JP2001340462A - Tube with balloons for assisting insertion of endoscope - Google Patents

Abstract

PROBLEM TO BE SOLVED: To establish a method which enables to insert an endoscope into a deep part of bowel such as small intestine. SOLUTION: A new method for inserting an endoscope into a small intestine is developed which adopts a soft sliding tube to prevent a bowel from extending by maintaining it with balloons. In addition, the tube with balloons is made to be used safely and effectively.

Description

DETAILED DESCRIPTION OF THE INVENTION

[0001]

BACKGROUND OF THE INVENTION 1. Field of the Invention The present invention relates to a gastrointestinal endoscopy as a medical technique, and more particularly to an endoscope and other auxiliary tools for inserting a body cavity observation tool and a treatment tool.

[0002]

2. Description of the Related Art As a conventional auxiliary tool for inserting an endoscope, there is a sliding overtube for keeping the intestinal tract straight. The present invention relates to “Endoscope-mounted balloons used for gastrointestinal endoscopy, sliding tubes with balloons, and methods for using them” (Japanese Patent Application No. 10-140358) filed on April 13, 1998. It is mainly used in the same way.

[0003]

In the insertion of an endoscope into a deep intestinal tract typified by a small intestine endoscope, the intestinal tract forms a loop as the endoscope is inserted, and the insertion force is reduced. There is a problem that it cannot be transmitted to the tip of the endoscope and cannot be inserted into a deep part. Conventionally, this is considered to be a problem in that the intestinal tract forms a loop, and a sliding tube having rigidity for substantially linearizing the loop has been used to assist insertion. However, the range of the intestinal tract that can be straightened is limited, and even if such a tube is used in combination, the insertion range of the endoscope in the small intestine endoscope is at most about 1 m from the ligament of Treitz.

[0004]

The real reason that it is difficult to insert the endoscope deeply is not to say that the intestinal tract is bent but to think that the bent intestinal tract is elongated. We have devised an endoscope insertion method that employs a soft sliding tube that holds and prevents intestinal extension.

[0005]

BEST MODE FOR CARRYING OUT THE INVENTION The present invention relates to "Endoscope-mounted balloons used for gastrointestinal endoscopy, sliding tubes with balloons, and methods of using them" (Japanese Patent Application No. 10-1).
40358) is a specific device for safely and effectively using the sliding tube with a balloon.

[0006] The overtube with a balloon according to the present invention is not intended to keep the intestinal tract straight due to its rigidity, but to prevent the intestinal tract from stretching.
For this reason, the tube in the present invention is made of a material that does not stretch, and does not need to have rigidity as long as it has a compliant property, and is preferably made of a soft material.

[0007] The balloon in the present invention must not damage the intestinal tract or the like and must have a sufficient gripping force. For this reason, it is preferable that the intestinal tract be applied with a uniform pressure over a wide contact area when the balloon is inflated. Specifically, a soft and durable material such as latex used for condoms is preferred.

[0008] The pressure suitable for balloon expansion in the present invention is a pressure that does not damage the intestinal tract or the like and can provide a sufficient gripping force. The actual expansion pressure is 40-100mmH
g, especially 50-60 mmHg, is considered optimal.

In the present invention, monitoring the inflation pressure of the balloon is necessary for safety measures. Since the air supply tube to the balloon of the present invention is thin and long, there is a difference between the air supply pressure and the balloon internal pressure. Therefore, a method of calculating the balloon internal pressure by measuring the air pressure and the air flow rate and subtracting the pressure difference calculated from the air flow rate from the air pressure is useful. If technically possible, it is desirable to monitor by directly measuring the pressure in the balloon.

In the present invention, in order to smoothly insert the endoscope, it is necessary to minimize the frictional resistance between the overtube and the endoscope. As a device for that,
We thought about a mechanism that could always supply lubricants such as olive oil. The distal end of the overtube is tapered slightly to reduce the gap with the endoscope. This will prevent gastrointestinal fluid from flowing back into the tube while minimizing lubricant outflow. In this way, damage due to entrapment of the mucous membrane can also be prevented. At the proximal end of the overtube, a squeeze valve is installed to prevent backflow of gastrointestinal fluid and lubricant. Provide a port that opens in the middle of the overtube so that the lubricant can always be supplied. It is convenient to provide a mechanism for storing a lubricant such as a balloon and automatically supplying the lubricant gradually in a port outside the lubricant supply route. Other measures to reduce frictional resistance include the use of a low friction material such as Teflon (registered trademark), coating of the endoscope outer surface and overtube inner surface with such a material, and vertical application to the inner surface of the overtube. A method of providing a large number of grooves to reduce the contact area can be considered.

[0011]

EXAMPLES Experiments Using Dog Small Intestine In order to examine the material and inflation pressure of a balloon suitable for the present invention, an experiment was performed using dog small intestine. Laparotomy was performed under general anesthesia, and a diameter of 10 mm and a length of about 15 c from the incision in the jejunum
A silicone balloon and a latex balloon attached to the tip of a m-shaped rod were inserted, and the relationship between the respective expansion pressures and the withdrawal resistance was examined.

Experimental Results A. Relationship between dilatation pressure and gripping force in two types of balloons Latex rubber (condom) balloon Balloon pressure (mmHg) Grasping force 1 (g) Grasping force 2 (g) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 200 120 90 220 180 100 100 100 140 120 180 180 140 210 160 500 500 Silicone balloon Balloon pressure (mmHg) Grasping force 1 (g) Grasping force 2 (g) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 2 0 2 0 2 0 2 0 2 0 100 20 20 120 30 30 140 60 30 160 160 60 40 180 60 60 200 200 70 70 240 360 B. The latex balloon was inflated at 100 mmHg and the mucous membrane was examined for damage when pulled out, but no damage was visually observed. From the above results, the balloon for the small intestine endoscope is a soft latex material, and the expansion pressure is 40-100 mmH.
g, especially 50-60 mmHg, was considered optimal.

Clinical Use Experience Using the method according to the invention, June 1999-1999
Small intestine was performed on 4 cases during December 2012.
The breakdown is shown in the separate table. Three of the four cases were performed for gastrointestinal bleeding with unknown bleeding source, and one was tried for the purpose of scrutinizing protein leaky gastroenteropathy. Effective length 103cm in the first three cases
Despite the use of a short endoscope, all three cases can be inserted up to about 30-40 cm from the ligament of Treitz, confirmation of bleeding points in two cases, confirmation of stenosis in one case and purpose Achievable. Deeper inability to insert was due to lack of effective endoscope length, not bowel bowing. In the fourth case, using an endoscope with an effective length of 2 m and an overtube of 140 cm,
Endoscopic insertion up to the cecum was possible, and a diverticulum thought to be Meckel's diverticulum about 1 m from the Bauhin valve and ulceration at the distal side edge of the opening was recognized. Endoscope XP-240 in the table: Olympus X
P-240 (effective length 103cm, outer diameter 7.7mm) SIF-Q240: Olympus SIF-Q240
(Effective length 200cm, outer diameter 9.8mm)

[0014]

According to the present invention, it is possible to insert an endoscope into the deep small intestine, etc., which could not be inserted by the conventional method, and it is considered that the endoscope is highly useful in both diagnosis and treatment. Can be Specifically, gastrointestinal bleeding of unknown cause, small intestinal lesions pointed out by contrast-enhanced X-ray examination, diagnostic purpose of chronic diarrhea or impaired absorption, endoscopic hemostasis for small intestinal bleeding,
It is considered that it can be used for therapeutic purposes such as endoscopic resection for small intestinal polyps and mucosal tumors, dilatation for small intestinal stenosis, and stenting. The use of the present invention has the potential to perform endoscopic treatments for those who had previously required open surgery. The present invention can be used for colonoscopy and the like in cases other than the small intestine, for example, in cases where it cannot be inserted by an ordinary method. In addition, the endoscope can be removed after inserting the tube of the present invention while leaving the tube, and can be used as a route for various treatment tools.

[Brief description of the drawings]

FIG. 1 is a distal end portion of a tube with a balloon for assisting insertion of an endoscope.

FIG. 2 is a central portion of a tube with a balloon for assisting insertion of an endoscope.

FIG. 3 is a proximal end of a tube with a balloon for assisting insertion of an endoscope.

FIG. 4 is a schematic diagram when actually mounted on an endoscope.

[Explanation of symbols]

1 Tube tip balloon 2 Tube tip 3 Balloon expansion air route: Connected to an air supply device equipped with a balloon internal pressure monitoring function. 4 Tube Body 5 Lubricant Route 6 Lubricant Injection Port 7 Tube Hand Closer 8 Tube Proximal End Sphincter 9 Endoscope 10 Endoscope Tip Balloon

Claims (5)

[Claims] A tube with a balloon used as an overtube for assisting insertion of an endoscope and other observation tools and treatment tools in a body cavity. 2. The balloon of claim 1 does not damage the intestinal tract or the like,
The material and shape of the balloon to provide sufficient gripping force. 3. The balloon of claim 1 does not damage the intestinal tract or the like,
In addition, the internal pressure of the balloon to provide a sufficient gripping force. 4. A method for monitoring internal pressure so that the balloon of claim 1 does not damage an intestinal tract or the like. 5. A device for reducing frictional resistance so that the tube according to claim 1 can be inserted smoothly.