Endoscope attachment and treatment device

Abstract

This endoscope attachment is attached to an endoscope and comprises: a first tube; and a second tube disposed on the proximal-end side of the first tube. The first tube is capable of advancing and retracting inside the second tube. This treatment device is attached to an endoscope and comprises: an end effector fixed to the distal end of the endoscope; a first flexible part fixed to the end effector; and a second flexible part disposed on the proximal-end side of the first flexible part. The first flexible part is capable of advancing and retracting inside the second flexible part.

Description

Endoscopic attachment and treatment device

[0001] This disclosure relates to an endoscopic attachment and a treatment device. This application claims the benefit of U.S. Provisional Application No. 63 / 738,849, filed on December 26, 2024, the entire content of which is incorporated herein by reference.

[0002] Endoscopic full-thickness resection (EFTR) enables endoscopic resection of cancers that infiltrate deeper than the submucosal layer and is less invasive than surgical resection. EFTR includes Exposed EFTR, which closes the defect after resection of the lesion, and Non-Exposed EFTR, which sutures around the lesion and then resections the lesion. In epithelial cancers, since the risk of seeding cannot be denied, Non-Exposed EFTR is desirable. Non-Exposed EFTR uses, for example, a cap-type device attached to the tip of an endoscopic scope as disclosed in Patent Document 1.

[0003] U.S. Patent Application Publication No. 2025 / 0025143

[0004] However, it is desired that the lesion can be more suitably treated in endoscopic full-thickness resection.

[0005] In view of the above circumstances, the present disclosure aims to provide an endoscopic attachment, a treatment device, and the like that can more suitably treat a lesion.

[0006] To solve the above problems, the present invention proposes the following means. The endoscopic attachment according to the first aspect of the present disclosure is an attachment to be attached to an endoscope, comprising a first tube, a second tube disposed on the proximal end side of the first tube, and the first tube is capable of advancing and retreating inside the second tube.

[0007] The treatment device according to the second aspect of the present disclosure is a device to be attached to an endoscope, comprising an end effector fixed to the tip of the endoscope, a first flexible part fixed to the end effector, and a second flexible part disposed on the proximal end side of the first flexible part, and the first flexible part is capable of advancing and retreating inside the second flexible part.

[0008] The endoscopic attachments and treatment devices of this disclosure enable more favorable treatment of lesions in endoscopic full-thickness resection.

[0009] A diagram showing an endoscope of a medical system according to the first embodiment of this disclosure. An overall view showing the high-frequency knife of the medical system. A perspective view of the tip of the high-frequency knife of the medical system. An overall view showing the flexible stapler of the medical system. A perspective view showing the gripping part of the flexible stapler. An overall view showing the endoscope attachment of the medical system. A diagram showing the endoscope attachment mounted on the endoscope. A diagram showing a flexible stapler through which a first tube is inserted. A diagram showing a modified example of the first tube. A diagram showing treatment of a lesion using the endoscope attachment. A diagram showing treatment of the lesion using the endoscope attachment. A diagram showing a modified example of the tube. A cross-sectional view showing an example of a path length change section. A cross-sectional view showing another example of the path length change section. A diagram showing a treatment device which is a modified example of the endoscope attachment. A diagram showing an overtube of a medical system according to the second embodiment of this disclosure. A diagram explaining treatment using the medical system. A diagram explaining treatment using the medical system. A diagram explaining treatment using the medical system. A diagram explaining treatment using the medical system. A diagram explaining treatment using the medical system. A diagram explaining treatment using the medical system. A diagram explaining treatment using a modified example of the flexible stapler. A diagram showing an approach using a guide wire. A diagram showing an approach using other guide members. A diagram showing a modified example of the bending function of a flexible stapler. A diagram showing a method of approaching a lesion with a flexible stapler. A diagram showing a method of approaching a lesion with a flexible stapler. A diagram showing a method of approaching a lesion with a flexible stapler. A diagram showing a first traction step by a medical system according to the third embodiment of this disclosure. A diagram showing a first folding step and a first suturing step. A diagram showing a first excision step. A cross-sectional view showing the lesion after the first excision step. A diagram showing a second excision step. A cross-sectional view showing the lesion after the second excision step. A diagram showing an auxiliary traction step. A diagram showing a modified example of the auxiliary traction step. A diagram showing a third suturing step. A cross-sectional view showing the lesion after the third excision step. A diagram showing a fourth suturing step. A diagram showing a modified example of the folding step. A diagram showing another modified example of the folding step. A diagram showing another modified example of the folding step. A diagram showing a procedure using a flexible stapler having a curved portion.

[0010] (First Embodiment) A medical system 1000 according to the first embodiment of this disclosure will be described with reference to Figures 1 to 15.

[0011] [Medical System 1000] The medical system 1000 comprises an endoscope 200, a high-frequency knife 100, a flexible stapler 300, and an endoscope attachment 400. The medical system 1000 includes a high-frequency knife 100 as an example of an endoscopic treatment instrument, but may also include other endoscopic treatment instruments such as clips, biopsy forceps, grasping forceps, hemostatic forceps, snares, needle holders, etc.

[0012] [Endoscope 200] Figure 1 shows an endoscope 200. The endoscope (medical device) 200 is a known flexible endoscope and comprises a long insertion section 210 and an operating section 220 provided on the proximal end side of the insertion section 210.

[0013] The insertion section 210 has a tip section 201, a curved section 204, and a flexible section 205. The tip section 201, the curved section 204, and the flexible section 205 are connected in order from the tip of the insertion section 210. The insertion section 210 has a treatment instrument channel 230 into which an endoscopic treatment instrument such as a high-frequency knife 100 is inserted.

[0014] The tip portion 201 includes a light guide 215, an imaging unit 216 having an image sensor such as a CCD or CMOS, and a tip opening 217 of the treatment instrument channel 230.

[0015] The curved section 204 is configured to bend freely in the vertical and horizontal directions. The tip of the operating wire is fixed to the tip of the curved section 204. The operating wire extends through the insertion section 210 to the operating section 220.

[0016] The base end of the operating section 220 is provided with a knob 223 for operating the operating wire and a switch 224 for operating the imaging unit 216, etc. The operator can bend the insertion section 210 in the desired direction by operating the knob 223.

[0017] The tip of the operating section 220 is provided with a forceps channel 222 that communicates with the treatment instrument channel 230. The operator can insert an endoscopic treatment instrument through the forceps channel 222.

[0018] Figure 2 is an overall view of the high-frequency knife 100. The high-frequency knife 100 is a high-frequency dual knife capable of, for example, water delivery and cutting, cauterization, and dissection. The high-frequency knife 100 comprises a sheath 110, a knife 120, an operating wire 140, and an operating unit 150. The high-frequency knife 100 is used by inserting it into the treatment instrument channel 230 of the endoscope 200.

[0019] Figure 3 is a perspective view of the tip of the high-frequency knife 100. The sheath 110 is a long cylindrical member that is flexible and insulating. An insulating tip 111 having a through hole 112 that penetrates in the longitudinal direction is attached to the tip of the sheath 110.

[0020] The knife (electrode, rod) 120 is a long, slender component made of metal. The knife 120 is made of a material such as stainless steel. The knife 120 has a knife body 121 and a flange 122.

[0021] The knife body 121 is a round, rod-shaped metal component. An operating wire 140 is attached to the base end of the knife body 121. When a high-frequency current is supplied to the knife 120 from the operating wire 250, the knife body 121 and flange 122 function as monopolar electrodes that output the high-frequency current to biological tissue.

[0022] The flange (tip portion) 122 is a ring-shaped conductive member provided at the tip of the knife body 121. The radial width of the flange 122, perpendicular to the longitudinal direction, is longer than the radial width of the knife body 121.

[0023] The knife body 121 and flange 122 have a water supply pipeline 123. The water supply pipeline 123 communicates with a tip opening 124 formed in the flange 122.

[0024] The operating wire 140 is a hollow coiled wire that passes through the sheath 110. The tip of the operating wire 140 is connected to the knife 120, and the base end of the operating wire 140 is connected to the slider 152 of the operating section 150.

[0025] The operating unit 150 includes an operating unit body 151, a slider 152, a power connector 153, and a liquid supply port 154.

[0026] The slider 152 is mounted so as to be movable along the operating unit body 151. The base end of the operating wire 140 is attached to the slider 152. When the operator moves the slider 152 forward and backward relative to the operating unit body 151, the operating wire 140 and the knife 120 move forward and backward.

[0027] The power supply connector 153 is connectable to a high-frequency power supply and is connected to the base end of the operating wire 140 via a conductive wire. The power supply connector 153 can supply high-frequency current from the high-frequency power supply to the knife 120 via the operating wire 140.

[0028] The fluid (such as a chemical solution) supplied from the liquid supply port 154 passes through the hollow section of the operating wire 140 and the water supply conduit 123 of the knife 120, and is discharged from the tip opening 124.

[0029] A high-frequency knife without a water supply function may be used instead of the high-frequency knife 100. In that case, a treatment instrument with a water supply function, such as a local injection needle, will be used in conjunction with it.

[0030] Figure 4 is an overall view of the flexible stapler 300. The flexible stapler (suturing device) 300 comprises a sheath 310, a gripping part 320, an operating wire 340, and an operating part 350. The flexible stapler 300 is used by inserting it into the tube 410 of the endoscope attachment 400, which will be described later.

[0031] The sheath 310 is a flexible, elongated cylindrical member. An operating wire 340 is inserted through the lumen of the sheath 310. A gripping portion 320 is attached to the tip of the sheath 110.

[0032] Figure 5 is a perspective view showing the gripping portion 320. The gripping portion 320 sutures the gripped biological tissue with staples (suture members) ST and also cuts the gripped biological tissue. The gripping portion 320 is fixed to the tip of the sheath 310. The gripping portion 320 has a first gripping member 321 and a second gripping member 322. The first gripping member 321 and the second gripping member 322 are connected so as to be openable and closable. The gripping portion 320 is an example of an end effector. The end effector is not limited to the gripping portion 320.

[0033] The first gripping member 321 has a cutter 323 and a plurality of staple dispensing sections 324.

[0034] The cutter 323 cuts the biological tissue held by the gripping portion 320. It is provided to move back and forth along the longitudinal direction of the sheath 310 and is operated by the operating wire 340. The cutter 323 moves back and forth along the longitudinal groove 321a provided on the upper surface 321e of the first gripping member 321.

[0035] Multiple staple release sections 324 are provided on the upper surface 321e of the first gripping member 321. The multiple staple release sections 324 are provided on both sides of the groove 321a. The staple release sections 324 are capable of accommodating staples (suture members) ST and release the staples ST by operation with the operating wire 340.

[0036] The second gripping member 322 is provided to be openable and closable relative to the first gripping member 321. The second gripping member 322 is opened and closed by operation using the operating wire 340. The second gripping member 322 has a staple receiving portion 325.

[0037] When the gripping portion 320 is in the closed position, the staple discharge portion 324 and the staple receiving portion 325 face each other. The staple receiving portion 325 is provided with a plurality of pockets capable of receiving staples ST discharged from the staple discharge portion 324.

[0038] The operating unit 350 is provided with a handle 351 for operating the operating wire 340. The user can operate the operating wire 340 by operating the handle 351.

[0039] FIG. 6 is an overall view showing the endoscope attachment 400. The endoscope attachment 400 is an attachment that is attached to the endoscope 200. The endoscope attachment 400 includes a tube 410, a first fixing portion 430, a second fixing portion 440, and an operation portion 450.

[0040] In the following description, the side inserted into the patient's body in the longitudinal direction (longitudinal axis direction, axial direction) A of the endoscope attachment 400 is referred to as the "tip side (distal side) A1", and the operation portion 450 side is referred to as the "base end side (proximal side) A2".

[0041] The tube 410 is a long cylindrical member into which an endoscope treatment tool can be inserted. The inner diameter of the tube 410 is larger than the inner diameter of the treatment tool channel 230 of the endoscope 200. Therefore, an endoscope treatment tool with a large outer diameter such as the flexible stapler 300 can be inserted into the tube 410. The tube 410 has a first tube 411 and a second tube 412.

[0042] The first tube 411 is a flexible and long cylindrical member. The first tube 411 can move forward and backward inside the second tube 412. The first tube 411 extends from the tip opening 421d of the second tube 412 to the tip side A1. A first fixing portion 430 is provided at the tip of the first tube 411.

[0043] The second tube 412 is a flexible and long cylindrical member. The second tube 412 is disposed on the base end side of the first tube 411. The first tube 411 is inserted into the lumen 412s of the second tube 412 so as to be able to move forward and backward along the longitudinal direction A.

[0044] The lumen 411s of the first tube 411 and the lumen 412s of the second tube 412 form a lumen 410s through which an endoscope treatment tool can be inserted. The tube 410 has a "path length changing portion 420" in which the path length from the tip of the tube 410 to the operation portion 450 changes as the first tube 411 and the second tube 412 move forward and backward relative to each other.

[0045] It is desirable that the distal end side of the first tube 411 extending from the second tube 412 to the distal end side A1 be softer than the proximal end side. This is because when the distal end side of the first tube 411 is soft, it is less likely to inhibit the bending of the endoscope at the path length change portion 420.

[0046] FIG. 7 is a view showing an endoscope attachment 400 attached to the endoscope 200. The first fixing portion 430 is provided at the tip of the first tube 411. The first fixing portion 430 is a substantially cylindrical cap that is detachably attached to the endoscope 200. The first fixing portion 430 has a first hole 431 and a second hole 432.

[0047] FIG. 8 is a view showing a flexible stapler 300 inserted into the first tube 411. An endoscope treatment tool such as the flexible stapler 300 can be inserted through the lumen 411s of the first tube 411 and protrude from and retract into the distal end opening 411d of the first tube 411 to the distal end side A1.

[0048] The first hole 431 is a hole that penetrates the first fixing portion 430 in the longitudinal direction A. The tip of the first tube 411 is inserted and fixed in the first hole 431. The distal end opening 411d of the first tube 411 is exposed on the distal end side A1 of the first fixing portion 430. Note that the distal end opening 411d of the first tube 411 may not be exposed on the distal end side A1 of the first fixing portion 430.

[0049] The second hole 432 is a hole that penetrates the first fixing portion 430 in the longitudinal direction A. The tip of the distal end portion 201 of the endoscope 200 is inserted into the second hole 432 and is detachably attached. The light guide 215, the imaging unit 216, and the distal end opening 217 of the distal end portion 201 attached to the second hole 432 are exposed on the distal end side A1 of the first fixing portion 430.

[0050] The second fixing portion 440 is provided on the second tube 412 and fixes the second tube 412 and the insertion portion 210 of the endoscope 200. The second fixing portion 440 is formed in a ring shape, for example. The tip of the second tube 412 is disposed on the proximal end side A2 of the bending portion 204 of the endoscope 200 when the first fixing portion 430 is fixed to the tip of the endoscope 200.

[0051] The endoscope attachment 400 is attached to the endoscope 200 by the first tube 411 being fixed to the tip of the endoscope 200 by the first fixing part 430, and the second tube 412 being fixed to the insertion part 210 of the endoscope 200 by the second fixing part 440.

[0052] The operating unit 450 has a first handle 451 and a second handle 452. The base end of the second tube 412 is connected to the first handle 451. The base end of the first tube 411 is connected to the second handle 452. The user can move the first tube 411 forward and backward relative to the second tube 412 by moving the second handle 452 forward and backward relative to the first handle 451. The user can insert an endoscopic treatment instrument through the base end opening 411p of the first tube 411, which is fixed to the second handle 452.

[0053] Figure 9 shows a modified example of the first tube 411, namely the first tube 411A. The base end of the first tube 411A does not extend to the operating section 450, but is located inside the second tube 412. The base end opening 411p of the first tube 411A is located in the lumen 412s of the second tube 412. An operating wire 411w is attached to the base end opening 411p of the first tube 411A. The operating wire 411w passes through the lumen 412s of the second tube 412 and extends from the base end opening 412p of the second tube 412 to the outside. The user can move the first tube 411A forward and backward relative to the second tube 412 by moving the operating wire 411w forward and backward relative to the first handle 451. The user can insert an endoscopic instrument through the base end opening 412p of the second tube 412, which is fixed to the first handle 451.

[0054] Endoscopic instruments such as the flexible stapler 300 can be inserted through the lumen 412s of the second tube 412 and the lumen 411s of the first tube 411A, and can be retracted into the tip side A1 from the tip opening 411d of the first tube 411A.

[0055] The outer circumference of the base end of the first tube 411A is provided with a projection 411c that protrudes radially outward. The inner circumference of the tip of the second tube 412 is provided with a projection 412c that protrudes radially inward. When the first tube 411A moves forward relative to the second tube 412, the projections 411c and 412c engage, preventing the first tube 411A from falling off.

[0056] [Procedure using medical system 1000] Next, we will explain procedures using medical system 1000. Specifically, we will explain how to treat a lesion TU in the stomach S. Figures 10 and 11 show the treatment of a lesion TU using an endoscopic attachment 400.

[0057] <Insertion Step> As shown in Figure 10, the operator inserts the endoscope 200 with the endoscopic attachment 400 into the stomach S. Assume that the lesion TU is formed in the lesser curvature L. The operator bends the curved portion 204 of the endoscope so that the tip 201 faces the lesser curvature L.

[0058] As the first tube 411 advances relative to the second tube 412, the path length of the path length changing section 420 increases. As a result, the tube 410 widens significantly towards the greater curvature G. By increasing the path length of the path length changing section 420, the tube 410 does not reduce the bending performance of the bending section 204 of the endoscope 200. The path length of the path length changing section 420 may change passively in accordance with the curvature of the bending section 204, or the path length may change actively by the operator operating the control unit 450.

[0059] The tip of the second tube 412 is fixed to the proximal end of the bending portion 204 of the endoscope 200. Therefore, when the bending portion 204 of the endoscope 200 is bent, the second tube 412 does not reduce the bending performance of the bending portion 204 of the endoscope 200.

[0060] The distal end of the first tube 411, which extends from the second tube 412 to the tip A1, is softer than the proximal end. Therefore, when the bending portion 204 of the endoscope 200 is bent, the distal end of the first tube 411 is more flexible and follows the curvature of the bending portion 204 of the endoscope 200.

[0061] <Procedure Steps> As shown in Figure 11, the operator inserts a flexible stapler 300 or the like into the tube 410 of the endoscopic attachment 400 and treats the lesion TU. The operator can treat the lesion TU using an endoscopic treatment instrument with a large outer diameter that cannot be inserted through the treatment instrument channel 230. The operator can also use a high-frequency knife 100 with the treatment instrument channel 230 inserted.

[0062] According to the medical system 1000 of this embodiment, the lesion TU can be treated more effectively. The medical system 1000 can be modified to include an external tube 410 that allows an endoscopic treatment instrument with a large outer diameter, such as a flexible stapler 300, to access the lesion TU, and the tube 410 does not reduce the bending performance of the curved portion 204.

[0063] Although the first embodiment of this disclosure has been described in detail above with reference to the drawings, the specific configuration is not limited to this embodiment and may include design changes, etc., that do not depart from the gist of this disclosure. Furthermore, the components shown in the above-described embodiment and the modifications shown below can be combined as appropriate.

[0064] (Modification 1-1) Figure 12 shows a modified tube 410, which is tube 410B. Tube 410B is a single long cylindrical member. Tube 410B has a path length changing section 420B between a first fixing section 430 and a second fixing section 440. The path length changing section 420B is an elastic member that can expand and contract in the longitudinal axis direction A of tube 410B, for example. The second fixing section 440 is provided on tube 410B and fixes tube 410B to the insertion section 210 of the endoscope 200. Similar to the above embodiment, it is desirable that the distal end of tube 410B is softer than the proximal end.

[0065] Figure 13 is a cross-sectional view showing an example of a path length changing section 420B. The path length changing section 420B illustrated in Figure 13 has a bellows shape. The path length changing section 420B can expand and contract along the longitudinal direction A of the tube 410B.

[0066] Figure 14 is a cross-sectional view showing another example of the path length changing section 420B. The path length changing section 420B illustrated in Figure 14 is folded back in the longitudinal axis direction A of the tube 410B. The path length changing section 420B can expand and contract along the longitudinal axis direction A.

[0067] (Modification 1-2) Figure 15 shows a treatment device 400C, which is a modification of the endoscope attachment 400. The treatment device 400C comprises a flexible stapler 300, a second tube (second flexible part) 412, a first fixing part 430, a second fixing part 440, and an operating part 450. That is, the treatment device 400C is equipped with a flexible stapler 300 instead of the first tube 411.

[0068] The sheath (first flexible part) 310 of the flexible stapler 300 allows the lumen 412s of the second tube (second flexible part) 412 to move forward and backward. The sheath 310 and the second tube 412 have a "path length changing section 420C" in which the path length from the tip of the sheath 310 to the operating section 450 changes as the sheath 310 and the second tube 412 move forward and backward relative to each other.

[0069] The gripping portion 320, fixed to the tip of the sheath 310, is fixed to the tip of the endoscope 200 via a first fixing portion 430. The first fixing portion 430 supports the gripping portion 320 so that its orientation relative to the endoscope 200 does not change when the sheath 310 is moved forward and backward relative to the second tube 412. The first fixing portion 430 may support the gripping portion 320 so that it is movable forward and backward and rotatable about its longitudinal axis relative to the first fixing portion 430.

[0070] This disclosure includes the following technical concept: (Note 1) A method for treating a lesion with a treatment instrument in an endoscopic procedure, comprising: attaching an access device to an endoscope through which the treatment instrument can be inserted and which has a path length changing function that can change the path length; bringing the endoscope close to the lesion using the path length changing function of the access device in addition to the bending function of the endoscope; making the treatment instrument protrude from the access device near the lesion; adjusting the position and angle of the treatment instrument using at least one of the bending function of the endoscope and the path length changing function of the access device; and treating the lesion with an end effector provided at the tip of the treatment instrument.

[0071] (Second Embodiment) The medical system 1000B according to the second embodiment of this disclosure will be described with reference to Figures 16 to 29. In the following description, components that are common to those already described will be denoted by the same reference numerals and redundant descriptions will be omitted.

[0072] [Medical System 1000B] Medical system 1000B comprises an endoscope 200, a high-frequency knife 100, and an overtube 500.

[0073] [Overtube 500] Figure 16 shows the overtube 500. The overtube 500 is a guide tube having a path through which the insertion portion 210 of the endoscope 200 can be inserted. The operator inserts the insertion portion 210 of the endoscope 200 and the endoscopic treatment instrument into the overtube 500, and inserts the insertion portion 210 of the endoscope 200 and the endoscopic treatment instrument together with the overtube 500 into a tubular organ such as the stomach or intestine.

[0074] The overtube 500 comprises an insertion portion 510 that is inserted into the body and a connecting portion 530 attached to the insertion portion 510.

[0075] The insertion portion 510 is a flexible tube and has a lumen 520 that extends in the longitudinal direction. The lumen 520 of the insertion portion 510 allows the insertion portion 210 of the endoscope 200 and endoscopic treatment instruments to be inserted through it. The lumen 520 of the insertion portion 510 opens longitudinally at a tip opening 521 formed on the tip side. The lumen 520 of the insertion portion 510 opens longitudinally at a base opening 522 formed on the base side.

[0076] The connecting portion 530 is attached to the base end side of the insertion portion 510 and has a tubular portion 531 and an airtight valve 535.

[0077] The tubular portion 531 is approximately cylindrical and coaxial with the insertion portion 510. The lumen 532 of the tubular portion 531 communicates with the lumen 520 of the insertion portion 510 via the base end opening 522 at the tip end. The lumen 532 of the tubular portion 531 opens longitudinally at the insertion port 533 formed at the base end.

[0078] The airtight valve 535 is located in the lumen 532 of the tubular section 531. The airtight valve 535 is a balloon-type valve that can be expanded and contracted by supplying and exhausting air. By closing the airtight valve 535 while the insertion section 210 of the endoscope 200 or an endoscopic treatment instrument is inserted through the insertion port 533, it is possible to prevent fluids flowing through the lumen 520 of the overtube 500 from coming out of the insertion port 533.

[0079] [Procedure using medical system 1000B] Next, we will explain the procedure using medical system 1000B. Specifically, we will explain how to treat lesions TU in the stomach S. Note that the procedure is not limited to lesions TU in the stomach S, but can be any lesion TU that has formed in the lumen. Figures 17 to 22 are diagrams illustrating the procedure using medical system 1000B.

[0080] <Insertion Step> As shown in Figure 17, the surgeon inserts the endoscope 200 into the stomach S. The surgeon observes the stomach S with the endoscope 200 and identifies the lesion TU.

[0081] As shown in Figure 18, the surgeon inserts an endoscopic instrument, independent of the endoscope 200, into the stomach S. In this embodiment, the endoscopic instrument to be inserted is a flexible stapler 300. When passing the flexible stapler 300 through the cardia CA, the surgeon pulls the endoscope 200 back to the oral side of the tip of the flexible stapler 300, and while confirming the tip of the flexible stapler 300 using the imaging unit 216 of the endoscope 200, passes the tip of the flexible stapler 300 through the cardia CA. Note that the endoscopic instrument inserted independently of the endoscope 200 is not limited to the flexible stapler 300.

[0082] As shown in Figure 19, the surgeon may insert the endoscope 200 and flexible stapler 300 into the stomach S using an overtube 500. Specifically, the surgeon inserts the endoscope 200 and flexible stapler 300 into the lumen 520 of the overtube 500, which is inserted through the mouth, and passes them through the oral cavity, pharynx, and larynx. The tip of the overtube 500 is inside the stomach S, and the endoscope 200 and flexible stapler 300 are inserted into the lumen 520 of the overtube 500, passing them through the cardia CA.

[0083] As shown in Figure 20, the operator inserts the endoscope 200 and the flexible stapler 300 into the stomach S using the method described above.

[0084] <Procedure Steps> As shown in Figure 21, the operator brings the imaging unit 216 of the endoscope 200 close to the lesion TU, and while confirming the lesion TU using the imaging unit 216 of the endoscope 200, brings the flexible stapler 300 close to the lesion TU. The operator treats the lesion TU using the gripping part 320 of the flexible stapler 300. While observing the gripping part 320 of the flexible stapler 300 with the endoscope 200, the operator rotates or bends the gripping part 320 of the flexible stapler 300 to adjust the position and angle of the flexible stapler 300 relative to the lesion TU.

[0085] The operator may use a grasping forceps 600 inserted through the instrument channel 230 of the endoscope 200 to grasp the flexible stapler 300 and support the adjustment of the position and angle of the flexible stapler 300 relative to the lesion TU.

[0086] As shown in Figure 22, the operator closes the gripping portion 320 of the flexible stapler 300 and grasps the treatment site of the lesion. With the treatment site of the lesion TU grasped by the gripping portion 320, the operator operates the endoscope 200 to observe the gripping position and confirm that the appropriate position has been grasped. If the treatment site is not appropriate, the operator changes the treatment position by changing the gripping position (re-grasping). Specifically, after closing the gripping portion 320, the operator operates the endoscope 200 and observes both sides of the gripping portion 320. The operator confirms that the treatment site of the lesion TU is grasped by the gripping portion 320.

[0087] The surgeon may rotate the gripping part 320 when observing it. After closing the gripping part 320, the surgeon may rotate or bend the gripping part 320 to adjust its position or angle relative to the lesion TU.

[0088] Figure 23 shows a procedure using a flexible stapler 300B, which is a modified version of the flexible stapler 300. The flexible stapler 300B has a bending function. Specifically, the flexible stapler 300B has a bending portion 360 at the tip of the sheath 310 that actively bends in at least one direction. The operator can bend the bending portion 360 by operating the operating portion 350. The flexible stapler 300B may also have a rotation function. The rotation function rotates the gripping portion 320 around a rotation axis along the longitudinal direction A. The operator can adjust the position or angle of the gripping portion 320 relative to the lesion TU by bending the gripping portion 320 using the bending function or by rotating the gripping portion 320 using the rotation function.

[0089] The surgeon uses the bending function described above to turn the tip of the flexible stapler 300B, bringing it closer to the lesion TU so that the tip of the flexible stapler 300B is parallel to the lumen wall, thereby bringing the gripping portion 320 closer to the lesion TU. The bending direction of the flexible stapler 300B after turning its tip is, for example, approximately perpendicular to the opening and closing direction of the gripping portion 320.

[0090] The operator processes the position grasped by the gripping part 320 of the flexible stapler 300.

[0091] The operator opens the gripping part 320 and releases the gripped position.

[0092] <Other Procedure Steps> Figure 24 shows an approach using a guidewire GW. Before bringing the gripping portion 320 of the flexible stapler 300 close to the lesion TU, the operator uses the endoscope 200 to position the guidewire (guide member) GW near the treatment site of the lesion TU. The operator advances the flexible stapler 300 along the guidewire GW, bringing the gripping portion 320 of the flexible stapler 300 closer to the lesion TU.

[0093] The guide wire GW may have a function that allows its hardness to be changed. The guide wire GW is flexible when it is being installed, and its shape is fixed by hardening the guide wire GW before bringing the gripping portion 320 of the flexible stapler 300 close to the lesion TU.

[0094] Figure 25 shows an approach using a different guide member. Before bringing the gripping portion 320 of the flexible stapler 300 close to the lesion TU, the surgeon may fix a cylindrical guide member GX near the lesion TU and bring the gripping portion 320 closer to the lesion TU by passing the cylindrical guide member GX through it. The cylindrical guide member GX may have an elastic member that expands to allow the gripping portion 320 of the flexible stapler 300 to pass through.

[0095] Figure 26 shows a modified example of the bending function of the flexible stapler 300B. The flexible stapler 300B may be bent by a connected bending wire 300w. The tip of the bending wire 300w is attached to the tip of the flexible stapler 300B. The bending wire 300w is inserted through a ring 300r provided in the middle of the sheath 310. When the bending wire 300w is pulled, the flexible stapler 300B bends.

[0096] Figures 27 to 29 illustrate the approach method of the flexible stapler 300 to the lesion TU. As shown in Figure 27, the operator places the treatment area of ​​the lesion TU inside the gripping part 320 with the gripping part 320 open. The operator hooks the open gripping part 320 onto the lesion TU. As shown in Figure 28, the operator adjusts the angle of the gripping part 320 relative to the lesion TU by pushing the gripping part 320 toward the tip so that the direction of the gripping part 320 is aligned with the treatment position. As shown in Figure 29, after the direction of the gripping part 320 has been adjusted to the appropriate orientation, the operator closes the gripping part 320 and performs the treatment.

[0097] According to the medical system 1000B of this embodiment, an endoscope 200 and an endoscopic treatment instrument independent of the endoscope 200 can be inserted into the lumen, allowing for more favorable treatment of the lesion TU.

[0098] Although the second embodiment of this disclosure has been described in detail above with reference to the drawings, the specific configuration is not limited to this embodiment and may include design changes and the like that do not depart from the gist of this disclosure. Furthermore, the components shown in the above-described embodiment and the modifications shown below can be combined as appropriate.

[0099] This disclosure includes the following technical concepts: (Note 1) A method for treating a lesion, comprising: inserting an endoscope and a treatment instrument independent of the endoscope into the lumen; bringing the endoscope and the treatment instrument closer to the lesion; rotating or bending the treatment instrument while observing it with the endoscope to adjust the position and angle of the treatment instrument relative to the lesion; closing the gripping part of the treatment instrument to grasp the treatment site of the lesion; treating the position grasped by the gripping part of the treatment instrument; and opening the gripping part to release the grasped position. (Note 2) The treatment method according to Note 1, wherein after closing the gripping part, the endoscope is operated to observe the gripping part. (Note 3) The treatment method according to Note 2, wherein the treatment instrument is rotated when observing the gripping part. (Note 4) The treatment method according to Note 1, wherein after closing the gripping portion, the treatment tool is rotated or bent to adjust the position or angle of the treatment tool relative to the lesion. (Note 5) The treatment tool has a bending function that bends in at least one direction and a rotation function, and the position or angle of the treatment tool relative to the lesion is adjusted by bending the treatment tool using the bending function or by rotating the treatment tool using the rotation function. (Note 6) The treatment method according to Note 5, wherein the tip of the treatment tool is turned by the bending function, and the tip of the treatment tool is brought closer to the lesion so that it is parallel to the lumen wall. (Note 7) The treatment method according to Note 6, wherein the bending direction of the treatment tool with its tip turned is substantially perpendicular to the opening and closing direction of the gripping portion. (Note 8) The treatment method according to Note 1, wherein in the step of adjusting the position and angle of the treatment instrument, the treatment portion of the lesion is placed inside the gripping portion with the gripping portion open, and the angle of the treatment instrument relative to the lesion is adjusted by pushing the treatment instrument toward the tip so that the direction of the treatment instrument is at an angle that aligns with the treatment position.(Note 9) The treatment method according to Note 1, wherein, before bringing the treatment instrument close to the lesion, the endoscope is used to position a guide member near the treatment site of the lesion, and the treatment instrument is advanced along the guide member to bring the treatment instrument closer to the lesion. (Note 10) The treatment method according to Note 1, wherein the treatment instrument is grasped using a grasping forceps inserted through the treatment instrument channel of the endoscope, and the adjustment of the position and angle of the treatment instrument relative to the lesion is supported. (Note 11) The treatment method according to Note 1, wherein the endoscope and the treatment instrument are inserted into a lumen provided in an overtube inserted through the mouth, and passed through the oral cavity, pharynx, and larynx. (Note 12) The treatment method according to Note 11, wherein the tip of the overtube is in the stomach, and the endoscope and treatment instrument are inserted into a lumen provided in the overtube, and passed through the cardia. (Note 13) The treatment method according to Note 11, wherein an airtight valve having an insertion port through which the endoscope and the treatment instrument are inserted is provided at the proximal end of the overtube. (Note 14) The treatment method according to Note 11, wherein a balloon-type airtight valve that can be expanded and contracted by supplying and venting is installed at the proximal end of the overtube. (Note 15) The treatment method according to Note 1, wherein when the treatment instrument passes through the cardia, the endoscope is pulled back to a position oral to the tip of the treatment instrument, and the treatment instrument is inserted into the lumen by passing it through the cardia while confirming the tip of the treatment instrument. (Note 16) The treatment method according to Note 1, wherein before bringing the treatment instrument close to the lesion, a cylindrical guide member is fixed near the lesion, and the treatment instrument is brought close to the lesion by passing it over the cylindrical guide member. (Note 17) The treatment method according to Note 16, wherein the cylindrical guide member has an elastic member that expands to allow the treatment instrument to be inserted. (Note 18) The treatment method according to Note 9, wherein the guide member can change hardness, is flexible when the guide member is installed, and hardens to fix its shape before bringing the treatment instrument close to the lesion.

[0100] (Third Embodiment) The medical system 1000C according to the third embodiment of this disclosure will be described with reference to Figures 30 to 44. In the following description, components that are common to those already described will be denoted by the same reference numerals and redundant descriptions will be omitted.

[0101] [Medical System 1000C] The medical system 1000C comprises an endoscope 200, a high-frequency knife 100, a flexible stapler 300, an endoscope attachment 400, and a gripping forceps 600.

[0102] [Procedure using Medical System 1000C] Next, we will explain the procedure using Medical System 1000C. Specifically, we will explain how to treat lesions (TUs) that have formed in the stomach (S). Note that the procedure is not limited to lesions (TUs) that have formed in the stomach (S), but is acceptable for lesions (TUs) that have formed in the lumen.

[0103] <Insertion Step> The surgeon inserts the endoscope 200, fitted with the endoscopic attachment 400, into the stomach S. The surgeon observes the stomach S with the endoscope 200 and identifies the lesion TU. The surgeon uses the high-frequency knife 100 to form a marking M around the lesion TU.

[0104] <First Traction Step> Figure 30 shows the first traction step. The operator inserts the grasping forceps 600 into the instrument channel 230 of the endoscope 200. The operator pulls the first point P1, located around the lesion, towards the endoscope side E1 using the grasping forceps 600, which is the traction device. Before pulling the first point P1, the operator may make an incision in the mucosal layer of the first point P1 with the high-frequency knife 100. The operator may also make an incision around the entire circumference of the lesion TU.

[0105] <First Folding Step> Figure 31 shows the first folding step and the first suturing step. The operator grasps the first point P1 with the grasping forceps 600 and folds it toward the endoscope side E1.

[0106] <First suturing step> The surgeon inserts the flexible stapler 300 into the tube 410 of the endoscopic attachment 400. The flexible stapler 300 may be inserted and removed while the endoscope 200 remains in place in the body, or it may be inserted into the body together with the endoscope 200 while inserted into the tube 410, or it may be removed from the body together with the endoscope 200 while inserted into the tube 410. If the flexible stapler 300 can be inserted into the instrument channel 230 of the endoscope 200, the surgeon may insert the flexible stapler 300 into the instrument channel 230 of the endoscope 200.

[0107] The surgeon sutures the folded first point P1 in two or more rows by releasing staples (suture members) ST using a flexible stapler 300, which is a suturing device. The staples ST housed in the staple release section 324 of the gripping section 320 are ejected toward the staple receiving section 325. The needle tip of the staple ST penetrates the suture site and bends upon contact with the staple receiving section 325. As a result, the suture site is sutured. This first suturing step may be performed in multiple steps. The surgeon reloads the staples ST into the staple receiving section 325 of the gripping section 320 as needed.

[0108] The operator may adjust the opening and closing direction by rotating the flexible stapler 300 before grasping the first point P1. The operator may also adjust the grasping position by bending the tip of the flexible stapler 300 in a direction approximately perpendicular to the direction in which the lumen runs relative to the opening and closing direction.

[0109] <First excision step> Figure 32 shows the first excision step. Figure 33 is a cross-sectional view showing the lesion TU after the first excision step. The surgeon excises the area between the first point P1 sutured with the cutter 323 of the flexible stapler 300. The series of procedure steps from the first traction step to the first excision step may be performed in multiple steps. The surgeon performs hemostasis using a high-frequency knife 100 as needed.

[0110] <Second Traction Step> The operator is positioned around the lesion TU and uses the grasping forceps 600 to pull the second point P2, which is different from the first point P1, toward the endoscope side E1. The first point P1 and the second point P2 are located on opposite sides of the lesion TU. Before pulling the second point P2, the operator may make an incision in the mucosal layer of the first point P1 with the high-frequency knife 100.

[0111] <Second folding step> The operator grasps the second point P2 with the grasping forceps 600 and folds it toward the endoscope side E1.

[0112] <Second suturing step> The surgeon sutures the folded second point P2 in two or more rows by releasing staples ST with the flexible stapler 300. This second suturing step may be performed in multiple steps. The surgeon reloads staples ST into the staple receiving portion 325 of the gripping portion 320 as needed.

[0113] The surgeon may adjust the opening and closing direction by rotating the flexible stapler 300 before grasping the second point P2. The surgeon may also adjust the grasping position by bending the tip of the flexible stapler 300 in a direction approximately perpendicular to the direction in which the lumen runs relative to the opening and closing direction.

[0114] <Second excision step> Figure 34 shows the second excision step. Figure 35 is a cross-sectional view showing the lesion TU after the second excision step. The surgeon excises the area between the second point P2 sutured with the cutter 323 of the flexible stapler 300. The series of procedure steps from the second traction step to the second excision step may be performed in multiple steps. The surgeon performs hemostasis using a high-frequency knife 100 as needed.

[0115] <Assisted Traction Step> Figure 36 shows the assisted traction step. The operator grasps the cut end of the first point P1 or the cut end of the second point P2 with the grasping forceps 600 and pulls it toward the endoscope side E1. This aligns the first point P1 and the second point P2 in the direction that the endoscope 200 is facing.

[0116] Figure 37 shows a modified example of the auxiliary traction step. The operator may use two gripping forceps 600 to pull one end of the cut end at the first point P1 or the cut end at the second point P2 toward the endoscope side E1, and push the other end toward the far side E2, which is opposite to the endoscope side E1. For example, the endoscope attachment 400 has two tubes 410 as shown in Figure 37, and one of the two gripping forceps 600 is inserted through the channel 230 of the endoscope 200, and the other is inserted through the tube 410 of the endoscope attachment 400. The operator may use three or more gripping forceps 600. In addition, the operator may use multiple gripping forceps in the first traction step and the second traction step as well.

[0117] As shown in Figure 37, when traction is applied to two locations using multiple gripping forceps 600, it is desirable for the surgeon to position the flexible stapler 300 between the multiple gripping forceps 600.

[0118] <Third Point Grasping Step> The operator grasps the third point P3 with a flexible stapler 300, which is located between the cut end of the first point P1 and the cut end of the second point P2, and is around the lesion TU. Specifically, the operator grasps the third point P3 with the flexible stapler 300, moving from the endoscope side E1 toward the far side E2, which is opposite the endoscope side E1.

[0119] The surgeon may adjust the opening and closing direction by rotating the flexible stapler 300 before grasping the third point P3. The surgeon may adjust the grasping position by bending the tip of the flexible stapler 300 in a direction approximately perpendicular to the direction in which the lumen runs relative to the opening and closing direction, before grasping the area around the lesion TU.

[0120] <Third suturing step> Figure 38 shows the third suturing step. The surgeon sutures the grasped third point P3 with two or more rows of flexible staples 300. This third suturing step may be performed in multiple steps. The surgeon reloads staples ST into the staple receiving portion 325 of the gripping portion 320 as needed.

[0121] <Third excision step> Figure 39 is a cross-sectional view showing the lesion TU after the third excision step. The surgeon excises the area between the third point P3 sutured with the cutter 323 of the flexible stapler 300. The series of procedure steps from the third point grasping step to the third excision step may be performed in multiple steps. The surgeon performs hemostasis using a high-frequency knife 100 as needed.

[0122] The series of procedure steps for the fourth site P4 shown below (from the fourth site grasping step to the fourth excision step) are not mandatory. The surgeon may complete the procedure by repeating the series of procedure steps from the third site grasping step to the third excision step.

[0123] <Fourth Point Grasping Step> The surgeon grasps the fourth point P4 with the flexible stapler 300, which is located between the cut end of the first point P1 and the cut end of the second point P2, and is around the lesion TU. The third point P3 and the fourth point P4 are located on opposite sides of the lesion TU. Specifically, the surgeon grasps the fourth point P4 with the flexible stapler 300, moving from the endoscope side E1 toward the far side E2, which is opposite the endoscope side E1.

[0124] The surgeon may adjust the opening and closing direction by rotating the flexible stapler 300 before grasping the fourth point P4. The surgeon may adjust the grasping position by bending the tip of the flexible stapler 300 in a direction approximately perpendicular to the direction in which the lumen runs relative to the opening and closing direction, before grasping the area around the lesion TU.

[0125] <Fourth Suturing Step> Figure 40 shows the fourth suturing step. The surgeon sutures the grasped fourth point P4 with two or more rows of flexible staples 300. This fourth suturing step may be performed in multiple steps. The surgeon reloads staples ST into the staple receiving portion 325 of the gripping portion 320 as needed.

[0126] <Fourth excision step> The surgeon excises the area between the fourth point P4, which has been sutured together, using the cutter 323 of the flexible stapler 300. The series of procedures from the fourth point grasping step to the fourth excision step may be performed in multiple steps. The surgeon performs hemostasis using the high-frequency knife 100 as needed.

[0127] As a result of the above procedure, the entire circumference of the lesion TU is resected and sutured with staples ST. The surgeon then removes the endoscope 200, to which the endoscopic attachment 400 is attached, from the stomach S.

[0128] <Other procedural steps> The surgeon may use multiple types of suturing devices. For example, the surgeon may use a flexible stapler 300 and clips to perform the first, second, third, or fourth suturing steps.

[0129] Figure 41 shows a modified example of the folding step. The endoscope attachment 400 may have two tubes 410. The two tubes 410 are positioned on either side of the endoscope 200. The surgeon inserts a grasping forceps 600 through the tube 410 positioned above the endoscope 200 and uses the grasping forceps 600 to grasp and lift the first point P1, etc. The surgeon inserts a flexible stapler 300 through the tube 410 positioned below the endoscope 200 and grasps the first point P1, etc. By lifting the first point P1, etc., the surgeon can easily grasp the suture site. The surgeon may also use thread or the like to lift the suture site.

[0130] Figure 42 shows another variation of the folding step. The operator may position the tip opening 411d of the tube 410 proximal to the curved portion 204 of the endoscope 200. The operator grasps and lifts the first point P1 etc. with the grasping forceps 600 protruding from the turned endoscope 200. The operator pulls the entire thickness of the first point P1 etc. between the open grasping portions 320 and sutures it to excise it.

[0131] Figure 43 shows another variation of the folding step. The operator may provide an additional tube 410 to the endoscopic attachment 400, with the tip opening 411d of the additional tube 410 positioned proximal to the curved portion 204 of the endoscope 200. The operator can insert a gripping forceps 600 through one tube 410 and a flexible stapler 300 through the other tube 410 to treat the lesion TU.

[0132] Figure 44 shows a procedure using a flexible stapler 300B having a curved portion 360. The flexible stapler 300B has a curved portion 360 at the tip of the sheath 310 that actively curves in at least one direction. Before the gripping step, the operator bends the curved portion 360 to bend the gripping portion 320 of the flexible stapler 300B approximately perpendicular to the direction in which the lumen runs. In this case, the operator does not need to perform an auxiliary traction step.

[0133] According to the medical system 1000C of this embodiment, the lesion TU can be treated more effectively. The operator can insert the flexible stapler 300 into the lumen by inserting the tube 410 of the endoscopic attachment 400, to which the endoscope 200 is attached. Compared to other treatment methods, the operator can operate the flexible stapler 300 and other treatment instruments more easily. As a result, it is possible to treat the lesion TU while ensuring a sufficient margin from the excision site to the suture site, and it is less likely that any remaining lesion TU will be left behind.

[0134] Although the third embodiment of this disclosure has been described in detail above with reference to the drawings, the specific configuration is not limited to this embodiment and may include design changes and the like that do not depart from the gist of this disclosure. Furthermore, the components shown in the above-described embodiment and the modifications shown below can be combined as appropriate.

[0135] This disclosure includes the following technical concepts. (Note 1) A method for resecting the entire wall of the digestive tract using an endoscope, comprising: a first traction step of pulling a first point located around the lesion toward the endoscope using a traction device; a first folding step of grasping the first point with the traction device and folding it toward the endoscope; a first suturing step of suturing the folded first point in two or more rows with a suturing device; a first resection step of resecting the area between the sutured first points; a second traction step of pulling a second point located around the lesion and different from the first point toward the endoscope using the traction device; a second folding step of grasping the second point with the traction device and folding it toward the endoscope; a second suturing step of suturing the folded second point in two or more rows with the suturing device; a second resection step of resecting the area between the sutured second points; and a grasping step of grasping a third point with the suturing device between the cut end of the first point and the cut end of the second point, which is around the lesion. A method for resecting the entire wall of a gastrointestinal tract, comprising: a third suturing step of suturing the grasped third point in two or more rows using the suturing device; and a third resection step of resecting the area between the sutured third points. (Appendix 2) The method for resecting the entire wall of a gastrointestinal tract according to Appendix 1, wherein the first point and the second point are located on both sides of the lesion. (Appendix 3) The method for resecting the entire wall of a gastrointestinal tract according to Appendix 1, further comprising an auxiliary traction step of grasping the cut end of the first point or the cut end of the second point with the traction device and pulling it toward the endoscope before the grasping step. (Appendix 4) The method for resecting the entire wall of a gastrointestinal tract according to Appendix 1, wherein at least one of the first suturing step, the first resection step, the second suturing step, the second resection step, the third suturing step, and the third resection step is performed in multiple steps. (Appendix 5) The method for full-thickness resection of the gastrointestinal wall according to Appendix 1, further comprising the step of rotating the suturing device to adjust the opening and closing direction before grasping the area around the lesion.(Note 6) The method for full-thickness resection of the gastrointestinal wall according to Note 1, wherein in the grasping step, the third point is grasped with the suturing device from the endoscope side toward the back side opposite the endoscope side. (Note 7) The method for full-thickness resection of the gastrointestinal wall according to Note 1, wherein the suturing device is a stapler and sutures by releasing a suturing member. (Note 8) The method for full-thickness resection of the gastrointestinal wall according to Note 7, further comprising a step of reloading the suturing member into the suturing device after the first suturing step, the second suturing step, or the third suturing step, wherein sutures by releasing a suturing member. (Note 9) The method for full-thickness resection of the gastrointestinal wall according to Note 3, wherein a plurality of the traction devices are used in the first traction step, the second traction step, or the auxiliary traction step. (Note 10) The method for full-thickness resection of the gastrointestinal wall according to Note 9, wherein the suturing device is positioned between a plurality of traction devices. (Note 11) The method for full-thickness resection of the gastrointestinal wall according to Note 1, wherein before grasping the first point, the second point, or the third point, the tip of the suturing device is bent in a direction substantially perpendicular to the direction in which the lumen runs relative to the opening and closing direction to adjust the grasping position. (Note 12) The method for full-thickness resection of the gastrointestinal wall according to Note 1, wherein the suturing device can be inserted and removed while the endoscope remains in the body via the channel of the endoscope or a tube attached externally to the endoscope. (Note 13) The method for full-thickness resection of the gastrointestinal wall according to Note 1, wherein hemostasis is performed after the first resection step, the second resection step, or the third resection step. (Note 14) The method for full-thickness resection of the gastrointestinal wall according to Note 1, wherein multiple types of devices are used as the suturing device. (Note 15) The method for full-thickness resection of the gastrointestinal wall according to Note 14, wherein the multiple types of devices are clips and staplers. (Note 16) The method for full-thickness resection of the gastrointestinal wall according to Note 1, wherein the suturing device has a bending function, and before the grasping step, the suturing device is bent substantially perpendicular to the direction in which the lumen runs.(Note 17) The method for full-thickness resection of the gastrointestinal wall according to Note 1, wherein an incision is made in the mucosal layer at the first point or the second point with a treatment instrument before the first traction step or the second traction step. (Note 18) The method for full-thickness resection of the gastrointestinal wall according to Note 3, wherein the auxiliary traction step involves pulling one of the cut ends of the first point or the second point toward the endoscope and pushing the other end toward the back, which is opposite to the endoscope.

[0136] 1000, 1000B, 1000C Medical System 100 High-Frequency Knife 200 Endoscope (Medical Device) 201 Tip 204 Bending Section 205 Flexible Section 210 Insertion Section 215 Light Guide 216 Imaging Unit 217 Tip Opening 220 Operating Section 222 Forceps Channel 230 Treatment Instrument Channel 300, 300B Flexible Stapler (Suture Device) 300r Ring 300w Bending Wire 310 Sheath (First Flexible Section) 320 Gripping Section 321 First Gripping Member 322 Second Gripping Member 323 Cutter 324 Staple Discharge Section 325 Staple Receiving Section 340 Operating Wire 350 Operating Section 351 Handle 360 ​​Bending Section 400 Endoscope Attachment 400C Treatment device 410, 410B Tube 410s Lumen 411, 411A First tube 411c Projection 411d Tip opening 411p Proximal opening 411s Lumen 411w Manipulation wire 412 Second tube (second flexible part) 412c Projection 412p Proximal opening 412s Lumen 420, 420B, 420C Pathway length change section 421d Tip opening 430 First fixing part 431 First hole 432 Second hole 440 Second fixing part 450 Manipulation part 451 First handle 452 Second handle 500 Overtube 600 Gripping forceps A Longitudinal direction (longitudinal axis direction, axial direction) A1 Tip side (distal side) A2 Proximal side (proximal side) E1 Endoscope side E2 Inner side GW Guidewire (guide member) GX Cylindrical guide member M Marking P1 First point P2 Second point P3 Third point P4 Fourth point ST Staple (suture member) TU Lesion

Claims

1. An attachment for an endoscope, comprising: a first tube; a second tube positioned at the proximal end of the first tube; and the first tube being able to move back and forth inside the second tube.

2. The endoscope attachment according to claim 1, wherein a first fixing portion is provided at the tip of the first tube.

3. The endoscope attachment according to claim 2, wherein the first fixing portion has a first hole, and the first tube is inserted into and fixed in the first hole.

4. The first fixing portion further has a second hole, and the endoscope is inserted into the second hole and fixed, the endoscope attachment according to claim 3.

5. The endoscope attachment according to claim 1, wherein a second fixing portion for fixing to the endoscope is provided on the second tube.

6. The endoscope attachment according to claim 1, wherein the first tube extends beyond the tip of the second tube.

7. The endoscopic attachment according to claim 6, further comprising an operating section to which the base ends of the first tube and the second tube are connected, wherein the operating section moves the first tube forward and backward relative to the second tube.

8. The endoscopic attachment according to claim 1, wherein the base end of the first tube is disposed inside the second tube.

9. The endoscopic attachment according to claim 8, wherein projections are provided on the outer circumference of the base end of the first tube and on the inner circumference of the tip end of the second tube.

10. The distal end of the first tube is softer than the proximal end, as described in claim 1.

11. An endoscope system comprising: an endoscope attachment according to any one of claims 2 to 4; and the endoscope.

12. The endoscope system according to claim 11, wherein the endoscope has a curved portion, and the tip of the second tube is positioned on the proximal side of the curved portion of the endoscope when the first fixing portion is fixed to the tip of the endoscope.

13. The endoscope system according to claim 11, wherein a second fixing part for fixing to the endoscope is provided on the second tube, the first tube is fixed to the endoscope by the first fixing part, and the second tube is fixed to the endoscope by the second fixing part.

14. An attachment for an endoscope, comprising a tube through which a treatment instrument is inserted, wherein a portion of the tube has a path length changing section through which the path length can be changed.

15. The endoscope attachment according to claim 14, wherein a first fixing portion is provided at the tip of the tube.

16. The endoscope attachment according to claim 15, wherein the first fixing portion has a first hole, and the tube is inserted into and fixed in the first hole.

17. The endoscope attachment according to claim 16, wherein the first fixing portion further has a second hole, and the endoscope is inserted into and fixed in the second hole.

18. The endoscope attachment according to claim 14, wherein a second fixing portion for fixing to the endoscope is provided on the tube.

19. The distal end of the tube is softer than the proximal end, as described in claim 14.

20. The endoscope attachment according to claim 14, wherein the path length changing portion is an elastic member that can expand and contract in the longitudinal axis direction of the tube.

21. The endoscope attachment according to claim 14, wherein the path length changing portion is bellows-shaped.

22. The endoscope attachment according to claim 14, wherein the path length changing portion is folded back in the longitudinal direction of the tube.

23. A device to be attached to an endoscope, comprising: an end effector fixed to the tip of the endoscope; a first flexible part fixed to the end effector; and a second flexible part positioned on the proximal end side of the first flexible part, wherein the first flexible part is capable of moving back and forth inside the second flexible part.

24. The treatment device according to claim 23, wherein the second flexible portion is fixed to the endoscope on the proximal end side of the bending portion of the endoscope, and the first flexible portion is movable forward and backward relative to the second flexible portion.

25. The treatment device according to claim 24, further comprising a fixing portion that supports the end effector so that the direction of the end effector relative to the endoscope does not change when the first flexible portion is moved forward and backward relative to the second flexible portion.

26. The treatment device according to claim 25, wherein the fixed portion supports the end effector so as to be able to move forward and backward relative to the fixed portion and so as to be able to rotate about the longitudinal axis.

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