Endoscopic treatment system and anastomotic method using this system

The endoscopic system includes an endoscope having an insertion portion which is inserted into a body and has a forceps insertion duct, and a light emitting member which has an end portion that emits the light and is inserted into a hollow organ in the body through the forceps insertion duct of the endoscope. The light emitting member issues positional information of the hollow organ which is detected through the endoscope orally and gastrically inserted into an abdominal cavity by causing the end portion to emit the light in the hollow organ. The system includes a treatment instrument by which a treatment is conducted in the abdominal cavity in cooperation with the endoscope.

BACKGROUND OF THE INVENTION

1. Field of the Invention

The present invention relates to an endoscopic intra-abdominal treatment system and an endoscopic gastrojejunostomy.

2. Description of the Related Art

Japanese Patent No. 32211141 discloses a coelomic duct identification apparatus which is inserted into a coelomic duct such as a bile duct, a pancreatic duct or a urethra which is thin and hard to be identified in an abdominal operation, and facilitates identification of this coelomic duct from the outside.

This coelomic duct identification apparatus includes a flexible tube having an end closed, and a light guide tube consisting of a light guide inserted into the flexible tube. This light guide has an optical fiber bundle in which positions of respective outgoing radiation ends are dispersed and arranged. The outgoing radiation ends emit the light for a predetermined length in an axial direction of the light guide tube. The entire bile duct can be irradiated with the light by inserting the light guide tube having this predetermined length formed longer than, e.g., the length of the bile duct and keeping it therein.

BRIEF SUMMARY OF THE INVENTION

According to one aspect of the present invention, there is provided an endoscopic treatment system comprising: an endoscope having an insertion portion orally inserted into a body and having a forceps insertion duct extended; and a light emitting member having an end portion that emits the light, and being inserted into a hollow organ in the body through the forceps insertion duct of the endoscope. The light emitting member issues positional information of the hollow organ which is detected through the endoscope orally and gastrically inserted into an abdominal cavity, by causing the end portion to emit the light in the hollow organ. The treatment system also includes a treatment instrument by which a treatment is conducted in the abdominal cavity in cooperation with the endoscope inserted into the abdominal cavity.

According to another aspect of the present invention, there is provided an endoscopic gastrojejunostomy procedure that comprises: orally inserting an endoscope into the duodenum; inserting a guide wire into the intestine through a forceps insertion duct of the endoscope; inserting the guide wire into a guide tube and inserting the guide tube into of the small intestine along the guide wire; confirming that the end of the guide tube has reached a target position in the small intestine based on an inserted length of the guide tube and/or fluoroscopy; providing an extension member to the proximal end portion of the guide tube protruding from the forceps insertion duct to the outside of the body; removing the endoscope while keeping the guide tube in the alimentary tract; removing the guide wire; removing the extension member from the guide tube and then inserting an illuminator into the guide tube; orally inserting an endoscope and an endoscopic guide tube into the stomach along the guide tube; incising the stomach wall by using the endoscope and the endoscopic guide tube and then advancing the endoscope into an abdominal cavity through this incision; confirming a target part in the small intestine by detecting the illuminator through the endoscope; and pulling the confirmed target part in the small intestine into the stomach and then conducting the gastrojejunostomy.

According to still another aspect of the present invention, there is provided an endoscopic gastrojejunostomy procedure that comprises: orally inserting an endoscope into the intestine duodenum; inserting a guide wire into the intestine through a forceps insertion duct of the endoscope; inserting the guide wire into a guide tube and inserting an illuminator into the small intestine along the guide wire; confirming that the end of the illuminator has reached a target part in the small intestine based on an inserted length of the illuminator and/or fluoroscopy; removing the endoscope and the guide wire while keeping the illuminator in the alimentary tract; orally inserting an endoscope and an endoscopic guide tube into the stomach along the guide tube; incising the stomach wall by using the endoscope and the endoscopic guide tube and then advancing the treatment endoscope into an abdominal cavity through this incision; confirming the target part in the small intestine by detecting the illuminator through the endoscope; and pulling the confirmed target part in the small intestine into the stomach and then conducting the gastrojejunostomy.

According to still another aspect of the present invention, there is provided an endoscopic treatment system that comprises: an elongated marker member which is inserted into a hollow organ in the endoscopic manner and kept at a necessary position. The marker member has energy generating member for generating at least one energy of energies including electromagnetic waves, radiation, and ultrasonic waves at least at a part thereof. The system also includes a sensor that is inserted into a body cavity in the endoscopic manner in order to detect an energy from the marker member through the wall part of the hollow organ, and an endoscope which is inserted into an abdominal cavity, orally and through a gastric incision, for conducting an endoscopic treatment at a part positioned based on information detected by the sensor.

According to still another aspect of the present invention, there is provided an endoscopic intra-abdominal treatment system that comprises: an endoscope which is orally inserted into a body and has an insertion portion having a forceps insertion duct extended, and an elongated optical marker having a portion that emits the light at least at a part of the optical marker and inserted into a hollow organ in the body through the forceps insertion duct of the endoscope. The optical marker causes the portion to emit the light in the hollow organ in the body. The endoscope is inserted into an abdominal cavity orally and through a gastric incision, and detects positional information of the hollow organ through the emission of the light. The system further includes a treatment instrument which conducts a treatment in the abdominal cavity in cooperation with the endoscope.

According to still another aspect of the present invention, there is provided an endoscopic treatment system that comprises: an endoscope having an insertion portion orally inserted into a body and having a forceps insertion duct extended; a light emitting member inserted into a hollow organ in the body through the forceps insertion duct of the endoscope and comprising an illumination device, a sheath which has an end portion and a proximal end portion and in which the illumination device is disposed, an end cap fluid-tightly provided at the end portion of the transparent sheath, a connector having a connector main body to which a light source device is connected, the light emitting member emitting the light by which positional information of the hollow organ is detected through the endoscope orally and gastrically inserted into an abdominal cavity; and a treatment instrument for conducting a treatment is conducted in the abdominal cavity in cooperation with the endoscope.

According to still another aspect of the present invention, there is provided an endoscopic treatment system that comprises: an elongated marker member inserted into a hollow organ in the endoscopic manner and being kept at a target position, and including energy generating means that generates energy at least at a part of the marker member; detecting means inserted into a body cavity in the endoscopic manner, for detecting the energy from the marker member through the wall part of the hollow organ; and an endoscope inserted into an abdominal cavity, orally and through a gastric incision, for conducting an endoscopic treatment at the target position based on information detected by the sensor.

FIGS. 1 to 7show an endoscopic treatment system according to a preferred embodiment of the present invention. It is to be noted that an endoscopic suture machine is used in the embodiment mentioned below but a treatment instrument such as grasping forceps, thread cutter forceps, scissor forceps, hot biopsy forceps or a swivel clip device may be used in place of this machine.

As shown inFIG. 1, the endoscopic treatment system1according to this embodiment includes an endoscopic system2, a suture machine3, a suture thread4and an illuminator10(seeFIG. 2).

The endoscopic system2includes an endoscope5, an image processing device6, a light source device7, an observation monitor8and an aspirator9, like a generally used electronic endoscopic system. The endoscope5is connected to the light source device7through a universal cord5a, an image signal supplied from a CCD camera (not shown) provided at a distal end portion of an insertion portion5bis processed in the image processing device6and then displayed on a monitor13. The illustrated endoscope5having one forceps insertion duct12is used but one having two forceps insertion ducts may be used in place of this.

Further, like the general type, the endoscope5has a CCD camera, a light guide, a forceps insertion duct12, and a nozzle for cleansing the lens of the CCD camera arranged at a distal end portion thereof. It is to be noted that a fiber endoscope having an eyepiece may be used in place of the electronic endoscope using the CCD. Although the suture machine3is detachably fixed to the insertion portion5bof the endoscope5by a fixing member38, the suture machine3may be constituted integrally with the endoscope5in place of this structure.

As shown inFIGS. 2 to 4, the illuminator10includes an illuminator body14and a light guide connector (LG connector)16which optically connects the illuminator body14with the light source device7. As shown inFIG. 3, the illuminator body14accommodates an optical fiber bundle20in a sheath18formed of a long hollow soft member made of transparent resin such as polyurethane, polyethylene, silicone, fluoroplastics, and a distal end portion of the transparent sheath18is closed to be fluid-tight, namely, so as to be capable of being sealed against both a liquid and a gas by an end cap22which is preferably formed of metal such as stainless steel, titanium or tungsten. This end cap22has a curved end surface22aand a proximal end surface22bhaving a substantially conical surface, and is fitted in the transparent sheath18to a substantially intermediate position. The spherical end surface22afacilitates insertion of the illuminator10, and the conical proximal end surface22bof the end cap22acts as a reflecting surface which evenly reflects the light outgoing from the end surface of the optical fiber bundle20to the peripheral part through the transparent sheath18.

Furthermore, a light guide connecting base (LG connecting base)24formed of a rigid material is fixed at the proximal end portion of the sheath18. The proximal end portions of many optical fibers forming the optical fiber bundle20are integrally bonded in the LG connecting base24by an adhesive and firmly fixed to the LG connecting base24. On the other hand, in the distal end portion of the optical fiber bundle20, distal end portions of the respective optical fibers are uniformly cut, thereby forming a flat surface which is substantially orthogonal to the axis of the optical fiber bundle20. Like the proximal end portions, the distal end portions of the many optical fibers are integrally bonded with adhesive. As a result, since the many optical fibers have the distal end portions and the proximal end portions being respectively integrated, the intermediate portion of the optical fiber bundle20can be bent in various directions. Moreover, the optical fiber bundle20does not move in the transparent sheath18even after repeating such bending, and the flatness of both end surfaces can be maintained.

It is to be noted that reference numeral21denotes a wire bonded to be fluid-tight and fixed to the distal end portion of the optical fiber bundle20. This wire21is used when pulling the optical fiber bundle20into the transparent sheath18, and the distal end portion of this wire is cut off so as not to protrude from the end cap22.

As shown inFIG. 4, the LG connector16which optically connects the illuminator main body14with the light source device7has a connector main body26and a front side body28which detachably fixes a LG connecting base24to the connector main body26. The LG connecting base24of the illuminator main body14is detachably fitted to the front side body28of the LG connector16. This front side body28has a protrusion portion30having a male screw thereto protruding from the proximal end side, and the LG connecting base24protrudes from a central opening28aopened on the proximal end side and surface of the protrusion portion30. A circumferential portion of the central opening28ais defined by a tapered surface converged on the distal end side.

On the other hand, the connector main body26to which the LG connecting base24is optically and mechanically connected has a main body portion26awith which the front side body28is coupled and a rod portion26bwhich protrudes from the proximal end side of this main body portion26aand is optically connected to the light source device7. To the main body portion26ais formed a concave portion32having a female screw screwed into the protrusion portion30of the front side body28. In addition, a central opening34is extended piercing the main body portion26aand the rod portion26b, and a rod lens36is accommodated on the proximal end side of the central opening34, and bonded to the connector main body26. The central opening34of the LG connector16is coaxially matched with the central opening28aof the front side body28when the protrusion portion30of the front side body28is screwed into the concave portion32.

Additionally, since the LG connecting base24is fixed being coaxially matched with the rod lens36, the connector main body26has a plurality of fingers36a, whose number is preferably three or more, extending to the distal end side from the circumferential portion of the opening end of the central opening34opened in the concave portion32. It is preferable that these fingers36ahave a slight gap formed between the LG connecting base24and themselves and are arranged at equal distances in the radial direction and at equal intervals in the circumferential direction. The distal end of each finger36aslightly expands to the outside. Therefore, when the protrusion portion30of the front side body28is fastened in the concave portion32of the LG connector16, it is pressed toward the inside in the radial direction by the tapered surface defining the opening end of the central opening28a, and the LG connecting base24can be fastened and fixed.

When connecting the illuminator main body14to the LG connector16, the LG connecting base24of the illuminator main body14is inserted into the central opening28aof the front side body28, and the LG connecting base24is caused to protrude from the protrusion portion30. Then, the distal end portion of the LG connecting base24is inserted into the central opening34of the connector main body26and comes into contact with the distal end surface of the rod lens36. Thereafter, the protrusion portion30of the front side body28is screwed into the concave portion32of the connector main body26. The front side body28presses the distal end portion of each finger36toward the inside in the radial direction while sliding against the LG connecting base24. When a plurality of the fingers36aare in contact with the LG connecting base24and the LG connecting base24is firmly fastened, the illuminator main body14and the LG connector16are optically and mechanically connected with each other. The light carried from the rod lens36passes through the optical fiber bundle20of the illuminator main body14and leaves the distal end surface, and is radiated in the circumferential direction from the reflecting surface22bof the end cap22.

It is noted that a diode (LED) may be used instead of an optical fiber bundle, and that at least a portion of the sheath at which light emitting member is disposed may be provided with transparent material.

FIG. 5shows a guide tube40for guiding an illuminator10. The guide tube40may be inserted into, for example, the small intestine from the stomach through the forceps insertion duct12of the endoscope5. The portion of the tube40, which may be inserted into a patient, has a soft transparent hollow member42. The hollow member42is made of resin or plastics such as polyurethane, polyethylene, silicone or fluoroplastics. A part of the hollow member42may be made of material that is opaque to X rays. The illuminator10may be inserted into the hollow member42. An end chip44is fixed to the distal end of the hollow member42. The chip44is made of material opaque to X rays, such as metal (stainless steel, titanium, tungsten, gold, platinum, or the like), resin or plastics. Further, a front side body46having an opening on the proximal end side is fixed to the proximal end portion of the hollow member42, and an exhaust port48is provided at a side wall portion of the front side body46. A valve or a cap which is usually closed but opened, e.g., when inserting the illuminator10, can be arranged on the proximal end side opening of the front side body46.

The distal end side of the end chip44is formed into a tapered shape, and the end chip44can be readily inserted into the forceps insertion duct12of the endoscope5. Furthermore, the distal end of the end chip44forms thereto an opening into which the guide wire is inserted, and a plurality of side openings45are formed on the circumferential wall portion on the proximal end side. Forming such side openings45can facilitate sucking of intestinal fluids and air.

This guide tube40forms a marking50indicative of an insertion length at an appropriate part of the hollow member42forming the insertion portion. The number of the marking50is not restricted one as shown in the drawing, and a plurality of markings may be provided at adequate intervals according to needs. Arrangement of the insertion portion of the guide tube40and a position of the distal end portion in a hollow organ can be correctly informed based on a protrusion length of the endoscope5from the forceps insertion duct12by the marking50and detection of a position of the end chip44by fluoroscopy.

This guide tube40is formed in such a manner that a length of the hollow member42when the insertion portion, i.e., the end chip44is attached thereto is substantially twice or more that of the insertion portion5bof the endoscope5. Therefore, by arranging the distal end portion of the end chip44at a necessary position in, e.g., the small intestine and then removing the endoscope5, the guide tube40can be kept in the body. Then, when the illuminator10is inserted from the opening on the proximal end side of the front side body46, the illuminator10is guided along the guide tube40. A position of the distal end portion of the illuminator10can be detected based on the insertion length in the guide tube40. Generally, the distal end portion of the illuminator10is arranged in the vicinity of the end chip44of the guide tube40. The light leaving the end surface of the optical fiber bundle20passes through the transparent hollow member42and reaches the outer side of the guide tube40, and the inside of the hollow organ such as the small intestine is irradiate with this light. As a result, positional information concerning the hollow organ is output to the outside of the hollow organ.

Air, a gas, a liquid or the like accumulated inside the small intestine or the like during the therapy technique can be discharged to the outside of the body from the end opening of the end chip44and the side openings45through the exhaust port48.

FIGS. 6A and 6Bshow the suture machine3which sutures a part of the small intestine confirmed based on the positional information provided by such an illuminator10on the stomach wall.

This suture machine3includes a flexible tube52and a holding member54which is fixed to the distal end portion and used to hold a later-described needle. To this holding member54are formed two support plate portions54aopposed to each other with a gap therebetween and a hole56(seeFIGS. 6A and 6B) communicating with the gap between these support plate portions and the inner hole of the flexible tube73. A push rod58is arranged in the hole56so as to be capable of moving forward and backward along the axial direction.

One end of each of first and second connection members62and63is pivoted on the end of the push rod58through a pin61. The other ends of the first and second connection members62and63are, respectively, pivoted on the proximal end portions of first and second arm members66and67through pins64and65. Furthermore, a first activation member68integrally formed with the first arm member66is rotatably coupled with the support plate portion54athrough a pin69. Likewise, a second activation member70integrally formed with the second arm member67is rotatably coupled with the support plate portion54athrough a pin71.

The end of each of these pins69and71is formed by a small-diameter portion, and a dimension of the gap formed between the support plate portions54aof the holding member54can be thereby maintained slightly larger than a sum of thicknesses of the first activation member68and the second activation member70. The first activation member68and the second activation member70can move in the gap without producing large friction.

The push rod58is coupled with an elongated flexible transmission member72. Moreover, the holding member54is coupled with coils73and74forming axial holes. The opposed end surfaces of these coils73and74are coupled with each other by laser welding, brazing, soldering or preferred means such as an adhesive. The coil74is formed of a strand having a smaller diameter than the coil73, and the end side of the suture machine3is thereby formed to be readily bent. The entire lengths of these coils73and74are covered with a flexible tube75and held appressed against the flexible tube75. The flexible tube75restricts expansion and contraction of the coils73and74in the axial direction, and the force to open/close the first activation member68and the second activation member70is thereby increased.

As shown inFIG. 7, the proximal end portions of the flexible tube75and the coil73are fixed to an operation portion main body77of a suture machine operation portion76. Moreover, the proximal end portion of the transmission member72is inserted into the operation portion main body77and coupled with a pipe78capable of sliding against the operation portion main body while being inserted into the pipe76. This pipe78is connected to a movable member79by a non-illustrated coupling member. Therefore, when the movable member79is retired with respect to the operation portion main body77, the first activation member68and the second activation member70can be opened/closed through the transmission member72.

As shown inFIGS. 6A and 6B, the first and second arm members66and67can be passed between the pins69and71and opened to an angle shown inFIG. 6B. It is needless to say that appropriately setting the lengths of the first and second arm members66and67and the lengths of the first and second connection members62and63can increase or decrease an angle between the first and second arm members66and67.

As shown inFIGS. 6A and 6B, a stopper pin80is fixed to the push rod58. As shown inFIG. 6B, the stopper pin80is guided in a slit81which is formed to the holding member54and extends in the longitudinal direction, thereby restricting the motion of the first and second activation members68and67in the opening direction.

A curved needle82is fixed at the distal end of the first activation member68. The curved needle82may be attached/detached with respect to the first activation member68in place of this structure. A needle hole82ainto which the suture thread4can be inserted is formed on the end side of the curved needle82. In addition, a radial thickness of the curved needle82is reduced in order to improve pushing through living tissue.

The second activation member70has a bifurcated fixed arm83, and two fixed needles84are respectively fixed at the end of the fixed arm83. Although the fixed needles84are integrally fixed to the fixed arm83in this embodiment, they may be detachably disposed to the fixed arm83. On the other hand, as shown inFIG. 6A, a protection member86having two holes86formed thereto is fixed to the first activation member68by a non-illustrated screw. As shown inFIG. 6A, this protection member86covers the needlepoint of the fixed needle81when the first and second activation members68and70are closed, and prevents the fixed needle81from being caught by, e.g., living tissue.

A channel member88is fixed at the holding member54through an L-shaped support member87. This channel member85has a pipe89formed of a relatively hard material arranged at the end and a tube91formed of a relatively soft material which is press-fitted into this pipe and then fastened by a fixing thread90, and this fixing thread90is fixed to the tube91by an adhesive. This pipe89is fixed to this support member87by brazing, soldering or appropriate means such as an adhesive.

Further, a protection member92is fixed to the pipe89by brazing, soldering or preferable means such as an adhesive. This protection member92covers a needlepoint of the curved needle82when the first and second activation member68and70are closed, in order to prevent the curved needle82from being caught by living tissue and the like.

Furthermore, two thread guides which guide the suture thread4between the suture machine operation portion76and the suture machine3are attached to the support member87. The thread guide93shown inFIGS. 6A and 6Bhas a pipe94formed of a relatively hard material and a tube95formed of a relatively soft material, the pipe94is disposed to the support member87, and the tube95is extended to the suture machine operation portion76. Reference numeral96shown inFIG. 7denotes a tube of the other thread guide.

As shown inFIG. 7, the tube91communicates with a mouth piece97coupled with the operation portion main body77on the front side thereof. A forceps tap98is provided to the front side of the mouth piece97. Furthermore, the tubes95and96communicate with holes99and100formed to the operation portion main body77on their front sides, respectively.

Moreover, a thread grasping tool101used to grasp the suture thread4has a flexible tubular member102formed of a coil or the like and a pipe103which can move forward and backward in the tubular member102. A hook provided at the distal end of the pipe103can be accommodated in or protrude from the flexible tubular member102by moving a grip104arranged on the proximal end side of the pipe103forward or backward. The suture thread4can slide on the hook when it is caught by the hook.

FIGS. 8 to 12show the procedures of the gastrojejunostomy which bypasses the intestine duodenum D occluded by the cancer tissue T.

As shown inFIG. 8, the endoscope5(FIG. 7) is orally inserted into a deep part of the duodenum D from the stomach G. At that time, it is preferable to release the fixing member38, remove the suture machine3from the insertion portion5band solely insert the endoscope5. Of course, it is possible to prepare another endoscope to which no suture machine3is attached in advance and use this endoscope.

Subsequently, a guide wire104is inserted from the forceps insertion duct12of the endoscope5, and the guide wire104is fed to a deep part of the small intestine S from the intestine duodenum D occluded by the cancer tissue T. Then, as shown inFIG. 9, the guide wire104is inserted into the guide tube40depicted inFIG. 5, and this guide tube40is likewise inserted to reach a deep part of the small intestine S from the forceps insertion duct12along the guide wire104. At that time, using the marking50formed at the insertion portion of the guide tube40can confirm a length of insertion into the endoscope5or a protrusion length from the distal end of the endoscope5. Moreover, detecting a position of the end chip44of the guide tube40by fluoroscopy can confirm a position of the end portion of the guide tube40in the small intestine S. In addition, after confirming that the end portion of the guide tube40has reached a target part in the small intestine, the endoscope5and the guide wire104are removed while the guide tube40is kept in the alimentary tract. At this moment, since the guide tube40is formed to be substantially double or more of the insertion portion5bof the endoscope5, the endoscope5can be completely removed from a patient.

Thereafter, as shown inFIG. 10, the endoscope5having the suture machine3attached thereto is orally inserted into the stomach G along the guide tube40. Then, an incision h is formed by incising the stomach wall GW, and the distal end portion of the endoscope5is advanced into the abdominal cavity from the incision h. Concurrently, the illuminator10shown inFIG. 2is inserted into the guide tube40, and its end portion is arranged in the vicinity of the end chip44of the guide tube40. The light led from the light source device7is caused to outgo from the end surface through the optical fiber bundle20of the illuminator main body14. This light is reflected from the reflecting surface22aof the end cap22in the circumferential direction and the wall part of the small intestine S is irradiated with this light. As a result, the necessary part in the small intestine can be detected through the endoscope5with the brightly illuminated part as a marker. At this moment, if the small intestine is inflated with air or intestinal fluids, the small intestine can be deflated by sucking air or the intestinal fluids to the outside through the guide tube40, thereby facilitating detection by the endoscope5.

As shown inFIG. 11, the part confirmed through the endoscope5is pulled into the stomach G by the forceps and, as depicted inFIG. 12, the small intestine S and the stomach wall GW are anastomosed. As a result, food in the stomach G of a patient can be directly supplied into the small intestine S. Such a stomach-small intestine anastomosis can be applied to an obesity treatment as well as a bypass treatment of the intestine duodenum stenosed by the cancer tissue.

FIGS. 13 to 23show an example of the anastomotic procedure.

(1) It is preferable to insert the endoscope5into the over tube106together with the suture machine3assembled into the state shown inFIG. 7. At this moment, the suture thread4is inserted into the needle hole82aof the curved needle82, each end portion is passed through the thread guide and pulled to the outside of the suture machine3from the holes99and100of the operation portion main body77, and this state is held. In addition, the endoscope5is previously connected to the image processing device6, the light source device7and the like (FIG. 1) through the universal cord5a. Thereafter, the over tube106having the suture machine3and the endoscope5accommodated therein is inserted into the stomach G through the mouth of a human body while observing the body cavity by the monitor8.

(2) As shown inFIG. 13, the over tube106is advanced toward the necessary part in the stomach G.

(3) As illustrated inFIG. 14, the over tube106is further moved forward and the distal end portion is brought into contact with the stomach wall GW. Then, the stomach wall GW is sucked by a non-illustrated aspirator through the over tube106or by a suction function of the endoscope5. The stomach wall GW is sucked into the over tube106, thereby forming a recession. When sucking the stomach wall, connecting a non-illustrated suction tube with the over tube106can form a path having a larger cross section than that of the channel of the endoscope5even if the endoscope5is inserted. Therefore, the suction action can be effected through the path or the inner hole in the over tube106having the smaller duct resistance, thereby forming a larger recession in a short period.

(4) As shown inFIG. 15, the needle-shaped scalpel5A is inserted from the forceps opening channel12(seeFIG. 7) of the endoscope5and caused to protrude from the distal end portion of the endoscope5. The needle-shaped scalpel5A is brought into contact with the stomach wall GW on which the recession is formed, a high-frequency current is supplied from a non-illustrated high-frequency power supply, and the stomach wall GW is perforated. Holding the recession on the stomach wall GW by the over tube106causes the stomach wall to be securely fixed by the over tube, and the stomach wall can be distanced from another organ close to the stomach G, e.g., the small intestine S. As a result, the necessary part on the stomach wall GW can be perforated without damaging any other organ close to the stomach wall GW. The needle-shaped scalpel5A used to perforate the stomach wall GW may have an ordinary structure.

(5) After perforating the stomach wall GW, the balloon dilator5B is inserted into the stomach G in place of the needle-shaped scalpel5A. The balloon dilator5B is inserted into the perforated part on the stomach wall GW, and this perforated part is expanded to a dimension enabling insertion of the end portion of the endoscope5.FIG. 16shows this state. The balloon dilator5B used to expand the perforated part may have an ordinary structure, and it is preferable to have a peanut-like shape as shown in the drawing. After the balloon dilator5B is inserted until the central portion thereof pierces the stomach wall GW, the balloon dilator5B is inflated into the peanut-like shape shown inFIG. 16by supplying a fluid by a non-illustrated inflation device. After the balloon dilator5B is inflated to a size enabling insertion of the endoscope5into the perforated part on the stomach wall GW, supply of the fluid is stopped.

(6) As shown inFIG. 17, the end portion of the endoscope5is inserted into the expanded perforated part. The end portion of the endoscope5is further inserted toward the outer side of the stomach wall GW, i.e., into the abdominal cavity, and the end portion of the endoscope5is caused to be opposed to the part in the small intestine to be anastomosed. At this moment, illumination of the end portion of the illuminator10inserted into the guide tube40as described above can facilitate confirmation of the necessary part in the small intestine S.

(7) Then, as shown inFIG. 18, the grasping forceps5C is inserted into the abdominal cavity through, e.g., the forceps insertion duct12of the endoscope5. The small intestine S is grasped by the grasping forceps5C and brought to the stomach wall GW side. At that time, it is preferable to enter the state ofFIG. 19by pulling a part of the small intestine S into the stomach G from the perforated part on the stomach wall. At this moment, as shown inFIG. 11, removal of the illuminator10and the guide tube40is preferable.

(8) As shown inFIG. 19, the needle5D is put through the small intestine S pulled into the stomach G, and the thread107is inserted into this small intestine. This thread107is used to sling up the small intestine and prevents the small intestine from protruding toward the outside from the stomach wall GW. Both end portions of the thread107can be extended to the outside of the body and fixed at the part outside the body.

(9) As shown inFIG. 20, the circumferential part of the small intestine S lifted by the thread107is anastomosed to the inner peripheral part of the perforated part on the stomach wall GW. This suture can be conducted by using the above-described curved needle suture machine3. It is to be noted that the procedures (1) to (8) can be performed by using the regular endoscope having no suture machine3fixed thereto without utilizing the endoscope5to which the suture machine3is fixed. In this case, suture can be conducted by inserting the endoscope5having the suture machine3fixed thereto from the mouth as shown inFIG. 7only in the procedure requiring the suture machine3.

(10) Then, as shown inFIG. 21, the needle-shaped scalpel5A is inserted into the stomach G, and the necessary part in the small intestine S pulled into the stomach G is dissected. It is to be noted that it is preferable to remove the thread for lifting107after dissecting the small intestine by the needle-shaped scalpel5A but it may be removed before dissection. That is because the small intestine S is sutured along the inner peripheral part of the perforated part on the stomach wall GW.

(11) Subsequently, as shown inFIG. 22, suture is made to the stomach wall GW by using the curved needle suture machine3so as to open the small intestine mucous membrane from the part dissected by the needle-shaped scalpel5A.

(12) The gastrojejunostomy is completed by removing the suture machine3which has finished suture from the stomach G together with the endoscope5.FIG. 23shows this state.

By conducting the gastrojejunostomy using the endoscope5orally inserted into the stomach G in this manner, the body surface of the living body does not have to be dissected, and the burden on a patient can be greatly reduced. Additionally, the illuminator10illuminates the part to be anastomosed in advance, and hence that part can be readily and securely confirmed by the endoscope inserted into the abdominal cavity through a gastric incision.

It is to be noted that such an anastomosis is not restricted to the above-described procedures, and it is possible to use various kinds of procedures, methods or instruments disclosed in the provisional application No. 60/365,687 (the non provisional application Ser. No. 10/390,443 filed on Mar. 17, 2003) entitled “ANASTOMOSIS SYSTEM” filed on Mar. 19, 2002, for example, therefore, the entire contents of which are incorporated herein by reference.

It is to be noted that such an anastomosis can be applied to anastomosing other hollow organs as well as anastomosing the stomach and the small intestine.

FIG. 24shows an example of bypassing a stenosed part in the bile duct C and anastomosing the stomach and the bile duct C. Reference character P designates the pancreatic duct. In this case, the above-described guide wire104(seeFIG. 8) is inserted into the bile duct C in the endoscopic manner, and the guide tube40is inserted into the bile duct C along the guide wire. Then, after removal of the guide wire, the illuminator10is inserted into the guide tube40and kept at a necessary position. When pulling the bile duct C into the stomach G, the bile duct C must be carefully peeled from the liver. Further, the guide tube40and the illuminator10can be inserted into the pancreatic duct P when necessary. As a result, the bile duct C or the pancreatic duct P can be readily confirmed through the endoscope5orally or through a gastric incision inserted into the abdominal cavity, thereby facilitating the endoscopic intra-abdominal treatment.

FIGS. 25A and 25Bshow a guide tube40A according to a modification.

As to this guide tube40A, the elongated hollow member42is divided into a distal end side hollow member42A and a proximal end side hollow member42B, and the proximal end side hollow member42B is formed as a detachable extension member. Therefore, a coupling tool43awhich can be coupled with the end of the front side body46is provided at both the proximal end portion of the distal end side hollow member42A and the proximal end portion of the proximal end side hollow member42B, and the coupling tool43aand a detachable coupling tool43bare provided to the distal end portions of the proximal end side hollow member42B. If the guide tube40A can maintain the outside diameter enabling insertion into the forceps insertion duct12of the endoscope5with the hollow members42A and42B being coupled therewith, it is possible to adopt an appropriate form such as a screw, snapping or pinning for the coupling tools43aand43b. Furthermore, the guide tube can be divided into three or more parts in case of need.

When using the guide tube40A, the distal end side hollow member42A and the proximal end hollow member42B are coupled with the front side body46in advance before inserting the guide tube40A into the forceps insertion duct12. Then, before inserting the illuminator10, namely, after removing the endoscope5and the guide wire104from the body, the proximal end hollow member42B is removed. As a result, the length of the guide wire104to be kept in the body can be reduced, thereby facilitating the handling. Moreover, if needed, the guide wire104can be restored to the length which is substantially twice or more that of the insertion portion5bof the endoscope5by coupling the proximal end hollow member42B.

FIG. 26shows a guide tube40B according to another modification.

This guide tube40B has a transparent balloon47attached on the distal end side thereof. A fluid such as a gas or a liquid can be injected into or discharged from the balloon47through a balloon port49provided to the front side body46. When keeping the distal end portion of the guide tube40B in, e.g., the small intestine, inflation of the balloon47can avoid movement of this end portion. In addition, the inflated balloon47can avoid excessive air supply to the deep part in the small intestine and prevent accidental inflation of the small intestine during the therapy technique from being an obstacle of the therapy technique.

FIGS. 27 and 28show the illuminator10A according to a modification.

In this illuminator10A, the optical fiber bundle20is formed of a plurality of small optical fiber bundles20a,20b,20c,20c. . . having lengths different from each other. The distal end portions of these small optical fiber bundles are sequentially displaced and arranged, and form an illumination area extending along the axial direction. Additionally, the proximal end portions of the small optical fiber bundles extend to the proximal end portion side through the front side body23provided at the proximal end portion of the transparent sheath18and are connected to the LG connectors16a,16b,16c,16d, . . . optically connected to the light source device7. Further, the light source device7can perform at least one of changing a quantity of light to be supplied to the respective small optical fiber bundles20a,20b,20c,20d. . . , sequentially guiding the light and changing the wavelength. In this case, it is preferable to obtain the maximum illumination by increasing the number of the optical fibers in the small optical fiber bundle20aextending farthest to the distal end or supplying a maximum quantity of light.

It is to be noted that arranging on the same side all of the small optical fiber bundles20b,20c,20d. . . except the small optical fiber bundle20aextending farthest to the distal end as shown in the drawing is not required, and these small optical fiber bundles can be sequentially shifted and arranged in the circumferential direction and the axial direction with the small optical fiber bundle20ain the center as long as illumination of each small optical fiber bundle can be confirmed.

By using such an illuminator10A, a position of the distal end portion can be clearly displayed by using the brightest small optical fiber bundle10a. Furthermore, a traveling direction of the hollow organ as well as a position of the same can be readily confirmed based on a change in a quantity of light, blinking, colors of the small optical fiber bundles20b,20c,20d. . . shifted and arranged in the axial direction.

FIG. 29shows an illuminator10B according to still another modification.

A channel25into which the guide wire104can be inserted is provided for this illuminator10B. When inserting the illuminator10B into the hollow organ, the previously inserted guide wire104can be inserted into the channel25to reach a necessary position. If the end cap22is formed of stainless steel which is the X-ray impermeable material as described above, a position in the body cavity can be detected by fluoroscopy. Moreover, when detecting an insertion length, a marking similar to that of the guide tube40can be made to an appropriate position on the outer peripheral surface of the transparent sheath18.

As a result, only the illuminator10B can be inserted into the hollow organ without using the guide tubes40,40A and40B mentioned above. The guide wire104can be removed after the end cap22is arranged at a necessary position. The channel25can be used to suck a liquid or a gas.

FIG. 30shows a marker member11which generates at least one energy of energies including electromagnetic waves, radiation rays, ultrasonic waves and the like from the end portion in place of the light marker formed by the illuminators10,10A and10B mentioned above. The energy emitted from the end portion of such a marker member11can be detected through a sensor110caused to protrude from the forceps insertion duct12opened at the end portion of the treatment endoscope5.

It is to be noted that the respective members in the foregoing embodiments can be appropriately combined with each other and are not restricted to any single conformation.