JPH01254135A - Endoscope device for bile and pancreatic ducts - Google Patents

Abstract

PURPOSE:To enable the safe and easy insertion of the insertion part of a sub- endoscope into the bile or pancreatic duct by utilizing >=2 guide tubes and first inserting the guide tube of a small diameter into the bile or pancreatic duct, then inserting the insertion part of said endoscope into this guide tube. CONSTITUTION:The endoscope device consists of the master endoscope 1 having the insertion part 2 which can be inserted down to the duodenum, the sub- endoscope 6 which has the insertion part 5 to be inserted into the bile or pancreatic duct through an insertion port 4 of a forceps port and the guide tube 7 of the small diameter. The tip of the insertion part of the master endoscope 1 is orally inserted down to the duodenum and after the position of the papilla is confirmed, the guide tube 7 is inserted therein. The insertion part 5 of the sub-endoscope 6 is then inserted into this guide tube 7. The guide tube of a large diameter is inserted into the bile or pancreatic duct by utilizing the guide tube 7 of the small diameter and thereafter the guide tube 7 of the small diameter is removed in case of utilizing the guide tube of the large diameter.

Description

DETAILED DESCRIPTION OF THE INVENTION [Field of Industrial Application] The present invention relates to an endoscopic device for biliary and pancreatic ducts for performing non-invasive endoscopic observation of biliary and pancreatic ducts.

[Conventional technology]

A parent-child scope system is known that uses a parent endoscope that has an insertion section that can be inserted up to the duodenum, and a child endoscope that has an insertion section that is inserted transpapillary through a forceps hole in the insertion section. In this method, the insertion section of the child endoscope is directly inserted into the nipple through the forceps hole of the parent endoscope to observe the inside of the biliary and pancreatic ducts. However, in order to observe the bile and pancreatic ducts, it is necessary to perform perfusion to clean the inside of the observation area. Therefore, the insertion section of the child endoscope requires a passage for sending saline for irrigation, and the diameter of the insertion section of the child endoscope has to be increased. The tip of the insertion section of such a child endoscope is
If it is not curved to determine the direction, it cannot be inserted into the nipple properly, so the tip has the function of being curved in two directions, up and down.

[Problem to be solved]

The outer diameter of the insertion part of the hand endoscope is 3-mm in order to provide a passage for saline water supply and a function of curving the tip. It will be about 5m,
Not only is there a risk of damaging the nipple or the bile/pancreatic duct if the operation is incorrect when inserting the nipple, but the operation of inserting the nipple is also difficult.

Therefore, in this invention, instead of directly inserting the insertion part of the child endoscope into the nipple, several guide tubes with different diameters are prepared, the narrowest guide tube is selected first, and the selected guide tube is is inserted into the bile/pancreatic duct via the papilla, and the insertion section of the hand endoscope is inserted into this guide tube, making the insertion operation easy and safe. Saline can be delivered using the gap between the insertion part of the tube and the larger diameter guide tube, which can be inserted into the biliary and pancreatic ducts using the smaller diameter guide tube, and then the smaller diameter guide tube can be pulled out for manual endoscopic observation. It is an object of the present invention to provide an endoscope device for biliary and pancreatic ducts in which the insertion portion of a mirror is inserted into a guide tube with a large diameter, and various treatment tools can be inserted into this gap.

[Means to solve the problem]

In order to achieve the above-mentioned object, the present invention includes a master endoscope whose insertion section having a forceps hole can be inserted up to the duodenum, and a guide tube having flexibility guided from the forceps hole of the master endoscope to insert the biliary tract into the gallbladder. A hand endoscope having an insertion section to be inserted into the pancreatic duct, and two or more fixing chains with different diameters are concentrically provided on the proximal side of the insertion section of the hand endoscope so as to cover the insertion section. , a fixing tube and a guide corresponding to the selected guide tube via an adapter according to the diameter of the selected guide tube among two or more guide tubes with different diameters inserted into the bile/pancreatic duct from the forceps hole of the parent endoscope. It is configured so that it can be connected to the tube in a communicable manner.

[Effect]

When attempting to observe the biliary and pancreatic ducts with the device of this invention, after orally inserting the insertion end of the master endoscope into the duodenum and confirming the position of the papilla, select a diameter that is easy to insert into the papilla through the forceps hole. Insert the guide tube and use the forceps stand provided at the tip of the parent endoscope to insert the tip of the guide tube toward the nipple.The tube is highly flexible. Because of this, it can be inserted transpapillary into the bile duct or pancreatic duct without damaging the papilla. In addition, the guide tube
The insertion section of the hand endoscope, which has only the observation function (no passageway or forceps hole required), is thin enough to allow insertion.
It can be easily inserted into the nipple. Once the guide tube has been inserted from the nipple into the bile duct or pancreatic duct, insert the insertion section of the hand endoscope into the guide tube. Saline can be delivered using the gap between the insertion part of the hand endoscope and the guide tube. At this time, a corresponding small-diameter guide tube is selected from two or more fixing tubes, these tubes are communicatively connected via an adapter, and saline is fed using the adapter. Furthermore, when using a larger diameter guide tube, use a smaller diameter guide tube to insert the larger diameter guide tube into the bile/pancreatic duct.
Remove the small diameter guide tube. A fixation tube corresponding to the large diameter guide tube is selected, these tubes are connected via an adapter so that they can communicate, and various treatment instruments are inserted using the adapter.

〔Example〕

Preferred embodiments of the present invention will be described below with reference to the drawings.

FIG. 1 is a schematic diagram showing the entire device, including a master endoscope 1 having an insertion section 2 that can be inserted into the duodenum, and an insertion section that is inserted into the biliary and pancreatic ducts from the insertion port 4 of the forceps hole 3. It consists of a hand endoscope 6 having a diameter of 5, and a small diameter guide tube 7. As shown in FIG. 2, the tip of the insertion section 2 inserted into the duodenum includes an image guide window 8, a light guide window 9, an air and water supply port 10, and a forceps stand provided at the forceps hole 3. It is equipped with 11. When observing the biliary and pancreatic ducts using the Il endoscope 1, guide tube 7, and hand endoscope 6, the guide tube 7 is inserted into the forceps hole 3 from the insertion port 4 of the parent endoscope 1. A luer lock 12 is attached to the proximal end of the guide tube 7.
A flexible core bar 13 is attached to the core bar 13. The tip of the core bar 13 is designed not to protrude from the tip of the guide tube 7, and is inserted into the duodenum 10 at the tip of the insertion section 2 of the parent endoscope 1.
Observe the nipples 101 and 102 at position 0, and insert the guide tube 7 from the forceps hole 3 into the nipple lO1.

The pancreatic duct 103 at the top in FIG. 4 is an accessory pancreatic duct, and the thicker one at the bottom is the main pancreatic duct. Further, reference numeral 104 indicates a bile duct, and reference numeral 105 indicates a pancreas. When inserting the guide tube 7 into the nipple 101, operate the forceps stand 11 while observing with the parent endoscope 2, and insert the tip of the guide tube 7 into the nipple 101.
Insert into. Since the core bar 13 is inserted into the guide tube 7, the flexible guide tube 7 is inserted into the nipple 101.
It becomes easier to insert the pancreatic duct 103 into the pancreatic duct 103. When photographing the pancreatic duct 103 or the bile duct 104, it can be seen to which part of the pancreatic duct 103 or the bile duct 104 the guide tube 7 has been inserted due to the presence of the core bar 13. Further, an imaging medium can be injected into the pancreatic duct 103 or the bile duct 104 via the guide tube 7. The diameter of the guide tube 7 inserted into the bile duct 104 and the pancreatic duct 103 was 1.7 mm. Inserting the core metal 13 into such a guide tube 7 prevents meandering within the forceps hole 3 and also prevents the guide tube 7 from meandering.
This is to make it easier to insert the guide tube 7 into the nipple 101 or 102, and to make it easier to insert the guide tube 7 into the nipple 101 or 102, as well as to make it easier to insert the guide tube 7 into the nipple 101 or 102. If the tip of the kite tube 7 inserted into the pancreatic duct 103 or the bile duct 104 is coated with metal powder or the like so that the image is visible when viewed through the pancreatic duct 103 or the bile duct 104, the core bar 13 does not have to be inserted. If the guide tube 7 is inserted into the forceps hole 3 from the insertion port 4 of the parent endoscope 1 in this way, and the distal end of the guide tube 7 is inserted into the pancreatic duct IO3, for example,
Remove the Luer lock 12 and pull out the core metal 13 from the guide tube 7.

Next, the insertion section 5 of the pre-nacroscopic scope 6, which does not have a saline water supply passage or a forceps hole, is inserted into the guide tube 7. When inserting the insertion section 5 into the guide tube 7 so that the insertion section 5 is approximately aligned and the insertion section 5 does not protrude beyond the distal end of the guide tube 7, pre-thickening is applied to prevent over-insertion of the insertion section 5. The endoscope 6 is provided with an adapter 14. adapter 14
consists of a straight pipe section 14A and a crossed pipe 14B that is perpendicular to and communicates with the straight pipe section 14A. One end of the straight tube portion 14A is a pre-nacroscope 6.
The cross tube of the adapter 14 is connected to the fixing tube 15 with a medium and small diameter of the fixing tube 15. 14B is connected to a tube 17, and serves as a conduit through which saline is supplied. Saline water is supplied from a syringe or the like connected by a luer lock 18 provided at the other end of the tube 17, and is supplied to the gap between the insertion section 5 and the guide tube 7 via the tube 17 and the straight tube section 14A of the crossed tube 14. Through the biliary and pancreatic ducts 103.1
Water is sent into 04. Among the fixing tubes 15 and 16 provided concentrically on the proximal end side of the insertion section 5 of the preliminary macroscope 6, the fixing tube 16 with a larger diameter is used when using the other guide tube 19 and adapter 20. This will be discussed later. A sealing ring 21 is provided to seal the gap between the small-diameter fixing tube 15 and the insertion section 5 of the pre-nacroscope 6 on the proximal end side of the insertion section 5, and a fixation ring is provided on the outermost periphery. 22 (see Figure 5).

Next, to explain the case where three endoscopes are used, once the guide tube 7 is inserted into the biliary and pancreatic ducts 103 and 104 using the master endoscope 1 and the guide tube 7 as described above, Connect the guide tube 7 and a joint tube 24 of the same diameter with a ditent 23 as shown in Fig. 7 (6th
(See figure) 0 Remove the parent endoscope 1 while leaving both tubes 7 and 24 as they are (with the tip of the guide tube 7 inserted into the biliary and pancreatic ducts 103 and 104) 0 Then, as shown in Figure 8, remove the parent endoscope 1 from the forceps hole 3. An endoscope 1' equipped with large forceps 3' is orally inserted into the duodenum 100.

At this time, both tubes 7.24 are inserted into the forceps hole 3', and the tubes 24 and 24 are sequentially passed through the insertion port 4' to the outside.
guide it and insert it into the biliary and pancreatic ducts 103° and 104.
(See Figure 9). Once the distal end of the guide thief 19 has been guided into the guide tube 7 that has already been inserted into the bile/pancreatic duct 103, 104, the tube 7, 24 is removed. The tip of the insertion section 2' of the endoscope 1' is inserted into the duodenum 100, and the tip of the guide tube 19 is inserted into the bile/pancreatic duct 103.
．． 104, insert the insertion section 5 of the hand endoscope 6 via the adapter 20 as shown in FIG.
into the guide tube 19. One end of the direct portion 20A of the adapter 20 is connected to the fixing tube 16, and the other end is connected to the guide tube 19. Details of this condition can be found in Chapter 11.
As shown in the figure, the communicating portion of the intersecting tube 20B is closer to the guide tube 19 than the distal end of the fixing tube 15. Of course, when this adapter 20 is attached to the hand endoscope 6 and the guide tube 19, the distal end of the insertion portion 5 is substantially aligned with the distal end of the guide tube 19 and is designed so as not to protrude. Utilizing the gap between the large-diameter guide tube 19 and the insertion section 5, it is possible not only to feed saline through the crossover tube 20B of the adapter 20, but also to use various treatment tools such as forceps 25 as shown in FIG. Can be inserted. In addition, endoscope 1, which can also be called the parent of parent endoscope 1,
. However, it is also possible to use the endoscope 1' as a parent from the beginning and insert the narrow guide tube 7 and then insert the large diameter guide tube 19.

〔effect〕

As explained above, according to the present invention, two or more guide tubes are used, and the small diameter guide tube is first
After inserting the endoscope into the pancreatic duct, the insertion section of the hand endoscope can be inserted into the guide tube, allowing the insertion section to be safely and easily inserted into the biliary and pancreatic ducts. The insertion of the guide tube into the biliary and pancreatic ducts is smooth because it is guided by a small-diameter guide tube.Furthermore, when inserting either guide tube, it is fixed at the proximal end of the insertion section of the hand endoscope via an adapter. The insertion tube and guide tube can be connected, and if you design this in advance, the tip of the insertion tube will not protrude from the tip of the guide tube (
Saline and various treatment instruments can be inserted into the guide tube from the adapter.

[Brief explanation of the drawing]

Fig. 1 is an overall view showing the outline of this device, Fig. 2 is an enlarged view of the tip of the main endoscope insertion section, and Fig. 3 is a perspective view of the guide tube inserted into the forceps hole of the main endoscope. Figure 4 is an explanatory diagram of the state in which the parent endoscope is inserted into the duodenum and the guide tube is inserted toward the nipple, Figure 5 is a cross-sectional view showing details of the adapter, and Figure 6 is a diagram showing how the connecting tube is connected. Front view, Figure 7 is a sectional view showing the joint, Figure 8 is an explanatory diagram of inserting the endoscope after removing the parent endoscope, Figure 9 is an explanatory diagram of inserting a large diameter guide tube, FIG. 10 is an explanatory view of inserting the insertion section of the hand endoscope, FIG. 11 is a sectional view showing details of the adapter, and FIG. 12 is a view with forceps inserted. 1... Parent endoscope, 1'... Endoscope, 2.2'... Insertion section, 3.3'... Forceps hole, 4.4'... Insertion port, 5. ... Insertion section, 6 ... Hand endoscope, 7.19 ... Guide tube, 11.11' ... Forceps stand, 14.20 ... Adapter, 15.16 ... For fixation tube.

Claims (1)

[Scope of Claims] 1. A master endoscope whose insertion part having a forceps hole can be inserted up to the duodenum and a flexible guide tube guided through the forceps hole of this master endoscope and inserted into the biliary and pancreatic ducts. The main endoscope is equipped with a secondary endoscope having an insertion section, and two or more fixing tubes with different diameters are concentrically provided on the proximal side of the insertion section of the secondary endoscope so as to cover the insertion section. The fixation tube corresponding to the selected guide tube can be communicated with the guide tube via an adapter according to the diameter of the selected guide tube among two or more guide tubes with different diameters inserted into the bile/pancreatic duct through the forceps hole of the An endoscope device for biliary and pancreatic ducts, characterized in that it is configured so that it can be connected to a biliary and pancreatic duct.