to this configuration, by removing the blood clot at the bleeding point B with the gel G, it becomes possible to easily identify the bleeding point B, which has been difficult to locate due to the blood clot. Furthermore, by spraying a gel G with higher viscosity than a typical medicinal liquid, it is possible to prevent the sprayed medicinal liquid from wetting and spreading beyond the spraying ranges S1 and S2. If a low-viscosity medicinal liquid were sprayed, the medicinal liquid would spread indefinitely within the large intestine C, making it impossible to limit the range for searching for blood, making it difficult to locate the bleeding point even if blood is found. According to this configuration, by spraying a highly viscous gel G, when blood is found, the surgeon need only search for the bleeding point within the sprayed range in the bleeding point confirmation step S440, thereby enabling the bleeding point to be found quickly. Furthermore, because the gel G is transparent, when blood flows out from the bleeding point B, the gel G bleeds red near the bleeding point B, making it easy to locate the blood.

[0175] Fifth Embodiment (Bleeding Point Identifying Method) Next, a bleeding point identifying method according to a fifth embodiment will be described. Note that components that are the same as those in the above-described embodiment or the modified examples thereof will be given the same reference numerals, and descriptions thereof will be omitted.

[0176] Fig. 31 is a flowchart showing the main flow of the bleeding point locating method of the fifth embodiment. As shown in Fig. 31, the bleeding point locating method of this embodiment includes an endoscope insertion step S510, a diverticulum search step S520, a closing step S530, a medicinal solution spraying step S540, and a bleeding point confirmation step S550. In the bleeding point locating method of this embodiment, the endoscope insertion step S510, the diverticulum search step S520, the closing step S530, the medicinal solution spraying step S540, and the bleeding point confirmation step S550 are performed in this order. The bleeding point locating method of this embodiment is performed using an endoscope 90.

[0177] The endoscope insertion step S510 is a step of inserting the endoscope 90 into the large intestine C. In the endoscope insertion step S510 of this embodiment, the tip of the insertion section 92 of the endoscope 90 is placed in the rectum C5 or the sigmoid colon C4 of the large intestine C.

[0178] The diverticulum searching step S520 is a step of searching for a diverticulum D while moving the tip of the endoscope 90 within the large intestine C. In the diverticulum searching step S520 of this embodiment, the diverticulum D is searched for by the imaging unit 93 while the tip of the endoscope 90 is advanced within the large intestine C (i.e., moved in a direction away from the anus).

[0179] 32 is a schematic diagram showing the closing step S530 of this embodiment. The closing step S530 is performed to close the area where the diverticulum D was found in the diverticulum search step S520. As shown in FIG. 32, the closing step S530 is a step of closing a part of the large intestine C with a balloon (partition portion) 90f to partition the internal space of the large intestine C.

[0180] In the closing step S530, the surgeon first extends the air supply tube 90g, which has a balloon 90f at its tip, from the distal end opening 96a of the endoscope 90. The surgeon then inflates the balloon 90f by supplying air to the balloon 90f from the air supply tube 90g. Inflating the balloon 90f presses the surface of the balloon 90f against the inner surface of the large intestine C, thereby closing the large intestine C. This allows the balloon 90f to separate the area in the large intestine C where the diverticulum D was found from other areas.

[0181] 33 is a schematic diagram showing the chemical solution spraying step S540 of this embodiment. In the chemical solution spraying step S540, the chemical solution J is released from the discharge hole 96c of the endoscope 90. The chemical solution J released from the endoscope 90 is blocked by the balloon 90f within the large intestine C and does not spread beyond the balloon 90f. In other words, according to the chemical solution spraying step S540 of this embodiment, the range over which the chemical solution J is sprayed can be limited by the balloon 90f. In the following description, the area over which the chemical solution J is wetted and spreads is referred to as a spraying area S3. The spraying area S3 is the area within the large intestine C behind the portion closed off by the balloon 90f (i.e., the side where the endoscope 90 is positioned).

[0182] The drug solution J is preferably transparent. The drug solution J contains a drug (blood clot dissolving agent) that contains a component that dissolves blood clots. More specifically, the drug solution J contains drugs such as an antithrombotic drug urokinase t-PA and an anticoagulant drug heparin.

[0183] In the medicinal solution spraying step S540, after spraying the medicinal solution J, a predetermined time is waited until the effects of the components contained in the medicinal solution J are fully manifested. If any diverticulum D formed in the spraying area S3 has a bleeding point B, the blood clot covering the bleeding point B is removed, and blood flows out from the bleeding point B.

[0184] The bleeding point confirmation step S550 is a step for confirming bleeding in the sprayed region S3. Because the medicinal solution J is transparent, when blood flows out from the bleeding point B, the medicinal solution J oozes red near the bleeding point B. When the surgeon confirms the area where the medicinal solution J oozes red based on the image of the sprayed region S3 captured by the imaging unit 93 of the endoscope 90, the surgeon determines that the bleeding point B is located on the inner surface of the diverticulum D in the oozing area.

[0185] In the bleeding point confirmation step S550, if a bleeding point B is confirmed in the scattering area S3 (bleeding point confirmation step S550: Yes), the surgeon identifies the responsible diverticulum Da having the bleeding point B, and uses the endoscope 90 to treat the responsible diverticulum Da.

[0186] In the bleeding point confirmation step S550, if the bleeding point B cannot be confirmed in the spray area S3 (bleeding point confirmation step S550: No), the surgeon determines that there is no bleeding point B in the spray area S3. In this case, the balloon 90f is deflated to release the closure, and the process returns to the diverticulum search step S520.

[0187] In the second diverticulum search step S520, the endoscope 90 is further advanced to search for diverticulum D in the area previously closed by the balloon 90f. If diverticulum D is found, the large intestine C is closed with the balloon 90f in front of the area where diverticulum D was found, a medicinal solution is sprayed, and bleeding point B is searched for. By repeating these steps, bleeding point B can be searched for over the entire inner surface of the large intestine C, and diverticulum D having bleeding point B can be identified from the inner surface of the large intestine C.

[0188] Summary of the Fifth Embodiment The bleeding point identification method of this embodiment includes a diverticulum search step S520, a closing step S530, a medicinal solution spraying step S540, and a bleeding point confirmation step S550. The diverticulum search step S520 is a step of searching for a diverticulum D while moving toward a first side (the front side in this embodiment) within the large intestine C using the endoscope 90. The closing step S530 is a step of closing the first side of the area where the diverticulum D was found in the diverticulum search step S520 with a partition (balloon 90f). The medicinal solution spraying step S540 is a step of spraying medicinal solution J in a spraying area S3 on the second side (the rear side in this embodiment) of the partition (balloon 90f). The bleeding point confirmation step S550 is a step of confirming bleeding in the area on the second side (the rear side in this embodiment) of the partition (balloon 90f). If no bleeding is found in the bleeding point confirmation step S550, the process returns to the diverticulum search step S520 and each step is repeated in order.

[0189] According to this configuration, by removing the blood clot at the bleeding point B with the medicinal liquid J, it becomes possible to easily identify the bleeding point B, which would have been difficult to locate due to the blood clot. Furthermore, by performing the medicinal liquid spraying step S540 after the closing step S530, the range over which the medicinal liquid J spreads can be limited. This allows the bleeding point B to be found quickly by searching only for the sprayed area S3 sprayed in the bleeding point confirmation step S550. Furthermore, because the medicinal liquid J is transparent, when blood flows out from the bleeding point B, the medicinal liquid J will bleed red near the bleeding point B, making it easy to find the blood.

[0190] In this embodiment, the case where the drug solution spraying step S540 and the bleeding point confirmation step S550 are performed in a state where the balloon 90f is connected to the endoscope 90 via the air supply tube 90g has been described. However, the balloon 90f may be disconnected from the endoscope 90 after the closing step S530.

[0191] In the present embodiment, the balloon 90f is used as the partition for closing the large intestine C in the closing step S530. However, the partition is not limited to this embodiment. The partition may be, for example, a flat plate or an umbrella-shaped member.

[0192] <Modification 1 of Fifth Embodiment> Next, the diverticulum searching step, closing step, and medicinal solution spraying step of Modification 1 that can be employed in the fifth embodiment will be described. This modification differs from the above-described embodiment mainly in that the bleeding point B is searched for while the endoscope 90 is retracted. That is, in the diverticulum searching step of this modification, the diverticulum D is searched for by the imaging unit 93 while the tip of the endoscope 90 is retracted (i.e., moved in a direction approaching the anus) within the large intestine C.

[0193] Fig. 34 is a schematic diagram showing the closing step of this modified example. The closing step is performed to close the area where the diverticulum D was found in the diverticulum search step. As shown in Fig. 32, in this modified example, an expandable balloon 90h is provided at the tip of the insertion section 92 of the endoscope 90.

[0194] The closing step of this modified example is a step of closing a part of the large intestine C with a balloon (dividing portion) 90h to partition the internal space of the large intestine C. By expanding the balloon 90h provided at the tip of the insertion portion 92, the surface of the balloon 90h is pressed against the internal surface of the large intestine C, thereby closing the large intestine C. In this way, the balloon 90h partitions the area in which the diverticulum D was found in the large intestine C from other areas.

[0195] 35 is a schematic diagram showing the medicinal liquid spraying step of this modified example. In the medicinal liquid spraying step, medicinal liquid J is released from the discharge hole 96c of the endoscope 90. The medicinal liquid J released from the endoscope 90 is blocked by the balloon 90f within the large intestine C and does not spread beyond the balloon 90f. In other words, according to the medicinal liquid spraying step of this modified example, the range over which the medicinal liquid J is sprayed can be limited by the balloon 90f. In this modified example, the spraying region S3 where the medicinal liquid J spreads is formed in front of the portion of the large intestine C closed off by the balloon 90f.

[0196] After performing the medicinal solution spraying step, the surgeon waits for a predetermined time and then performs a bleeding point confirmation step on the area where the medicinal solution J was sprayed. If bleeding point B is found in the bleeding point confirmation step, the surgeon uses the endoscope 90 to treat the responsible diverticulum Da containing bleeding point B. If bleeding point B cannot be confirmed in the bleeding point confirmation step, the surgeon deflates the balloon 90h to release the closure and returns to the diverticulum search. In the second diverticulum search step, the endoscope 90 is further retracted to search for diverticulum D in the area previously closed by the balloon 90h. If diverticulum D is found, the large intestine C is closed with the balloon 90f behind the area where diverticulum D was found, the medicinal solution is sprayed, and bleeding point B is searched for. By repeating these steps, the diverticulum D containing bleeding point B is identified from the inner surface of the large intestine C.

[0197] <Modification 2 of Fifth Embodiment> Next, a description will be given of a closing step of Modification 1 that can be employed in Embodiment 5. Fig. 36 is a schematic diagram showing a closing step S530 of this modification.

[0198] As shown in Figure 36, in the closing step S530 of this modified example, a portion of the large intestine C is closed with two balloons 90f, 90h to partition the internal space of the large intestine C. According to this modified example, the first side (front side) and the second side (rear side) of the area where the medicinal liquid J is sprayed and the bleeding point B is searched for can be completely closed with the two balloons 90f, 90h. This makes it possible to limit the range in which the medicinal liquid J spreads, allowing the bleeding point B to be found quickly. In this modified example, the spraying area S3 where the medicinal liquid J is wetted and spreads is formed between the two balloons 90f, 90h within the large intestine C.

[0199] While the embodiments and modifications of the present invention have been described above, the configurations and combinations thereof in the embodiments and modifications are merely examples, and additions, omissions, substitutions, and other modifications of the configurations are possible without departing from the spirit of the present invention. Furthermore, the present invention is not limited to the embodiments.

[0200] For example, in the above-described embodiments and their modifications, the balloon is inflated by supplying air into the balloon. However, the balloon may be inflated by supplying a gas other than air or a liquid into the balloon.

[0201] The present invention can be applied to treatment tools for endoscopes and the like.

[0202] DESCRIPTION OF SYMBOLS 1, 1A, 1B... Insertion tool 10, 10A, 1B... Tube 10a... Tip portion 10b... Base portion 10h... Hollow portion 11... Balloon 12... Partition portion 12A Balloon (Partition portion) 14a, 14b... Concave and convex portion 15... Suction portion 16... Drainage hole (Drainage structure) 16c... Valve portion 90... Endoscope 96... Channel A... Partition area C... Large intestine C1... Ascending colon C3... Descending colon S10... Insertion step S20... Drainage step S30... Removal step S40... Partition identification step

Claims

a tube that can be inserted into the large intestine; a plurality of partitions provided on the outer periphery of the tube and in contact with the inner surface of the large intestine; and a drainage structure located between the partitions. Insertion tool. 　 Each of the plurality of partitions is in the form of a flexible pleat. The insert of claim 1 . 　 Each of the plurality of partitions is balloon-shaped. The insert of claim 1 . 　 The drainage structure is a drainage hole connecting the outside of the tube with the hollow portion. The insert of claim 1 . 　 The drain hole is provided with a valve portion that allows liquid to flow into the hollow portion from the outside and restricts fluid from flowing out from the hollow portion to the outside. The insert of claim 4. 　 A suction section that maintains a negative pressure in the hollow section is provided at the base end of the tube.

6. An insert according to claim 4 or 5. 　 At least one surface of the tube or the plurality of partitions is provided with an uneven portion for retaining blood adhering thereto. The insert of claim 1 . The container has three or more of the partitions. The insert of claim 1 . 　 The plurality of partitions are arranged at intervals of 10 cm or more and less than 30 cm. The insert of claim 1 . 　 At least one of the plurality of partitions is disposed at a position separating the ascending colon from the descending colon. The insert of claim 1 . an insertion step of inserting an insertion tool having a tube, a plurality of partitions provided on the outer periphery of the tube, and drainage structures positioned between the partitions into the large intestine, and bringing the plurality of partitions into contact with the inner surface of the large intestine to divide the inside of the large intestine into a plurality of partitioned regions; a drainage step of draining blood from the compartment region using the drainage structure when bleeding occurs from the inner surface of the large intestine; and a compartment identification step of identifying the compartment area where bleeding has occurred. How to use the insert. 　 a removal step performed after the draining step and before the compartment identifying step; the removing step is a step of removing the insertion tool from the large intestine; the compartment identifying step is a step of observing the removed insertion tool and identifying the compartment area where bleeding has occurred from a position where blood has adhered; 12. A method of using the insert of claim 11. 　 the step of identifying the compartment is performed by observing a computed tomography image of the large intestine in which the insertion tool is placed.

12. A method of using the insert of claim 11. 　 The inserting step includes: First, an endoscope is inserted into the large intestine, Next, the distal end of the insertion tool is placed in the large intestine through the channel of the endoscope, Next, the balloon provided at the tip of the insertion tool is expanded to fix the balloon to the inner surface of the large intestine, The endoscope is then withdrawn from the colon.

12. A method of using the insert of claim 11.

Images