JP7626703B2 - Endoscopic treatment tools - Google Patents

Description

The present invention relates to an endoscopic treatment tool and its operating method.

In the treatment of tumors such as cancer, a method has been proposed in which target tissue is sampled using a diagnostic instrument such as a biopsy needle to make a definitive diagnosis, and then a treatment instrument such as a drug injection catheter is used to inject a drug into the tissue.

As a therapeutic device, Patent Document 1 discloses a catheter that delivers a therapeutic agent into a substrate. The catheter has a curved delivery member that includes one or more lumens and a hollow tube. Patent Document 1 also discloses that the curved delivery member includes an opening at its distal tip and that the curved delivery member is a hollow needle. Patent Document 2 discloses a drainage catheter with an inner needle that is inserted into the body to puncture and aspirate and discharge fluids, etc.

Special Publication No. 2012-525181 Japanese Patent Application Publication No. 8-52220

When an affected area such as a tumor is close to the body surface, for example, the affected area can be visually identified, the needle of the instrument described in Patent Documents 1 and 2 can be inserted into the affected area, and a drug can be directly injected from the needle into the affected area to perform treatment. However, in the past, diagnostic instruments such as biopsy needles for identifying the affected area and treatment instruments such as drug injection catheters were separate. For this reason, when the affected area is in an organ deep inside the body, such as the lungs, liver, pancreas, or bile duct, it is not easy for the surgeon to visually identify the affected area, and even if the affected area is identified with a diagnostic instrument, it is not necessarily possible to accurately place a treatment instrument on the affected area and perform treatment such as injecting a drug. Therefore, the present invention aims to provide an endoscopic treatment instrument and an operating method thereof that can appropriately place a treatment instrument on the identified affected area even if the identified affected area is deep inside the body.

One embodiment of the endoscopic treatment tool of the present invention that has achieved the above object is an endoscopic treatment tool that is inserted into a forceps channel of an endoscope, and includes an outer tube having a first end and a second end in the longitudinal direction and a lumen extending in the longitudinal direction, an inner tube that is disposed in the lumen of the outer tube and is movable in the longitudinal direction of the outer tube relative to the outer tube and has a lumen, and a needle that is disposed in the lumen of the inner tube and is movable in the longitudinal direction of the outer tube relative to the inner tube. According to the above endoscopic treatment tool, after the inner tube and the needle are punctured into the target tissue, the needle can be moved proximally relative to the inner tube. Therefore, it is possible to remove the needle while the inner tube is fixed to the target tissue, and an instrument other than the needle, such as a treatment instrument, can be inserted into the removed portion. This allows the insertion position of the needle relative to the target tissue to coincide with the insertion position of the other instrument. By configuring the endoscopic treatment tool in this way, even if the site identified as an affected area such as a tumor is deep in the body, the treatment instrument can be placed in the identified affected area, making it possible to perform appropriate treatment.

In the above-mentioned endoscopic treatment tool, it is preferable that the needle can be removed from the inner tube when the inner tube protrudes distally beyond the outer tube.

It is preferable that the above-mentioned endoscopic treatment tool further comprises a fluid supply device, the fluid supply device being connected to the proximal portion of the inner tube for supplying fluid to the inner cavity of the inner tube, and the inner tube having a side hole at its distal end that connects the inner cavity of the inner tube with the outside of the inner tube.

In the above-mentioned endoscopic treatment tool, it is preferable that the inner tube has a tapered portion whose outer diameter decreases toward the distal side of the inner tube, and that the tapered portion is located distal to the side hole.

In the above-mentioned endoscopic treatment tool, it is preferable that the inner tube has an abutment portion where the inner wall of the inner tube abuts against the outer wall of the needle, and a separation portion located proximal to the abutment portion where the inner wall of the inner tube is separated from the outer wall of the needle.

In the above-mentioned endoscopic treatment tool, it is preferable that the cross-sectional area of the distal end of the outer tube is larger than the cross-sectional area at the center position in the longitudinal axis direction of the outer tube.

In the above-mentioned endoscopic treatment tool, it is preferable that the needle has an ultrasonic reflecting portion at its distal end.

In the above-mentioned endoscopic treatment tool, it is preferable that the ultrasonic reflecting portion has a first reflecting portion and a second reflecting portion located closer to the first reflecting portion.

In the above-mentioned endoscopic treatment tool, it is preferable that the first reflecting portion and the second reflecting portion are irregularities provided on the outer surface of the needle.

In the above-mentioned endoscopic treatment tool, it is preferable that the needle has a hollow portion at its distal end for collecting biological tissue.

In the above-mentioned endoscopic treatment tool, it is preferable that an expandable portion is provided in the distal portion of the inner tube that is exposed from the outer tube.

In the above-mentioned endoscopic treatment tool, it is preferable that a first stopper protruding radially outward is provided at the proximal portion of the inner tube.

In the above-mentioned endoscopic treatment tool, it is preferable that the inner tube has a small diameter portion whose inner diameter at its distal end is smaller than the center position in the longitudinal axis direction of the inner tube, the needle has an engagement portion whose outer diameter is larger than the small diameter portion, and the small diameter portion is located distal to the engagement portion.

It is preferable that the needle is removable from the inner tube, and that the endoscopic treatment tool further includes a treatment instrument that is disposed in the inner cavity of the inner tube and is movable in the longitudinal direction of the outer tube relative to the outer tube.

The present invention also provides a method for operating an endoscopic treatment tool. One embodiment of the method for operating an endoscopic treatment tool of the present invention, which has achieved the above object, is a method for operating an endoscopic treatment tool comprising an outer tube having a first end and a second end in the longitudinal direction and a lumen extending in the longitudinal direction, an inner tube arranged in the lumen of the outer tube and movable in the longitudinal direction of the outer tube relative to the outer tube, and having a lumen, and a needle arranged in the lumen of the inner tube and movable in the longitudinal direction of the outer tube relative to the inner tube, and includes a step of inserting the endoscopic treatment tool into a forceps channel of an endoscope, a step of protruding the inner tube and the needle from the distal side of the outer tube, a step of removing the needle from the inner tube, and a step of inserting a treatment tool into the lumen of the inner tube after the step of removing the needle from the inner tube. Since the above-mentioned operating method includes a step of inserting a treatment tool into the lumen of the inner tube after the step of removing the needle from the inner tube, the insertion position of the needle with respect to the target tissue can be aligned with the insertion position of the treatment tool. This makes it possible to place a treatment instrument at an affected area, such as a tumor, even if the affected area is deep inside the body, thereby enabling appropriate treatment.

In the above-mentioned endoscopic treatment tool, after the inner cylinder and the needle are inserted into the target tissue, the needle can be moved proximally relative to the inner cylinder. Therefore, the needle can be removed while the inner cylinder is fixed to the target tissue, and an instrument other than the needle, such as a treatment instrument, can be inserted into the removed site. This allows the insertion position of the needle into the target tissue to coincide with the insertion position of the other instrument. By configuring the endoscopic treatment tool in this way, even if a site identified as an affected area such as a tumor is deep in the body, the treatment instrument can be placed in the identified affected area, making it possible to perform appropriate treatment.
In addition, since the above-mentioned operating method includes a step of inserting a treatment instrument into the inner cavity of the inner tube after the step of removing the needle from the inner tube, the insertion position of the needle with respect to the target tissue can be matched with the insertion position of the treatment instrument. This allows the treatment instrument to be placed in the identified affected area, such as a tumor, even if the area identified as the affected area is deep in the body, making it possible to perform appropriate treatment.

1 is a cross-sectional view (partially a side view) of an endoscopic treatment tool according to one embodiment of the present invention; 2 is a schematic diagram showing a state in which an inner cylinder and a needle of the endoscopic treatment tool shown in FIG. 1 are inserted into biological tissue. 3 is a schematic diagram showing a state in which the needle of the endoscopic treatment tool shown in FIG. 2 has been removed. FIG. 3 is a schematic diagram showing a state in which a treatment instrument is inserted into the inner cavity of the inner cylinder of the endoscopic treatment tool shown in FIG. 2 . 1. FIG. 4 is a cross-sectional view (partially a side view) showing a modified example of the endoscopic treatment tool shown in FIG. 1. FIG. 4 is a cross-sectional view (partially a side view) showing another modified example of the endoscopic treatment tool shown in FIG. 1. FIG. 4 is a cross-sectional view (partially a side view) showing still another modified example of the endoscopic treatment tool shown in FIG. 8 is a schematic diagram showing a state in which an inner cylinder and a needle of the endoscopic treatment tool shown in FIG. 7 are inserted into biological tissue.

The present invention will be described in more detail below based on the following embodiments, but the present invention is not limited to the following embodiments and can of course be modified as appropriate within the scope of the above and below, all of which are included in the technical scope of the present invention. In addition, hatching and component symbols may be omitted in each drawing for convenience, but in such cases, reference should be made to the specification or other drawings. Furthermore, the dimensions of various components in the drawings may differ from the actual dimensions, as priority is given to contributing to an understanding of the features of the present invention.

1. Endoscopic Treatment Tool One embodiment of the endoscopic treatment tool of the present invention is an endoscopic treatment tool inserted into a forceps channel of an endoscope, and includes an outer tube having a first end and a second end in a longitudinal direction and a lumen extending in the longitudinal direction, an inner tube disposed in the lumen of the outer tube and movable in the longitudinal direction of the outer tube relative to the outer tube, and a needle disposed in the lumen of the inner tube and movable in the longitudinal direction of the outer tube relative to the inner tube. According to the endoscopic treatment tool, after the inner tube and the needle are punctured into the target tissue, the needle can be moved proximally relative to the inner tube. Therefore, the needle can be removed while the inner tube is fixed to the target tissue, and an instrument other than the needle, such as a treatment instrument, can be inserted into the removed portion. This allows the insertion position of the needle relative to the target tissue to coincide with the insertion position of the other instrument. By configuring the endoscopic treatment tool in this way, even if a site identified as an affected area such as a tumor is deep in the body, the treatment instrument can be placed in the identified affected area, making it possible to perform appropriate treatment.

In the present invention, the endoscopic treatment tool is a treatment tool used to collect target tissue from a body cavity in an endoscopic operation, and to perform various treatments such as injection of medicine, heating, cauterization, light therapy, ultrasonic therapy, and shock wave therapy on the target tissue. The endoscopic treatment tool is inserted into the forceps channel of an endoscope (preferably an ultrasonic endoscope), placed inside the body from the distal side of the forceps channel of the endoscope, and delivered to the treatment site. The endoscopic treatment tool can be used to treat the biological tissue of any organ, but is preferably used to treat the tissue of organs deep inside the body, such as the lungs, liver, pancreas, and bile duct. In addition, the endoscopic treatment tool can be preferably used in various treatments such as gene therapy, photoimmunotherapy, photodynamic therapy, and anticancer drug local injection therapy, and is particularly preferably used in endoscopic ultrasonic fine needle aspiration (EUS-FNA). Hereinafter, the endoscopic treatment tool may be simply referred to as the treatment tool.

The basic configuration of an endoscopic treatment tool will be described with reference to Figures 1 to 4. Figure 1 shows a cross-sectional view (partial side view) of an endoscopic treatment tool according to one embodiment of the present invention. Figure 2 shows a schematic diagram showing the inner tube and needle of the endoscopic treatment tool shown in Figure 1 inserted into biological tissue. Figure 3 shows a schematic diagram showing the needle of the endoscopic treatment tool shown in Figure 2 removed. Figure 4 shows a schematic diagram showing a treatment instrument inserted into the inner cavity of the inner tube of the endoscopic treatment tool shown in Figure 2. The endoscopic treatment tool 1 comprises an outer tube 10, an inner tube 20, and a needle 30.

In the present invention, the distal side of the endoscopic treatment tool 1 refers to the first end side in the longitudinal direction of the outer tube 10, which is the side to be treated. The proximal side of the endoscopic treatment tool 1 refers to the second end side in the longitudinal direction of the outer tube 10, which is the side closest to the user (operator). When each component is divided into two equal parts in the longitudinal direction, the proximal side may be referred to as the proximal portion, and the distal side may be referred to as the distal portion. The inward side of the endoscopic treatment tool 1 refers to the direction toward the center of the longitudinal axis of the outer tube 10 in the radial direction of the outer tube 10, and the outward side refers to the radial direction opposite to the inward side.

It is desirable that the materials of each component constituting the endoscopic treatment tool 1 be biocompatible.

As shown in FIG. 1, the outer cylinder 10 is a member having a first end and a second end in the longitudinal direction and an inner cavity 11 extending in the longitudinal direction. Preferably, the first end corresponds to the distal end of the outer cylinder 10, and the second end corresponds to the proximal end of the outer cylinder 10. The outer cylinder 10 has a tubular structure for disposing the inner cylinder 20 and the needle 30 in the inner cavity 11 of the outer cylinder 10 so as not to damage the tissue site not to be treated or the inside of the forceps channel of the endoscope. In addition, since the outer cylinder 10 is inserted into the body, it is preferably flexible. The outer cylinder 10 communicates with the outside through an opening provided in its distal portion. When the inner cylinder 20 and the needle 30 are inserted into the target tissue, the inner cylinder 20 and the needle 30 are protruded from the opening.

The outer tube 10 may be a resin tube, a cylindrical body formed by arranging a single wire or multiple wires or stranded wires in a specific pattern, a metal tube, or a combination of these. The resin tube may be manufactured by extrusion molding, for example. Examples of cylindrical bodies in which wires are arranged in a specific pattern include cylindrical bodies having a mesh structure formed by simply crossing or weaving wires, and coils in which wires are wound. The type of mesh structure is not particularly limited, and the number of turns and density of the coil are also not particularly limited. The mesh structure or coil may be formed with a constant density throughout the axial direction, or may be formed with different densities depending on the position in the longitudinal direction. In order to increase the flexibility of the metal tube, a plurality of annular grooves or spiral grooves may be formed on the outer surface of the metal tube. In particular, it is preferable that the grooves are formed on the outer surface distal to the center of the axial direction of the metal tube, particularly on the outer peripheral surface.

The outer tube 10 is preferably made of resin or metal. Examples of resins constituting the outer tube 10 include polyamide resins, polyester resins, polyurethane resins, polyolefin resins, fluorine resins, vinyl chloride resins, silicone resins, and natural rubber. These may be used alone or in combination of two or more. Among them, polyamide resins, polyester resins, polyurethane resins, polyolefin resins, and fluorine resins are preferably used. Examples of metals constituting the outer tube 10 include stainless steel such as SUS304 and SUS316, platinum, nickel, cobalt, chromium, titanium, tungsten, gold, Ni-Ti alloys, Co-Cr alloys, and combinations thereof. In particular, wires made of Ni-Ti alloys are excellent in shape memory and high elasticity. The wires may also be fiber materials such as the above-mentioned metals, polyarylate fibers, aramid fibers, ultra-high molecular weight polyethylene fibers, PBO fibers, and carbon fibers. The fiber materials may be monofilaments or multifilaments. Moreover, the outer cylinder 10 may be a cylindrical body made of resin with a reinforcing material such as a metal wire disposed therein.

The outer tube 10 may be made of a single layer or multiple layers. In addition, in the longitudinal direction, a part of the outer tube 10 may be made of a single layer, and another part may be made of multiple layers.

It is preferable that the cross-sectional area of the distal end of the outer tube 10 is larger than the cross-sectional area at the center position in the longitudinal direction of the outer tube 10. This makes it easier for the distal end of the outer tube 10 to abut against an internal organ (e.g., a body cavity wall), thereby fixing the position of the treatment tool 1 inside the body.

The inner cylinder 20 is disposed in the inner cavity 11 of the outer cylinder 10, is movable in the longitudinal direction of the outer cylinder 10 relative to the outer cylinder 10, and has an inner cavity 21. The inner cylinder 20 also has a distal portion and a proximal portion. The inner cylinder 20 is inserted into the target tissue by puncturing together with the needle 30. The inner cylinder 20 can fix the position of the treatment tool 1 inside the body.

The inner tube 20 can be made of the resin or metal described above as the constituent material of the outer tube 10. The material of the inner tube 20 may be the same as or different from the material of the outer tube 10. As with the outer tube 10, the inner tube 20 can be a resin tube, a cylindrical body formed by arranging a single wire or multiple wires, stranded wires in a specific pattern, a metal tube, or a combination of these.

It is preferable that the Shore hardness of the outer tube 10 is greater than that of the inner tube 20. This prevents excessive bending of the outer tube 10 while ensuring a moderate flexibility of the inner tube 20. The Shore hardness is measured based on the ISO868:2003 Plastic Durometer Hardness Test Method.

Since the inner tube 20 is configured to be movable relative to the outer tube 10 in the longitudinal direction of the outer tube 10, it is preferable that the inner tube 20 and the outer tube 10 are not fixed to each other.

It is preferable that the longitudinal axis direction of the inner tube 20 is parallel to the longitudinal axis direction of the outer tube 10. This makes it easier for the inner tube 20 to move along the longitudinal axis direction of the outer tube 10.

It is preferable that the distal end (more preferably the portion including the distal end) of the inner tube 20 is provided with a tapered section 23 in which the outer diameter decreases toward the distal side of the inner tube 20. This makes it easier to insert the inner tube 20 together with the needle 30 into the target tissue by puncturing.

The needle 30 is disposed in the inner cavity 21 of the inner tube 20 and is movable in the longitudinal direction of the outer tube 10 relative to the inner tube 20. The needle 30 is preferably disposed in the inner cavity 21 of the inner tube 20 so that the tip 31 of the needle 30 is located on the distal side. The needle 30 is inserted into the target tissue together with the inner tube 20 by puncturing. By puncturing the target tissue with the needle 30, treatment such as collection of biological tissue and injection of medicine becomes possible.

Here, an example of application of the treatment tool 1 to pancreatic cancer will be described. First, the insertion portion of the ultrasonic endoscope is inserted into the stomach, and the treatment tool 1 is protruded from the distal opening of the forceps channel of the ultrasonic endoscope. As shown in FIG. 2, the inner tube 20 and the needle 30 are protruded from the opening at the distal end of the outer tube 10, and the inner tube 20 and the needle 30 are punctured into the target tissue. For example, in the case of treating pancreatic cancer, the target tissue is pancreatic tissue. By puncturing the stomach wall and the pancreatic wall with the inner tube 20 and the needle 30, the treatment tool 1 placed in the stomach reaches the pancreas, which is the target tissue. In this case, the first body cavity wall 61 is the stomach wall, and the second body cavity wall 62 is the pancreatic wall. Next, by moving the needle 30 proximally relative to the inner tube 20, it is possible to remove the needle 30 while the inner tube 20 is fixed to the target tissue, as shown in FIG. 3. At this time, the needle 30 can function as a biopsy needle for collecting biological tissue. Once the collected tissue is definitively diagnosed as a malignant tumor, a treatment instrument 70 is inserted into the location from which the needle 30 was removed, i.e., into the inner cavity 21 of the inner cylinder 20, as shown in Fig. 4. This allows the insertion position of the needle 30 with respect to the target tissue to coincide with the insertion position of the treatment instrument 70. By configuring the treatment tool 1 in this manner, even if a site identified as an affected area such as a malignant tumor is deep in the body, the treatment instrument 70 can be placed at the identified affected area, making it possible to perform appropriate treatment.

The distal end of the needle 30 is not particularly limited as long as it is formed to facilitate puncturing tissue, but it is preferable that the needle 30 has a sloped opening edge 32 at the distal end as shown in FIG. 1.

It is preferable that the tip 31 of the needle 30 can protrude from the distal opening of the inner tube 20. It is preferable that the tip 31 of the needle 30 is located distal to the distal end of the inner tube 20 when the needle 30 is moved to the most distal side relative to the inner tube 20 so that the tip 31 of the needle 30 can puncture the tissue prior to the inner tube 20.

It is preferable that the inner diameter of the inner tube 20 at its distal end is smaller than that of the central position in the longitudinal direction of the inner tube 20, and the needle 30 has an engagement portion 34 having an outer diameter larger than that of the small diameter portion 27, and the small diameter portion 27 is located distal to the engagement portion 34. This makes it possible to fix the position of the needle 30 in the longitudinal direction relative to the inner tube 20, thereby preventing the needle 30 from protruding too far from the opening at the distal end of the inner tube 20.

It is preferable that the maximum outer diameter of the engagement portion 34 of the needle 30 is smaller than the maximum inner diameter of the inner tube 20. This makes it easier to move the inner tube 20 and the needle 30 relative to each other in the longitudinal axis direction of the inner tube 20.

The engaging portion 34 may be one or more protrusions provided on the outside of the needle 30. The needle 30 may also have a needle body extending in the longitudinal direction and a ring-shaped member provided on the outside of the needle body as the engaging portion 34. The engaging portion 34 may be integrally formed with the needle body, or may be a separate member from the needle body. Therefore, the engaging portion 34 may be made of the same material as the needle body, or may be made of a different material from the needle body.

Since the needle 30 is configured to be movable relative to the inner tube 20 in the longitudinal direction of the inner tube 20, it is preferable that the needle 30 and the inner tube 20 are not fixed to each other.

It is preferable that the longitudinal axis direction of the needle 30 is parallel to the longitudinal axis direction of the inner tube 20. This makes it easier for the needle 30 to move along the longitudinal axis direction of the inner tube 20, so that when the needle 30 is protruded from the distal opening of the inner tube 20, the tip 31 of the needle 30 is less likely to come into contact with the distal end of the inner tube 20.

The needle 30 preferably has a hollow portion 33 at its distal end for sampling biological tissue, thereby allowing the target tissue to be held within the hollow portion 33 for biopsy.

Although not shown, the needle 30 may be solid proximal to the hollow portion 33. By forming at least a portion of the needle 30 in the longitudinal direction in this manner as the hollow portion 33, the target tissue can also be held.

The hollow portion 33 of the needle 30 may be provided over the entire longitudinal axis of the needle 30. For example, the needle 30 may be formed in a tubular shape such as a circular tube or an elliptical tube. By forming the hollow portion 33 in this manner, it is possible to increase the amount of target tissue that can be held within the hollow portion 33. Note that the elliptical tube shape includes tubes with an elliptical, egg-shaped, or rounded rectangular cross section.

When the needle 30 is used for drug injection, in order to improve the flow of liquid in the hollow portion of the needle 30, it is preferable that the cross-sectional shape perpendicular to the longitudinal axis of the needle 30 is circular or elliptical. Oval shapes include ellipses, egg shapes, and rounded rectangular shapes. The same applies to the following explanations.

The materials that can be used to construct the needle 30 include the resin materials and metal materials listed as preferred materials for the outer tube 10 and the inner tube 20.

As shown in Figure 1, the needle 30 is preferably disposed throughout the entire longitudinal axis direction of the inner cavity 21 of the inner tube 20. The proximal end of the needle 30 is preferably located closer to the proximal end of the outer tube 10. The proximal end of the needle 30 is preferably located closer to the proximal end of the inner tube 20. This makes it easier to move the needle 30 relative to the inner tube 20 in the longitudinal axis direction of the inner tube 20.

As shown in Figure 3, it is preferable that the needle 30 can be removed from the inner tube 20 while the inner tube 20 protrudes distally beyond the outer tube 10. This allows the inner tube 20 to be fixed inside the body even after the needle 30 is removed from the inner tube 20, making it possible to fix the insertion position of an instrument other than the needle 30, such as a treatment instrument.

It is preferable that the needle 30 is removable from the inner tube 20, and the endoscopic treatment tool 1 further includes a treatment tool that is disposed in the inner cavity 21 of the inner tube 20 and is movable in the longitudinal direction of the outer tube 10 relative to the outer tube 10. This allows the needle 30 to be replaced with another tool while the inner tube 20 is fixed to the biological tissue. Figure 4 shows an example in which a treatment tool 70 is disposed in the inner cavity 21 of the inner tube 20 after the needle 30 has been removed from the inner tube 20.

Therapeutic instruments are used to perform various types of treatments on target tissue, such as drug injection, heating, cauterization, light therapy, ultrasound therapy, and shock wave therapy. Examples of therapeutic instruments include drug injection catheters, high-frequency treatment devices equipped with electrodes for heating or cauterization, ultrasound probes, light irradiation probes, laser probes, shock wave probes, and forceps.

The structure of the proximal part of the treatment tool 1 will be described with reference to FIG. 1. It is preferable that an operating part 50 is provided at the proximal part of the inner tube 20 for the surgeon to grasp the treatment tool 1. The operating part 50 can be, for example, a single tube with one lumen 51, or a branched tube with the lumen 51 branched into multiple parts. A fluid supplier 45 is preferably connected to the lumen 51 of the operating part 50. This allows a drug such as a contrast agent to be supplied into the inner tube 20. Note that in FIG. 1, the operating part 50 is a Y-shaped tube with the lumen 51 branched in two directions.

The inner tube 20 or the needle 30 may be provided with a stopper 54 for fixing the longitudinal position of the components relative to each other. A cylindrical body can be used as the stopper 54. The stopper 54 can be fixed to the outside of the inner tube 20 or the needle 30 by inserting the inner tube 20 or the needle 30 into the inner cavity of the cylindrical body.

As shown in Figure 1, it is preferable that a first stopper 55 protruding radially outward is provided at the proximal portion of the inner tube 20. This makes it possible to fix the longitudinal position of the inner tube 20 relative to the outer tube 10, thereby preventing the inner tube 20 from protruding too far from the opening at the distal end of the outer tube 10.

The first stopper 55 may protrude radially outward from the inner tube 20, and may protrude radially outward from the outer tube 10. The first stopper 55 abuts against the outer tube 10, making it easier to fix the position of the inner tube 20 relative to the outer tube 10 in the longitudinal direction.

It is preferable that the first stopper 55 is disposed distal to the distal end of the operating portion 50. This makes it easier to move the inner tube 20 relative to the outer tube 10 in the longitudinal direction.

A first check valve 58 is connected to the distal portion of the first stopper 55, and it is preferable that the first check valve 58 abuts against the proximal end of the outer tube 10. In this case, it is more preferable that the first check valve 58 abuts against the proximal end of the outer tube 10 in a liquid-tight manner. This makes it possible to prevent bodily fluids that have entered the outer tube 10 from flowing back toward the hand side.

It is preferable that a second stopper 56 protruding radially outward is provided at the proximal portion of the needle 30. This allows the needle 30 to be fixed in the longitudinal position relative to the inner tube 20, thereby preventing the needle 30 from protruding too far from the opening at the distal end of the inner tube 20.

It is preferable that the second stopper 56 is disposed proximally relative to the first stopper 55. This makes it easier to move the needle 30 in the longitudinal direction relative to the inner tube 20.

A second check valve 59 is connected to the distal portion of the second stopper 56, and it is preferable that the second check valve 59 abuts against the operating unit 50. In this case, it is more preferable that the second check valve 59 abuts against the operating unit 50 in a liquid-tight manner. This makes it possible to prevent the backflow of the contrast agent or other drug supplied to the lumen 21 of the inner tube 20 toward the hand side.

The operating unit 50 and the stopper 54 may be made of a synthetic resin such as ABS or polycarbonate. The operating unit 50 and the stopper 54 may also be made of foamed plastic such as polyurethane foam.

The joining of the operating portion 50 and the inner tube 20, the first stopper 55 and the inner tube 20, or the second stopper 56 and the needle 30 can be carried out using conventional joining means such as adhesives or thermal welding.

Figure 5 is a cross-sectional view (partial side view) showing a modified example of the endoscopic treatment tool 1 shown in Figure 1. As shown in Figure 5, the treatment tool 1 preferably further includes a fluid supply device 45. In this case, the fluid supply device 45 that supplies fluid to the inner cavity 21 of the inner tube 20 is connected to the proximal part of the inner tube 20, and the inner tube 20 preferably has a side hole 24 at its distal end (more preferably, the peripheral wall of the distal end) that communicates the inner cavity 21 of the inner tube 20 with the outside of the inner tube 20. This allows a drug such as a contrast agent to be released from the side hole 24 using the fluid supply device 45, so that it is possible to know whether the needle 30 and the inner tube 20 have been inserted into the target tissue.

When the inner cylinder 20 is moved to the most distal side relative to the outer cylinder 10, it is preferable that the side hole 24 is located distal to the distal end of the outer cylinder 10. This makes it possible to release the drug into the target tissue.

The number of side holes 24 is not particularly limited, and may be one or more. When multiple side holes 24 are provided, it is preferable that the multiple side holes 24 are arranged side by side in the circumferential direction of the inner tube 20. The shape of the side hole 24 is not particularly limited, and may be a circle, an oval, a polygon, or a combination thereof.

The fluid supplier 45 may be a syringe or a motor-controlled injection pump.

The inner tube 20 has a tapered section 23 whose outer diameter decreases toward the distal side of the inner tube 20, and the tapered section 23 is preferably located distal to the side hole 24. This makes it easier to insert the needle 30 and inner tube 20 into the target tissue, and also makes it possible to inject a contrast agent into the target tissue through the side hole 24 while these members are inserted into the target tissue. As a result, it is possible to determine whether the needle 30 and inner tube 20 have been inserted into the target tissue using an imaging diagnostic device such as an ultrasonic endoscope, PET, MRI, or X-ray CT.

It is preferable that the inner cylinder 20 has an abutment portion 25 where the inner wall of the inner cylinder 20 abuts against the outer wall of the needle 30, and a separation portion 26 located closer to the abutment portion 25 and where the inner wall of the inner cylinder 20 is separated from the outer wall of the needle 30. This allows the needle 30 and the inner cylinder 20 to abut against each other, thereby preventing leakage of the drug from the inner cylinder 20. It is more preferable that the abutment portion 25 is a portion where the inner wall of the inner cylinder 25 abuts against the outer wall of the needle 30. It is also more preferable that the separation portion 26 is a portion where the inner wall of the inner cylinder 20 is separated from the outer wall of the needle 30, located closer to the abutment portion 25.

It is preferable that the abutment portion 25 of the inner cylinder 20 is disposed at the distal end of the inner cylinder 20. This makes it possible to prevent leakage of the drug from the distal side of the inner cylinder 20.

It is preferable that the side hole 24 of the inner tube 20 is disposed in the separation portion 26. This allows a drug such as a contrast agent supplied to the lumen 21 of the inner tube 20 to be released to the outside through the side hole 24.

It is preferable that the side hole 24 of the inner tube 20 is located closer to the proximal end of the engagement portion 34. This allows a drug such as a contrast agent to flow toward the side hole 24 without passing through a portion of the inner cavity 21 of the inner tube 20 where the lumen 21 is narrowed by the presence of the engagement portion 34, making it easier to release the drug from the side hole 24.

It is preferable that the inner cylinder 20 and the needle 30 are movable relative to each other in the longitudinal direction of the inner cylinder 20, and that the inner cylinder 20 and the needle 30 are in liquid-tight contact at the distal end of the inner cylinder 20. This makes it possible to prevent leakage of the drug from the distal side of the inner cylinder 20.

Figure 6 is a cross-sectional view (partial side view) showing another modified example of the endoscopic treatment tool 1 shown in Figure 1. As shown in Figure 6, the needle 30 preferably has an ultrasonic reflecting portion 35 at its distal end. When the needle 30 and the inner tube 20 are inserted into body tissue, ultrasonic waves are emitted toward the ultrasonic reflecting portion 35, and the time and intensity of the ultrasonic waves reflected by the ultrasonic reflecting portion 35 until they return can be measured to determine whether the needle 30 and the inner tube 20 have been inserted into the target tissue.

It is preferable that the ultrasonic reflecting portion 35 has a first reflecting portion 35A and a second reflecting portion 35B located closer to the first reflecting portion 35A. By arranging the first reflecting portion 35A and the second reflecting portion 35B at a distance in the longitudinal axis direction of the needle 30, it is possible to use the two reflecting portions to determine whether the needle 30 and the inner tube 20 have been inserted into the target tissue.

When the needle 30 is moved to the most distal side relative to the inner tube 20, it is preferable that the first reflecting portion 35A is located distal to the distal end of the inner tube 20, and the second reflecting portion 35B is located proximal to the distal end of the inner tube 20. This makes it possible to know that the needle 30 has been inserted into the target tissue when the reflection from the first reflecting portion 35A is measured, and to know that the inner tube 20 has been inserted into the target tissue when the reflection from the second reflecting portion 35B is measured.

It is preferable that the first reflecting portion 35A and the second reflecting portion 35B are irregularities 36 provided on the outer surface of the needle 30. By providing such irregularities 36 on the needle 30, it becomes possible to reflect ultrasonic waves. It is preferable that the irregularities 36 are provided on the outer peripheral surface of the needle 30.

The unevenness 36 is a portion in which the recesses 37 and the protrusions 38 are arranged alternately. It is preferable that a plurality of recesses 37 and a plurality of protrusions 38 are provided. It is preferable that the unevenness 36 is provided on at least a portion of the circumference of the needle 30, and it is preferable that the unevenness 36 is arranged over the entire circumference of the needle 30.

Although the arrangement of the irregularities 36 is not particularly limited, it is preferable that the recesses 37 and the protrusions 38 are arranged side by side in the longitudinal direction or circumferential direction of the needle 30, and it is more preferable that they are arranged at equal intervals in the longitudinal direction or circumferential direction of the needle 30. Figure 6 shows an example in which the recesses 37 and the protrusions 38 are arranged side by side in the longitudinal direction of the needle 30.

The protrusions 38 may extend along the longitudinal axis of the needle 30, or may extend along the circumferential direction of the needle 30. In addition, multiple protrusions 38 may be arranged in a stripe pattern.

The arrangement of the first reflecting portion 35A and the second reflecting portion 35B may be the same. In order to easily distinguish the first reflecting portion 35A from the second reflecting portion 35B, the arrangement of the irregularities 36 of the first reflecting portion 35A and the second reflecting portion 35B may be different. For example, the arrangement interval of the recesses 37 and the protrusions 38 in the first reflecting portion 35A may be different from the arrangement interval of the recesses 37 and the protrusions 38 in the second reflecting portion 35B.

In order to reflect ultrasound, it is preferable that at least the portion of the needle 30 in the longitudinal direction where the ultrasound reflecting portion 35 is provided is made of metal, and it is even more preferable that the needle 30 is made of metal throughout its entire longitudinal direction.

The treatment tool 1 may include an ultrasonic transducer that converts an electrical signal into ultrasonic waves and transmits and receives ultrasonic waves. The ultrasonic transducer preferably includes a piezoelectric vibrator that vibrates when a voltage is applied to the piezoelectric vibrator. The piezoelectric vibrator may be made of, for example, piezoelectric ceramics or quartz crystal.

Figure 7 is a cross-sectional view (partial side view) showing yet another modified example of the endoscopic treatment tool 1 shown in Figure 1, and Figure 8 is a schematic diagram showing the state in which the inner tube 20 and needle 30 of the endoscopic treatment tool 1 shown in Figure 7 are inserted into biological tissue. It is preferable that an expandable part 40 is provided in the distal part of the inner tube 20 that can be exposed from the outer tube 10. Thereby, after confirming that the distal end of the inner tube 20 has been inserted into the target tissue, the expandable part 40 can be expanded to fix the distal end of the inner tube 20 in the body so that the position of the distal end does not shift. The expandable part 40 can be, for example, a balloon 41 as shown in Figure 7. In addition to the balloon 41, the expandable part may be an expansion wire or a basket composed of multiple elastic wires.

The balloon 41 has, from the distal side, a distal fixed portion 42 fixed to the inner tube 20, an expansion portion 43 not fixed to the inner tube 20, and a proximal fixed portion 44 fixed to the inner tube 20.

When the balloon 41 is provided in the inner cylinder 20, it is preferable that a side hole 24 is provided at a position corresponding to the inflation portion 43 of the balloon 41, and a fluid supplier 45 is connected to the proximal portion of the inner cylinder 20. The balloon 41 is configured so that pressurized fluid is supplied to the inside of the balloon 41 from the fluid supplier 45 through the side hole 24 of the inner cylinder 20, and the supply of pressurized fluid to the inside of the balloon 41 makes the balloon 41 expandable. On the other hand, the balloon 41 can be deflated by withdrawing the pressurized fluid from the inside of the balloon 41.

The type of fluid supplied into the balloon 41 is not particularly limited, but may be, for example, a liquid such as saline, contrast agent, or a mixture of these, or a gas such as air, nitrogen, or carbon dioxide.

The balloon 41 is preferably made of a resin. Examples of resins constituting the balloon 41 include polyamide-based resins, polyester-based resins, polyurethane-based resins, polyolefin-based resins, vinyl chloride-based resins, silicone-based resins, and natural rubber. These may be used alone or in combination of two or more. Of these, polyamide-based resins, polyester-based resins, and polyurethane-based resins are preferably used. As for these resins, elastomer resins can be used in terms of thinning the balloon 41 and flexibility.

Although not shown, it is preferable that when the balloon 41 is in a deflated state, the balloon 41 is wound around the outside of the inner tube 20. This allows the outer diameter of the inner tube 20 to be reduced when the balloon 41 is deflated, making it easier to insert the inner tube 20 into the target tissue.

It is preferable that the distal fixing portion 42 of the balloon 41 is located more proximal than the tapered portion 23 of the inner tube 20. This makes it easier to insert the inner tube 20 into the target tissue.

2. Operation method of an endoscopic treatment tool An operation method of an endoscopic treatment tool 1 including an outer tube 10 having a first end and a second end in the longitudinal direction and an inner cavity 11 extending in the longitudinal direction, an inner tube 20 disposed in the inner cavity 11 of the outer tube 10 and movable in the longitudinal direction of the outer tube 10 relative to the outer tube 10 and having an inner cavity 21, and a needle 30 disposed in the inner cavity 21 of the inner tube 20 and movable in the longitudinal direction of the outer tube 10 relative to the inner tube 20 will be described.

The endoscopic treatment tool 1 is inserted into the forceps channel of the endoscope (step 1). More specifically, the distal side of the treatment tool 1 is inserted into the proximal opening of the forceps channel of the endoscope. The endoscope is preferably an ultrasonic endoscope. In order to collect biological tissue using the needle 30, it is preferable that the needle 30 has a hollow portion 33. For other specific configurations of the treatment tool 1, please refer to the explanation of "1. Endoscopic treatment tool".

The inner tube 20 and the needle 30 are protruded from the distal side of the outer tube 10 (Step 2). In particular, it is preferable to protrude the inner tube 20 and the needle 30 from an opening on the distal side of the outer tube 10. This allows the inner tube 20 and the needle 30 to puncture the target tissue. Step 2 can be performed by moving the inner tube 20 and the needle 30 distally relative to the outer tube 10.

If the inner tube 20 has a side hole 24, it is preferable to release the contrast agent from the side hole 24 of the inner tube 20 after step 2 (step 3). This makes it possible to determine whether the distal end of the inner tube 20 has been inserted into the target tissue using an imaging diagnostic device such as an ultrasonic endoscope, PET, MRI, or X-ray CT. This allows the distal end of a treatment instrument used in a subsequent process to be reliably positioned in the target tissue, improving the treatment effect.

If the needle 30 is provided with an ultrasonic reflector 35, it is preferable to irradiate the ultrasonic reflector 35 with ultrasonic waves (step 4). This step also makes it possible to determine whether the distal end of the inner tube 20 has been inserted into the target tissue.

If the inner tube 20 is provided with an expandable section 40, it is preferable to expand the expandable section 40 after step 2 (step 5). This allows the expandable section 40 to be positioned between the first body cavity wall 61 and the second body cavity wall 62, and the inner tube 20 can be fixed inside the body so that it does not shift in position. Note that if the inner tube 20 is provided with a balloon 41 as the expandable section 40, it is preferable that the balloon 41 is deflated and wound around the outside of the inner tube 20 in step 2.

The needle 30 is removed from the inner tube 20 (step 6). In step 6, it is preferable to move the needle 30 proximally relative to the inner tube 20 and remove the needle 30 from the proximal side of the inner tube 20. This makes it possible to insert the treatment instrument 70 into the part where the needle 30 was located in a later process. If the needle 30 has a hollow portion 33, the hollow portion 33 of the needle 30 can hold the biological tissue, making it possible to perform a definitive diagnosis of the biological tissue after step 6.

After the step of removing the needle 30 from the inner tube 20, the treatment instrument 70 is inserted into the inner cavity 21 of the inner tube 20 (step 7). Examples of the treatment instrument 70 include a drug injection catheter, a catheter equipped with an electrode for heating or burning, an ultrasonic probe, a light irradiation probe, a laser probe, a shock wave probe, and forceps. Step 7 allows the insertion position of the needle 30 relative to the target tissue to coincide with the insertion position of the treatment instrument 70. This allows the treatment instrument 70 to be placed in the identified affected area, even if the area identified as the affected area, such as a tumor, is deep in the body, making it possible to perform appropriate treatment.

After step 7, it is preferable to protrude the treatment instrument 70 from the distal side of the outer tube 10 (step 8). This allows treatment to be performed using the treatment instrument 70.

3. Treatment method using endoscopic treatment tool A treatment method using the endoscopic treatment tool 1 will be described. Here, an example of treating pancreatic cancer will be described. The first organ is the stomach, and the second organ is the pancreas. For the specific configuration of the treatment tool 1, please refer to the description in "1. Endoscopic treatment tool."

First, the endoscopic treatment tool 1 is inserted into an endoscope placed in a body cavity (step 10). The endoscope is preferably an ultrasonic endoscope. In the case of treating pancreatic cancer, the distal part of the ultrasonic endoscope is placed in the stomach.

The needle 30 and the inner tube 20 are inserted into the first body cavity wall 61 (step 11). In the case of treating pancreatic cancer, the first body cavity wall 61 is preferably the stomach wall.

The needle 30 and the inner tube 20 are inserted into the second body cavity wall 62 (step 12). Here, the second body cavity wall 62 is located more distal than the first inner cavity wall 61. In the case of treating pancreatic cancer, the second body cavity wall 62 is preferably a pancreatic wall. When the needle 30 has a hollow portion 33, the needle 30 penetrates the second body cavity wall 62, and pancreatic tissue is introduced into the hollow portion 33 of the needle 30.

If the inner tube 20 is provided with an expandable portion 40, it is preferable to expand the expandable portion 40 after step 12 (step 13). This allows the expandable portion 40 to be positioned between the first body cavity wall 61 and the second body cavity wall 62, and the inner tube 20 can be fixed inside the body so that it does not shift in position. If the inner tube 20 is provided with a balloon 41 as the expandable portion 40, it is preferable that the balloon 41 is deflated and wound around the outside of the inner tube 20 in steps 11 and 12. This allows the outer diameter of the inner tube 20 to be reduced even if the balloon 41 is provided on the inner tube 20, making it easier to insert the inner tube 20 into the target tissue.

If the inner cylinder 20 has a side hole 24, it is preferable that the side hole 24 is placed in a second organ (e.g., the pancreas) after step 12 (step 14). This makes it easier to inject a drug such as a contrast agent into the target tissue through the side hole 24 in step 15, which will be described later.

When the inner tube 20 has a side hole 24, it is preferable to inject a contrast agent into the target tissue through the side hole 24 of the inner tube 20 (step 15). This makes it possible to determine whether the distal end of the inner tube 20 has been inserted into the target tissue using an imaging diagnostic device such as an ultrasonic endoscope, PET, MRI, or X-ray CT. This allows the distal end of the treatment instrument 70 used in the subsequent process to be reliably positioned in the target tissue, thereby improving the treatment effect. It is preferable to perform step 15 at least one of the following times: after step 11, after step 12, during step 11, and during step 12.

When the needle 30 is provided with an ultrasonic reflecting portion 35, it is preferable to irradiate the ultrasonic reflecting portion 35 with ultrasonic waves (step 16). This makes it possible to determine whether the distal end of the inner tube 20 has been inserted into the target tissue. This step also makes it possible to determine whether the distal end of the inner tube 20 has been inserted into the target tissue. It is preferable to perform step 16 from at least one of the following timings: before step 11, during step 11, after step 11, before step 12, during step 12, and after step 12, until the completion of step 12. Step 16 can also be performed together with or instead of step 15.

The needle 30 is removed from the first body cavity wall 61 and the second body cavity wall 62 (step 17).

A definitive diagnosis is made on the biological tissue collected by the needle 30 (step 18). For the definitive diagnosis, imaging diagnostic devices such as PET, MRI, and X-ray CT can be used, as well as a fluorescent spray. The fluorescent spray contains a fluorescent probe that reacts with specific enzymes such as gamma-glutamyl transpeptidase (GGT) in cancer cells to emit fluorescence.

If the definitive diagnosis indicates that the tumor is malignant or the like and requires treatment, it is preferable to inject a therapeutic drug such as a virus preparation, a plasmid preparation, a photosensitizer, or an anticancer drug into the target tissue (step 19). By using a therapeutic drug, the therapeutic effect of the treatment instrument 70 used in the subsequent process can be improved. Step 19 can be performed by inserting a drug injection instrument into the lumen 21 of the inner tube 20.

After step 19, it is preferable to irradiate the target tissue with ultrasound (step 20). This allows the therapeutic drug to easily penetrate or diffuse into the target tissue, making it possible to treat a wide area. In addition, compared to conventional treatments, the number of drug injections and the amount of drug used to achieve the same effect can be reduced.

A treatment instrument 70 is inserted into the inner cavity 21 of the inner tube 20 (step 21). For an example of the treatment instrument 70, refer to the explanation in "2. Operation method of an endoscopic treatment tool." When performing light therapy, for example, a light irradiation probe can be used as the treatment instrument 70. After step 21, it is preferable to protrude the treatment instrument 70 from the distal side of the outer tube 10 (step 22).

Treatment is performed using the treatment instrument 70 (step 23). For example, in the case of light treatment, light is irradiated using a light-irradiating probe.

This application claims the benefit of priority based on Japanese Patent Application No. 2019-148589, filed on August 13, 2019. The entire contents of the specification of Japanese Patent Application No. 2019-148589, filed on August 13, 2019, are incorporated by reference into this application.

1: Endoscopic treatment tool 10: Outer tube 11: Cavity 20: Inner tube 21: Cavity 23: Tapered portion 24: Side hole 25: Contact portion 26: Separation portion 27: Small diameter portion 30: Needle 31: Needle tip 32: Opening edge 33: Hollow portion 34: Engagement portion 35: Ultrasound reflection portion 35A: First reflection portion 35B: Second reflection portion 36: Irregularities 37: Irregularities 38: Irregularities 40: Expandable portion 41: Balloon 42: Distal side fixing portion 43: Inflatable portion 44: Proximal side fixing portion 45: Fluid supplier 50: Operation portion 51: Cavity 54: Stopper 55: First stopper 56: Second stopper 58: First check valve 59: Second check valve 61: First body cavity wall (stomach wall)
62: Second body cavity wall (pancreatic wall)
70: Medical equipment

Claims (15)

An endoscopic treatment tool to be inserted into a forceps channel of an endoscope,
a barrel having a first end and a second end in a longitudinal direction and an inner cavity extending in the longitudinal direction;
an inner cylinder disposed in an inner cavity of the outer cylinder, movable in the longitudinal direction relative to the outer cylinder, and having an inner cavity for supplying a fluid toward a distal side;
a needle disposed in the inner cavity of the inner cylinder and movable in the longitudinal direction relative to the inner cylinder;
An endoscopic treatment instrument in which, when the needle protrudes distally from the inner tube, the inner wall of the inner tube is separated from the outer wall of the needle, and the inner tube has a separation portion through which the fluid can pass. The endoscopic treatment tool according to claim 1, in which the needle can be removed from the inner tube when the inner tube protrudes distally from the outer tube. The endoscopic treatment tool further includes a fluid supplier,
The fluid supply device is connected to a proximal portion of the inner cylinder to supply fluid to the inner cavity of the inner cylinder;
3. The endoscopic treatment tool according to claim 1, wherein the inner cylinder has a side hole at a distal end thereof for communicating an inner cavity of the inner cylinder with the outside of the inner cylinder. The endoscopic treatment tool according to claim 3, wherein the inner tube has a tapered portion whose outer diameter decreases toward the distal side of the inner tube, and the tapered portion is located distal to the side hole. The endoscopic treatment tool according to claim 3 or 4, wherein the inner tube has an abutment portion where the inner wall of the inner tube abuts against the outer wall of the needle, and a separation portion located proximal to the abutment portion where the inner wall of the inner tube is separated from the outer wall of the needle. An endoscopic treatment tool according to any one of claims 1 to 5, in which the cross-sectional area of the distal end of the outer tube is greater than the cross-sectional area of the outer tube at the center position in the longitudinal axis direction. An endoscopic treatment tool according to any one of claims 1 to 6, wherein the needle has an ultrasonic reflector at its distal end. The endoscopic treatment tool according to claim 7, wherein the ultrasonic reflecting portion has a first reflecting portion and a second reflecting portion located closer to the first reflecting portion. The endoscopic treatment tool according to claim 8, wherein the first reflecting portion and the second reflecting portion are irregularities provided on the outer surface of the needle. The endoscopic treatment tool according to any one of claims 1 to 9, wherein the needle has a hollow portion at its distal end for collecting biological tissue. The endoscopic treatment tool according to any one of claims 1 to 10, wherein an expandable portion is provided in a distal portion of the inner tube that can be exposed from the outer tube. An endoscopic treatment tool according to any one of claims 1 to 11, in which a first stopper protruding radially outward is provided at the proximal portion of the inner tube. The inner tube has a small diameter portion at a distal end portion, the inner diameter of which is smaller than the inner diameter at a central position in a longitudinal axis direction of the inner tube,
The needle has an engagement portion having an outer diameter larger than that of the small diameter portion,
The endoscopic treatment tool according to any one of claims 1 to 12, wherein the small diameter portion is located distal to the engagement portion. The needle is removable from the inner cylinder,
The endoscopic treatment tool according to any one of claims 1 to 13, further comprising a treatment instrument disposed in an inner cavity of the inner tube and movable in a longitudinal direction of the outer tube relative to the outer tube. An endoscopic treatment tool to be inserted into a forceps channel of an endoscope,
a barrel having a first end and a second end in a longitudinal direction and an inner cavity extending in the longitudinal direction;
an inner cylinder disposed in an inner cavity of the outer cylinder, movable in the longitudinal direction relative to the outer cylinder, and having an inner cavity;
a needle disposed in the inner cavity of the inner cylinder and movable in the longitudinal direction relative to the inner cylinder;
an expandable portion provided in a portion of the distal portion of the inner tube that can be exposed from the outer tube;
An endoscopic treatment instrument capable of expanding the expandable portion with the inner tube and the needle protruding from the distal side of the outer tube.

Images