JP4403440B2 - Transparent hood for endoscope and method for mounting the same - Google Patents

Description

[0001]
BACKGROUND OF THE INVENTION
The present invention relates to gastrointestinal endoscopy as a medical technique, and is completely new as an auxiliary tool for endoscopic treatment.
[0002]
[Prior art]
Grip forceps were often used to secure the field of view and retain mucous membranes during conventional endoscopic mucosal resection, but to perform mucosal incision and snare after grasping the mucosa with grasping forceps Needed to use a two-channel endoscope or two endoscopes.
[0003]
[Problems to be solved by the invention]
When attempting to remove a relatively large flat-type mucosal tumor of 2 cm or more endoscopically, it has been difficult to perform batch excision by the conventional method. In particular, when the size exceeds 4 cm, it is very difficult to cut all together with a snare, and there is a risk of perforation. In order to collectively remove such a large lesion, it is necessary to incise the submucosa. As a method of incising the submucosa, there has been a report of trying to incise with a needle knife after grasping the mucous membrane with grasping forceps, but it is dangerous and satisfactory results have not been obtained . When a two-channel endoscope is used, the grasping forceps and the needle knife move at the same time, so the operability is limited. When two endoscopes are used, one person cannot operate alone. It is difficult to perform the highlighting operation. Moreover, even if the mucous membrane is lifted with grasping forceps and a visual field can be secured well, incision with a needle knife is difficult and risky. Therefore, I previously developed a mucosal incision forceps and tried to use it (separately pending patent application: Application No. 10-225158, claim 1). When this forceps is used, the mucosa to be incised is first sandwiched between the forceps, and after confirming that the incised portion is appropriate, an incision can be made by flowing a high-frequency current. By adopting such a method, the incision position and depth can be determined appropriately, and if pinching is performed at an inappropriate position, it can be re-pinned before high-frequency current is passed, Incision can be prevented. This method enables more reliable and safe mucosal dissection. This can also be applied to the incision in the submucosa. However, when this forceps is used for incision of the submucosa, it is difficult to determine the direction in which the forceps open because the mucosa is covered and the field of view of the treatment area cannot be secured. There were problems such as difficulty.
[0004]
[Means for Solving the Problems]
A flat surface that can be attached to the distal end of the endoscope and open the mucosal incision as a means of securing a visual field when the mucosal incision is made with the forceps for mucosal dissection and then the lower mucosa is incised with the same forceps. A transparent mold hood was devised. When the incision is opened with the transparent hood lifting the mucosa peeled off by incising the submucosa, the wound is well observed endoscopically. The forceps for mucosal incision can be taken out from the distal end opening of the flat type transparent hood and opened, and the tissue under the mucosa of the part to be incised can be grasped and incised by high-frequency current. At this time, the visual field is always kept good through the flat hood. Further, since the distal end opening of the flat type transparent hood has a narrow horizontally long form, the forceps for mucosal dissection are always corrected in the direction to open sideways and come out. Therefore, it is not necessary to adjust the opening direction of the forceps, and there is an advantage that it is very easy to use. Further, by pulling the forceps base portion into the hood and energizing after grasping the tissue to be incised, it is possible to prevent the non-insulated portion of the forceps from coming into contact with the tissue and causing a leakage so that the incision cannot be performed well.
[0005]
DETAILED DESCRIPTION OF THE INVENTION
First, a planned incision gland is assumed in the peripheral mucosa of the mucosal tumor to be excised, and marking is performed using a high-frequency current or the like. Thereafter, a liquid such as physiological saline is injected into the submucosa below the mucosa to be incised to raise the mucosal layer, and then a mucosal incision is performed using a needle knife or forceps for mucosal incision. At this time, the mucosa on the distal side of the tumor should be incised first using a needle knife. The proximal side of the tumor is incised using a needle knife or mucosal incision forceps. Once the mucosal incision around the tumor has been made, the submucosa is incised from the proximal side of the tumor using mucosal dissection forceps. When using forceps for mucosal dissection, the purpose of securing the visual field of the incision, maintaining the direction of opening of the forceps in a certain direction (sideways), and preventing leakage from the non-insulated portion of the forceps is claimed. A flat transparent hood, which is a transparent hood for endoscopes, is attached to the distal end of the endoscope to assist. A specific method for incising the submucosa will be described. The flat type transparent hood is mounted so that the long axis of the opening portion is in the horizontal direction with the up angle direction of the endoscope facing up. The tissue in the submucosa is exposed by opening the mucosal incision on the proximal side of the tumor with the tip of a flat transparent hood attached to the tip of the endoscope. The tip of the hood is aligned with the portion of the submucosa to be incised, the tissue to be incised is grasped with the forceps for mucosal incision protruding from the opening, and the base of the forceps is pulled into the hood and energized to conduct the incision. At this time, pay close attention to whether the grasped tissue does not contain the intrinsic muscle layer, and if it is deeply grasped too much, it will be energized after re-gripping. The above operation is repeated and the incision of the submucosa is gradually advanced. Even if the incision of the submucosa progresses and the peeled mucosa covers the incision, the visual field is kept good by moving the peeled mucosa with the tip of the flat transparent hood. It is possible to go. The submucosal layer may be incised by this method until the tumor mucous membrane is completely dissected, but if the exfoliation progresses and the snare can be applied easily, it is easier to separate with the snare at the end. It is. When the above method is used, as long as the lesion remains in the mucous membrane, the lump excision can be safely performed regardless of the size. It can also be applied to endoscopic procedures other than mucosal resection, such as endoscopic hemostasis, and in the case of hemostasis, a visual field is secured while peeling a clot with the tip of a flat hood, and bleeding Once the point is confirmed, the clip can be opened from the hood opening and the bleeding point can be reliably clipped.
[0006]
【Example】
Endoscopic mucosal resection for flat mucosal tumors in the digestive tract such as the esophagus, stomach, and large intestine. Especially effective for excision of large tumors of 2 to 3 cm or larger. In addition, it is effective for securing a visual field in endoscopic procedures such as endoscopic hemostasis.
[0007]
【The invention's effect】
According to the present invention, even a large flat-type mucosal tumor that cannot be removed endoscopically by conventional methods can be removed safely and reliably. Moreover, this method is a simple method that can be performed without anesthesia and using a single normal channel endoscope. Therefore, large mucosal tumor lesions that have been treated with open surgery or laparoscopic-assisted surgery can be treated with less invasive endoscopic procedures.
In addition, the present invention can be applied to other endoscopic procedures such as endoscopic hemostasis, and enables a simpler and more reliable endoscopic procedure.
[Brief description of the drawings]
FIG. 1 is an appearance of a flat transparent hood.
FIG. 2 is a schematic view when the endoscope is actually used after being attached to the endoscope.
[Explanation of symbols]
DESCRIPTION OF SYMBOLS 1 Tip opening part 2 Endoscope mounting part 3 Tip flat type transparent hood 4 Endoscope 5 Mucosal incision forceps

Claims (3)

Tapered shape,
A narrow, horizontally long tip opening is formed at the tip ,
Having a flat portion that continues from the side in the major axis direction of the tip opening,
Transparent hood for endoscopes characterized by The dimension in the major axis direction of the tip opening is the same as the diameter of the endoscope mounting portion;
Transparent hood for an endoscope according to claim 1, characterized in. A transparent hood for an endoscope having a tapered shape and a narrow laterally wide front end opening formed at the front end and having a flat portion extending from the side in the long axis direction of the front end opening. Attaching to the endoscope so that the long axis of the distal end opening portion is sideways with the angle direction facing upward,
A mounting method for a transparent hood for an endoscope characterized by the above.

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