Patent Publication Number: US-2019191983-A1

Title: Balloon guided endoscopy

Description:
INCORPORATION BY REFERENCE TO ANY PRIORITY APPLICATIONS 
     Any and all applications for which a foreign or domestic priority claim is identified in the Application Data Sheet as filed with the present application are hereby incorporated by reference under 37 CFR 1.57. 
     BACKGROUND OF THE INVENTION 
     Field of the Invention 
     The present invention relates to endoscopy generally and more particularly to endoscope guiding accessory. 
     Description of the Related Art 
     The following U.S. Patent Documents are believed to represent the current state of the art: 
     U.S. Pat. Nos. 4,195,637; 4,616,652 and 6,663,589 
     SUMMARY OF THE INVENTION 
     The present invention seeks to provide an endoscope guiding accessory. 
     There is thus provided in accordance with a preferred embodiment of the present invention apparatus for fluid supply to the interior of a portion of a tubular body portion including at least one first selectably extendible tubular body portion sealing element adapted to be located at a first location along a length of the tubular body portion and at least one second selectably extendible tubular body portion sealing element adapted to be located at a second location along the length, the at least one first selectably extendible tubular body portion sealing element and the at least one second selectably extendible tubular body portion sealing element being adapted to define an intermediate region of the length of the tubular body portion therebetween, a controller adapted for selectably sealing the at least one first and second tubular body portion sealing elements to the tubular body portion and fluid supply functionality adapted for supplying a fluid to the intermediate region. 
     Preferably, the apparatus for fluid supply also includes an endoscope at least partially extending along the tubular body portion. Preferably, the at least one first and second tubular body portion sealing elements are movable relative to each other along the length. 
     Preferably, at least one of the at least one first and second tubular body portion sealing elements includes a selectably inflatable balloon. Additionally, the selectably inflatable balloon includes a stretchable balloon. Alternatively, the selectably inflatable balloon includes a polyurethane balloon. 
     Preferably, the selectably inflatable balloon includes an anchoring balloon. 
     Preferably, at least one of the at least one first and second tubular body portion sealing elements is mounted on a distal portion of the endoscope. Alternatively or additionally, at least one of the at least one first and second tubular body portion sealing elements is located forward of the endoscope. 
     Preferably, the apparatus for fluid supply also includes fluid suction functionality for suctioning fluid from the intermediate region. 
     Preferably, the fluid supply functionality employs an instrument channel of the endoscope. 
     There is also provided in accordance with another preferred embodiment of the present invention apparatus for fluid supply to the interior of a portion of a tubular body portion including at least one tube including at least first, second and third lumens, a forward selectably inflatable balloon in fluid communication with the first lumen, the forward selectably inflatable balloon being adapted to seal the tubular body portion when inflated, a rear selectably inflatable balloon in fluid communication with the second lumen, the rear selectably inflatable balloon being adapted to seal the tubular body portion when inflated, a fluid supply outlet, located intermediate the forward and rear selectably inflatable balloons, the outlet being in fluid communication with the third lumen, a controller being adapted for selectably inflating the forward and rear selectably inflatable balloons within the tubular body portion, thereby to define an at least partially sealed intermediate region therebetween and fluid supply functionality adapted for supplying a fluid to the at least partially sealed intermediate region. 
     Preferably, the fluid supply functionality includes an external tube. 
     Preferably, the fluid supply functionality includes an external tube extending internally of the rear selectably inflatable balloon. 
     Preferably, the fluid is air. 
     Preferably, the fluid supply functionality is adapted to inflate the intermediate region of the tubular body portion. 
     There is further provided in accordance with yet another preferred embodiment of the present invention an endoscope assembly including an endoscope, an external tube extending alongside the endoscope and defining at least one lumen and an endoscope tool adapted to travel through the at least one lumen of the external tube, the endoscope tool including a selectably inflatable balloon. 
     Preferably, the selectably inflatable balloon is an anchoring balloon. 
     Preferably, the endoscope tool is bendable forwardly of the external tube. Additionally or alternatively, the endoscope tool is inflatable forwardly of the endoscope. Preferably, the endoscope tool is generally more flexible than the endoscope. 
     Preferably, the endoscope assembly also includes endoscopy functionality cooperating with the endoscope. Preferably, the endoscope assembly also includes a balloon inflation/deflation controller. Preferably, the external tube is adapted for insertion and removal of the endoscope tool therethrough. 
     Preferably, the endoscope tool includes a tube portion and a tip portion. Additionally, the tip portion is generally more flexible than the tube portion. 
     There is even further provided in accordance with still another preferred embodiment of the present invention an endoscope tool including a tube portion, a tip portion and a selectably inflatable balloon, the endoscope tool being adapted to travel through a lumen of an external tube. 
     Preferably the tip portion is generally more flexible than the tube portion. Additionally or alternatively, the inflatable balloon is mounted on the tube portion. Preferably, an interior portion of the inflatable balloon communicates with an interior portion of the tube portion in order to enable inflation of the inflatable balloon via the tube portion. Alternatively or additionally, the balloon is an anchoring balloon. 
     There is also provided in accordance with yet another preferred embodiment of the present invention an endoscope assembly including an endoscope, a selectably inflatable balloon mounted onto a distal portion of the endoscope and an external tube extending alongside the endoscope and traversing the selectably inflatable balloon. 
     Preferably, the external tube passes between the selectably inflatable balloon and the distal portion of the endoscope. 
     Preferably, the endoscope assembly also includes a tubular sleeve mounted onto the distal portion of the endoscope underlying the selectably inflatable balloon. Preferably, the external tube extends at least partially through a tubular passageway fixed to the distal portion of the endoscope. Additionally, the external tube is slidable within the tubular passageway. 
     Preferably, the tubular passageway extends through the tubular sleeve. Additionally or alternatively, the tubular passageway includes at least one relatively rigid reinforcement element which permits predetermined bending of the tubular passageway. Preferably, the reinforcement element includes a plurality of mutually spaced relatively rigid elements. Additionally, the mutually spaced relatively rigid elements are tubular. 
     Preferably, the endoscope assembly also includes a balloon inflation tube communicating with the selectably inflatable balloon. Additionally or alternatively, the selectably inflatable balloon is an anchoring balloon. 
     Preferably, the endoscope assembly also includes an accessory which is slidably insertable through the external tube to a location forward of the endoscope. 
     Preferably, the endoscope assembly also includes an endoscope tool at least part of which extends through the external tube, the endoscope tool including a selectably inflatable balloon. Additionally, the endoscope tool is slidably insertable through the external tube. Alternatively, the endoscope tool is not insertable through the external tube. 
     Preferably, the endoscope tool is slidably insertable through the tubular passageway. Alternatively, the endoscope tool is not insertable through the tubular passageway. 
     Preferably, the selectably inflatable balloon of the endoscope tool is an anchoring balloon. Additionally or alternatively, the selectably inflatable balloon of the endoscope tool is inflatable forward of the endoscope. 
     Preferably, the endoscope assembly also includes fluid supply functionality adapted for supplying a fluid via the external tube. 
     There is yet further provided in accordance with still another preferred embodiment of the present invention apparatus for medical interaction with a tubular body portion including at least one tube including at least first and second lumens, a forward selectably inflatable balloon in fluid communication with the first lumen, the forward selectably inflatable balloon being adapted to engage the tubular body portion when inflated, a controller being adapted for selectably inflating the forward selectably inflatable balloon and an accessory which is slidably insertable through the second lumen to a location rearward of the forward selectably inflatable balloon. 
     The term “medical interaction” includes for example, inspection, treatment, diagnosis, sampling, removal, marking and any other suitable medical activity. 
     Preferably, the at least one tube includes an endoscope. Additionally, the endoscope includes an instrument channel which defines the second lumen. 
     Preferably, the apparatus for medical interaction with a tubular body portion also includes an external tube through which slidably extends one of the at least one tube which defines the first lumen. 
     Preferably, the at least one tube includes an endoscope and an external tube and a balloon inflation tube defining the first lumen which slidably extends through the external tube. Additionally, the balloon inflation tube is generally more flexible than the endoscope. 
     Preferably, the forward selectably inflatable balloon is an anchoring balloon. Additionally or alternatively, the forward selectably inflatable balloon is selectably positionable forwardly of the endoscope. Alternatively or additionally, the apparatus for medical interaction with a tubular body portion also includes a rear selectably inflatable balloon. Additionally, the rear selectably inflatable balloon is an anchoring balloon. Alternatively, the rear selectably inflatable balloon is peripherally mounted on a distal portion of an endoscope. 
    
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
       The present invention will be understood and appreciated more fully from the following detailed description, taken in conjunction with the drawings in which: 
         FIG. 1  is a simplified pictorial illustration of an endoscopy system constructed and operative in accordance with a preferred embodiment of the present invention; 
         FIGS. 2, 3A, 3B, 4A and 4B  are respective simplified pictorial and sectional view illustrations of a portion of an endoscope and an auxiliary assembly constructed and operative in accordance with a preferred embodiment of the present invention; 
         FIG. 5  is a simplified pictorial illustration of an endoscopy system constructed and operative in accordance with another preferred embodiment of the present invention; 
         FIGS. 6, 7A, 7B, 8A, 8B, 8C and 8D  are respective simplified pictorial and sectional view illustrations of a portion of an endoscope and an auxiliary assembly constructed and operative in accordance with another preferred embodiment of the present invention; 
         FIG. 9  is a simplified pictorial illustration of an endoscopy system constructed and operative in accordance with yet another preferred embodiment of the present invention; 
         FIGS. 10, 11A, 11B, 12A, 12B and 12C  are respective simplified pictorial and sectional view illustrations of a portion of an endoscope and an auxiliary assembly constructed and operative in accordance with yet another preferred embodiment of the present invention; 
         FIG. 13  is a simplified pictorial illustration of an endoscopy system constructed and operative in accordance with further another preferred embodiment of the present invention; 
         FIGS. 14, 15A, 15B, 16A and 16B  are respective simplified pictorial and sectional view illustrations of a portion of an endoscope and an auxiliary assembly constructed and operative in accordance with further another preferred embodiment of the present invention; 
         FIGS. 17A, 17B, 17C, 17D, 17E, 17F, 17G, 17H, 17I and 17J  are simplified illustrations of various functionalities which may be provided by the systems of  FIGS. 13-16B ; and 
         FIGS. 18A and 18B  are simplified illustrations of a functionality which may be provided by the system of  FIGS. 13-16B . 
     
    
    
     DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENT 
     The terms “endoscope” and “endoscopy” are used throughout in a manner somewhat broader than their customary meaning and refer to apparatus and methods which operate within body cavities, passageways and the like, such as, for example, the small intestine, the large intestine, arteries and veins. Although these terms normally refer to visual inspection, as used herein they are not limited to applications which employ visual inspection and refer as well to apparatus, systems and methods which need not necessarily involve visual inspection. 
     The term “distal” refers to the remote end of an endoscope, accessory or tool furthest from the operator. 
     The term “proximal” refers to the end portion of an endoscope, accessory or tool closest to the operator, typically outside an organ or body portion of interest. 
     Reference is now made to  FIGS. 1-4B , which illustrate an endoscopy system constructed and operative in accordance with a preferred embodiment of the present invention and respective simplified pictorial and sectional view illustrations of an auxiliary assembly constructed and operative in accordance with a preferred embodiment of the present invention. 
     As seen in  FIGS. 1-4B  a conventional endoscopy system  100 , such as a console including a CV-100 video system center, a CLV-U20 light source, a SONY PVM-2030 video monitor, and an OFP flushing pump, all commercially available from Olympus America Inc. of 2 Corporate Center Drive, Melville, N.Y. 11747, USA, is being employed. The system preferably includes a conventional endoscope  101 , which forms part of conventional endoscopy system  100  such as a CIF-100 video enteroscope or a CF-Q160AL video colonoscope which is commercially available from Olympus America Inc. of 2 Corporate Center Drive, Melville, N.Y. 11747, USA. 
     In accordance with a preferred embodiment of the invention, an endoscopy auxiliary assembly  102  comprising a peripheral balloon  103  may be mounted onto endoscope  101  as shown, by means of a tubular sleeve  104  which is fixed over the distal portion of endoscope  101 , and is associated with peripheral balloon  103 . 
     It is appreciated that the tubular sleeve  104  may be constructed of a flexible and stretchable material, such as flexible and stretchable silicon, latex or rubber, thereby enabling it to conform with bending of endoscope  101 . It is further appreciated that tubular sleeve  104  may have an untensioned inner diameter slightly smaller than the diameter of endoscope  101 , thereby allowing it to be pulled and slid over the endoscope  101  when being stretched, while ensuring firm positioning at the desired location on the distal end of endoscope  101 . 
     Alternatively, tubular sleeve  104  may be constructed of a less stretchable material, such as polyurethane or nylon, and of an inner diameter slightly larger than that of endoscope  101 , thereby allowing it to be pulled and slid over endoscope  101 . Preferably tubular sleeve  104  is formed with a relatively thin wall allowing it to be compliant with the bending of endoscope  101 . It is appreciated that once positioned at a desired location, tubular sleeve  104  may be fastened to endoscope  101  by any suitable conventional means, such as a medical adhesive tape. 
     As illustrated in  FIGS. 1-4B , peripheral balloon  103  at least partially overlays tubular sleeve  104 , and is fixed thereon at both edges by any suitable conventional means such as an adhesive in order to define a sealed volume therebetween. Preferably inflation and deflation of peripheral balloon  103  is provided via a tube  106  communicating with the interior thereof. Tube  106  may be attached to endoscope  101  at multiple locations along its length by any suitable conventional means such as a medical adhesive tape. Alternatively, tube  106  may be detached from endoscope  101 . 
     It is appreciated that in accordance with a preferred embodiment of the present invention peripheral balloon  103  is generally stretchable, and can be inflated to a diameter about 3-10 times larger than its diameter when not inflated. In accordance with a preferred embodiment of the present invention, useful for small intestine endoscopy, the diameter of peripheral balloon  103  when fully inflated is in the range of 3-4 centimeters. 
     In a specific embodiment, useful for small intestine endoscopy, the diameter of the peripheral balloon, when it is fully inflated is four centimeters. Preferably, inflation of the peripheral balloon  103  to a diameter less than four centimeters may be achieved using relatively low pressure, such as in the range of 30-70 millibars. 
     In another specific embodiment, useful for large intestine endoscopy, the diameter of the peripheral balloon, when it is fully inflated is in the range of 4-6 centimeters. In a further embodiment, also useful for large intestine endoscopy, diameter of the peripheral balloon, when it is fully inflated is six centimeters. Preferably, inflation of the peripheral balloon  103  to a diameter less than six centimeters may be achieved using relatively low pressure, such as in the range of 30-70 millibars. 
     It is appreciated that in accordance with a preferred embodiment of the present invention, useful for in vivo inspection of a generally tubular body portion having a variable cross-sectional diameter, the expansion diameter range of peripheral balloon  103  is larger than the maximum cross-sectional diameter of the generally tubular body portion, thereby enabling engagement of expanded peripheral balloon  103  with the interior surface of the generally tubular body portion, and anchoring of the endoscope  101  thereto. Preferably, peripheral balloon  103  is a relatively soft, highly compliant balloon, operative to at least partially conform to the shape of the interior surface of the generally tubular body portion when in engagement therewith. 
     It is appreciated that peripheral balloon  103  may be formed of suitable well-known stretchable materials such as latex, flexible silicon, or highly flexible nylon. Alternatively, peripheral balloon  103  may be formed of polyurethane, which is less stretchable and conforming than latex, flexible silicon or highly flexible nylon. Preferably, the diameter of peripheral balloon  103  is sufficient to ensure tight anchoring at any part of the generally tubular body portion. 
     In a preferred embodiment of the present invention, endoscopy auxiliary assembly  102  may comprise at least one external tube  108 . External tube  108  may be attached to the endoscope  101  at multiple locations along its length by any suitable conventional means such as a medical adhesive tape. Alternatively, external tube  108  may be detached from the endoscope  101 . 
     It is appreciated that external tube  108  may be flexible and highly bendable, allowing it to be compliant with the bending of endoscope  101 . It is further appreciated that external tube  108  may be constructed of a low friction material, such as TEFLON®. 
     In a preferred embodiment of the present invention, external tube  108  may be inserted through a tubular passageway  109 , which extends longitudinally within tubular sleeve  104 . Alternatively, the tubular passageway may be located interiorly of the sleeve but external to the endoscope  101 . External tube  108  may be inserted fully or partially through tubular passageway  109 , and may be fixed to tubular sleeve  104  by any conventional means, such as by friction or by use of a suitable adhesive. Alternatively, external tube  108  may be slidable with respect to tubular passageway  109 . 
     An endoscope tool  110 , constructed and operative in accordance with a preferred embodiment of the present invention, extends through external tube  108 . Endoscope tool  110  preferably comprises a guiding tube  112 , which includes at least a first lumen  114  for inflation and deflation of a balloon  116  via an inflation aperture  118 . Preferably, the cross-sectional area of guiding tube  112  is sufficiently smaller than that of external tube  108 , so as to allow generally free passage of guiding tube  112  through external tube  108 , particularly when the external tube  108  is in a bent or curved state, and to allow supply of fluid for inflation or other uses and draining of fluid therethrough. 
     It is appreciated that guiding tube  112  may be flexible and highly bendable, so as to allow its compliance with the bending of endoscope  101  and with the curves of the intestine. It is further appreciated that guiding tube  112  may be constructed of a low friction material, such as TEFLON®. 
     Preferably, guiding tube  112  is sealed at its distal end forward of balloon  116  in any suitable manner such as by mechanical sealing or use of an appropriate adhesive, to facilitate inflation and deflation of balloon  116  through guiding tube  112 . 
     Preferably, endoscope tool  110  comprises a tip portion  119  located distally of balloon  116 . The tip portion  119  may be made of a highly flexible tube, such as a TYGON® tube, with a diameter of 1.5 millimeters. The tip portion  119  may be connected to the distal end of guiding tube  112  by any conventional means such as a suitable adhesive. In a preferred embodiment of the present invention the length of tip portion  119  is 20-30 millimeters. 
     It is appreciated that the high bendability of tip portion  119  prevents endoscope tool  110  from getting stuck in obstacles and bends as it advances through the generally tubular body portion, forward of endoscope  101 . 
     It is appreciated that in accordance with a preferred embodiment of the present invention the endoscope tool  110  and the guiding tube  112  are substantially more flexible than endoscope  101 . 
     It is further appreciated that in accordance with a preferred embodiment of the present invention the tube  106  is substantially more flexible than endoscope  101 . 
     It is appreciated that in accordance with yet another preferred embodiment of the present invention the external tube  108  is substantially more flexible than endoscope  101 . 
     It is appreciated that in accordance with a preferred embodiment of the present invention balloon  116  is generally stretchable, and can be inflated to a diameter about 5-20 times larger than its diameter when not inflated. In a specific embodiment, useful for small intestine endoscopy, the balloon diameter when fully inflated is in the range of 3-4 centimeters. In a specific embodiment, useful for small intestine endoscopy, the balloon diameter when fully inflated is four centimeters. Preferably, inflation of the balloon  116  to a diameter less than four centimeters may be achieved using relatively low pressure, such as in the range of 30-70 millibars. In accordance with another preferred embodiment of the present invention, useful for large intestine endoscopy, the balloon diameter when fully inflated is in the range of 4-6 centimeters. In another specific embodiment, useful for large intestine endoscopy, the balloon diameter when fully inflated is six centimeters. Preferably, inflation of the balloon  116  to a diameter less than six centimeters may be achieved using relatively low pressure, such as in the range of 30-70 millibars. 
     It is appreciated that in accordance with a preferred embodiment of the present invention which is particularly useful for in vivo inspection of a generally tubular body portion having a variable cross-sectional diameter, the expansion range of the diameter of balloon  116  is larger than the maximum cross-sectional diameter of the generally tubular body portion, thereby enabling engagement of expanded balloon  116  with the interior surface of the generally tubular body portion, and anchoring of the endoscope tool  110  thereto. Preferably, balloon  116  is a relatively soft, highly compliant balloon, operative to at least partially conform to the shape of the interior surface of the generally tubular body portion when in engagement therewith. 
     It is appreciated that balloon  116  may be formed of well-known stretchable materials such as latex, flexible silicon, or highly flexible nylon. Alternatively, balloon  116  may be formed of polyurethane, which is less stretchable and conforming than latex, flexible silicon or highly flexible nylon. Preferably, the diameter of balloon  116  is sufficient to ensure tight anchoring at any location in the generally tubular body portion. 
     As seen in  FIG. 1 , the endoscope tool  110  preferably includes a balloon inflation/deflation control interface  122  which communicates with guiding tube  112  at a proximal portion  123  thereof which extends outwardly of a proximal end  124  of external tube  108  and governs inflation and deflation of balloon  116 . Additionally, there is preferably provided a peripheral balloon inflation/deflation control interface  125 , which communicates with tube  106  and governs inflation and deflation of peripheral balloon  103 . 
     Preferably, proximal end  124  of external tube  108  is fixed to the proximal portion of endoscope  101  adjacent to an operator control  129  of endoscope  101 , by a band  132  or by any other suitable conventional means, such as a clips or medical adhesive tape. 
     Preferably, the operator positions balloon  116  at a desired location forward of the distal end of endoscope  101  within the generally tubular body portion, by controlled pulling or pushing of the proximal portion  123  of guiding tube  112 , relative to the proximal end  124  of external tube  108 . 
       FIG. 4A  shows rearward positioning of endoscope tool  110  in which the balloon  116  is located just ahead of the distal end of endoscope  101 . The rearward positioning is preferably accomplished by pulling the proximal portion  123  of guiding tube  112  rearwardly relative to the proximal end  124  of external tube  108 . 
       FIG. 4B  shows forward positioning of endoscope tool  110  in which the balloon  116  is located a substantial distance forward of the distal end of endoscope  101 . The forward positioning is preferably accomplished by pushing the proximal portion  123  of guiding tube  112  forwardly relative to the proximal end  124  of external tube  108 . 
     It is appreciated that controlled positioning of the endoscope tool  110  at desired distances forward of the distal end of endoscope  101  may be achieved by suitable controlled positioning of the proximal portion  123  of guiding tube  112  relative to the proximal end  124  of external tube  108 . 
     It is appreciated that in accordance with a preferred embodiment of the present invention useful for in vivo inspection of a generally tubular body portion having a variable cross-sectional diameter, balloon  116  may be controllably positioned in a range of 0-45 centimeters forward of the distal end of endoscope  101 . 
     As seen in  FIGS. 4A and 4B , balloon  116  is fixed to guiding tube  112  via a forward balloon sleeve portion  144  and via a rear balloon sleeve portion  146 , both of which are preferably integrally formed with balloon  116 . As seen in  FIG. 4A , the outer cross sectional diameter of rear sleeve portion  146  is larger than the inner cross sectional diameter of external tube  108  and larger than the inner cross sectional diameter of tubular passageway  109 , thereby preventing balloon  116  from being inserted through external tube  108  and through tubular passageway  109 . 
     It is appreciated that rear sleeve portion  146  may function as a stopper that prevents further pulling of guiding tube  112  when rear sleeve portion  146  is in contact with tubular sleeve  104  or with external tube  108 . 
     Reference is now made to  FIGS. 5-8D , which are respectively a simplified pictorial illustration of an endoscopy system constructed and operative in accordance with another preferred embodiment of the present invention and respective simplified pictorial and sectional view illustrations of an auxiliary assembly constructed and operative in accordance with another preferred embodiment of the present invention. 
     As seen in  FIGS. 5-8D  a conventional endoscopy system  200 , such as a console including a CV-100 video system center, a CLV-U20 light source, a SONY PVM-2030 video monitor, and an OFP flushing pump, all commercially available from Olympus America Inc. of 2 Corporate Center Drive, Melville, N.Y. 11747, USA, is being employed. The system preferably includes a conventional endoscope  201 , which forms part of conventional endoscopy system  200  such as a CIF-100 video enteroscope or a CF-Q160AL video colonoscope which is commercially available from Olympus America Inc. of 2 Corporate Center Drive, Melville, N.Y. 11747, USA. 
     In accordance with a preferred embodiment of the invention, an endoscopy auxiliary assembly  202  comprising a peripheral balloon  203  may be mounted onto endoscope  201  as shown, by means of a tubular sleeve  204  which is fixed over the distal portion of endoscope  201 , and is associated with peripheral balloon  203 . It is appreciated that the tubular sleeve  204  may be constructed of a flexible and stretchable material, such as flexible and stretchable silicon, latex or rubber, thereby enabling it to conform with bending of endoscope  201 . It is further appreciated that tubular sleeve  204  may have a an untensioned inner diameter slightly smaller than the diameter of endoscope  201 , thereby allowing it to be pulled and slid over the endoscope  201  when being stretched, while ensuring firm positioning at the desired location on the distal end of endoscope  201 . 
     Alternatively, tubular sleeve  204  may be constructed of a less stretchable material, such as polyurethane or nylon, and of an inner diameter slightly larger than that of endoscope  201 , thereby allowing it to be pulled and slid over endoscope  201 . Preferably tubular sleeve  204  is formed with a relatively thin wall allowing it to be compliant with the bending of endoscope  201 . It is appreciated that once positioned at a desired location, tubular sleeve  204  may be fastened to endoscope  201  by any suitable conventional means, such as a medical adhesive tape. 
     As illustrated in  FIGS. 5-8D , peripheral balloon  203  at least partially overlays tubular sleeve  204 , and is fixed thereon at both edges by any suitable conventional means such as an adhesive in order to define a sealed volume therebetween. Preferably inflation and deflation of peripheral balloon  203  is provided via a tube  206  communicating with the interior thereof. Tube  206  may be attached to endoscope  201  at multiple locations along its length by any suitable conventional means such as a medical adhesive tape. Alternatively, tube  206  may be detached from endoscope  201 . 
     It is appreciated that in accordance with a preferred embodiment of the present invention peripheral balloon  203  is generally stretchable, and can be inflated to a diameter about 3-10 times larger than its diameter when not inflated. In accordance with a preferred embodiment of the present invention, useful for small intestine endoscopy, the diameter of peripheral balloon  203  when fully inflated is in the range of 3-4 centimeters. In a specific embodiment, useful for small intestine endoscopy, the diameter of the peripheral balloon diameter when it is fully inflated is four centimeters. Preferably, inflation of the peripheral balloon  203  to a diameter less than four centimeters may be achieved using relatively low pressure, such as in the range of 30-70 millibars. 
     In another specific embodiment useful for large intestine endoscopy, the diameter of the peripheral balloon when it is fully inflated is in the range of 4-6 centimeters. In a further embodiment, also useful for large intestine endoscopy, diameter of the peripheral balloon, when it is fully inflated is six centimeters. Preferably, inflation of the peripheral balloon  203  to a diameter less than six centimeters may be achieved using relatively low pressure, such as in the range of 30-70 millibars. 
     It is appreciated that in accordance with a preferred embodiment of the present invention, useful for in vivo inspection of a generally tubular body portion having a variable cross-sectional diameter, the expansion diameter range of peripheral balloon  203  is larger than the maximum cross-sectional diameter of the generally tubular body portion, thereby enabling engagement of expanded peripheral balloon  203  with the interior surface of the generally tubular body portion, and anchoring of the endoscope  201  thereto. Preferably, peripheral balloon  203  is a relatively soft, highly compliant balloon, operative to at least partially conform to the shape of the interior surface of the generally tubular body portion when in engagement therewith. 
     It is appreciated that peripheral balloon  203  may be formed of suitable well-known stretchable materials such as latex, flexible silicon, or highly flexible nylon. Alternatively, peripheral balloon  203  may be formed of polyurethane, which is less stretchable and conforming than latex, flexible silicon or highly flexible nylon. Preferably, the diameter of peripheral balloon  203  is sufficient to ensure tight anchoring at any part of the generally tubular body portion. 
     In a preferred embodiment of the present invention, endoscopy auxiliary assembly  202  may comprise at least one external tube  208 . External tube  208  may be attached to the endoscope  201  at multiple locations along its length by any suitable conventional means such as a medical adhesive tape. Alternatively, external tube  208  may be detached from the endoscope  201 . 
     It is appreciated that external tube  208  may be flexible and highly bendable, allowing it to be compliant with the bending of endoscope  201 . It is further appreciated that external tube  208  may be constructed of a low friction material, such as TEFLON®. 
     In a preferred embodiment of the present invention, external tube  208  may be inserted through a tubular passageway  209 , which extends longitudinally within tubular sleeve  204 . Alternatively, the tubular passageway may be located interiorly of the sleeve but external to the endoscope  201 . External tube  208  may be inserted fully or partially through tubular passageway  209 , and may be fixed to tubular sleeve  204  by any conventional means, such as by friction or by use of a suitable adhesive. Alternatively, external tube  208  may be slidable with respect to tubular passageway  209 . 
     An endoscope tool  210 , constructed and operative in accordance with a preferred embodiment of the present invention, extends through external tube  208 . Endoscope tool  210  preferably comprises a guiding tube  212 , which includes at least a first lumen  214  for inflation and deflation of a balloon  216  via an inflation aperture  218 . Preferably, the cross-sectional area of guiding tube  212  is sufficiently smaller than that of external tube  208 , so as to allow generally free passage of guiding tube  212  through external tube  208 , particularly when the external tube  208  is in a bent or curved state, and to allow supply of fluid for inflation or other uses and draining of fluid therethrough. 
     It is appreciated that guiding tube  212  may be flexible and highly bendable, so as to allow its compliance with the bending of endoscope  201  and with the curves of the intestine. It is further appreciated that guiding tube  212  may be constructed of a low friction material, such as TEFLON®. 
     Preferably, guiding tube  212  is sealed at its distal end forward of balloon  216  in any suitable manner such as by mechanical sealing or use of an appropriate adhesive, to facilitate inflation and deflation of balloon  216  through guiding tube  212 . 
     Preferably, endoscope tool  210  may comprise a tip portion  219  located distally of balloon  216 . The tip portion  219  may be made of a highly flexible tube, such as a TYGON® tube, with a diameter of 1.5 millimeters. The tip portion  219  may be connected to the distal end of guiding tube  212  by any conventional means such as a suitable adhesive. In a preferred embodiment of the present invention the length of tip portion  219  is 20-30 millimeters. 
     It is appreciated that the high bendability of tip portion  219  prevents endoscope tool  210  from getting stuck in obstacles and bends as it advances through the generally tubular body portion, forward of endoscope  201 . 
     It is appreciated that in accordance with a preferred embodiment of the present invention the endoscope tool  210  and the guiding tube  212  are substantially more flexible than endoscope  201 . 
     It is further appreciated that in accordance with a preferred embodiment of the present invention the tube  206  is substantially more flexible than endoscope  201 . 
     It is appreciated that in accordance with yet another preferred embodiment of the present invention the external tube  208  is substantially more flexible than endoscope  201 . 
     It is appreciated that in accordance with a preferred embodiment of the present invention the balloon  216  is generally stretchable, and can be inflated to a diameter about 5-20 times larger than its diameter when not inflated. In a specific embodiment useful for small intestine endoscopy, the balloon diameter when fully inflated is in the range of 3-4 centimeters. In a specific embodiment, useful for small intestine endoscopy, the balloon diameter when fully inflated is four centimeters. Preferably, inflation of the balloon  216  to a diameter less than four centimeters may be achieved using relatively low pressure, such as in the range of 30-70 millibars. 
     In another preferred embodiment of the present invention, useful for large intestine endoscopy, the balloon diameter when fully inflated is in the range of 4-6 centimeters. In another specific embodiment, useful for large intestine endoscopy, the balloon diameter when fully inflated is six centimeters. Preferably, inflation of the balloon  216  to a diameter less than six centimeters may be achieved using relatively low pressure, such as in the range of 30-70 millibars. 
     It is appreciated that in accordance with a preferred embodiment of the present invention which is particularly useful for in vivo inspection of a generally tubular body portion having a variable cross-sectional diameter, the expansion range of the diameter of balloon  216  is larger than the maximum cross-sectional diameter of the generally tubular body portion, thereby enabling engagement of expanded balloon  216  with the interior surface of the generally tubular body portion, and anchoring of the endoscope tool  210  thereto. Preferably, balloon  216  is a relatively soft, highly compliant balloon, operative to at least partially conform to the shape of the interior surface of the generally tubular body portion when in engagement therewith. 
     It is appreciated that balloon  216  may be formed of well-known stretchable materials such as latex, flexible silicon, or highly flexible nylon. Alternatively, balloon  216  may be formed of polyurethane, which is less stretchable and conforming than latex, flexible silicon or highly flexible nylon. Preferably, the diameter of balloon  216  is sufficient to ensure tight anchoring at any location in the generally tubular body portion. 
     As seen in  FIG. 5 , the endoscope tool  210  preferably includes a balloon inflation/deflation control interface  222  which communicates with guiding tube  212  at a proximal portion  223  thereof which extends outwardly of a proximal end  224  of external tube  208  and governs inflation and deflation of balloon  216 . Additionally, there is preferably provided a peripheral balloon inflation/deflation control interface  225 , which communicates with tube  206  and governs inflation and deflation of peripheral balloon  203 . 
     Preferably, the proximal end  224  of external tube  208  is fixed to the proximal portion of endoscope  201  adjacent to an operator control  229  of endoscope  201 , by a band  232  or by any other suitable conventional means, such as a clips or medical adhesive tape. 
     Preferably, the operator positions balloon  216  at a desired location forward of the distal end of endoscope  201  within the generally tubular body portion, by controlled pulling or pushing of the proximal portion  223  of guiding tube  212 , relative to the proximal end  224  of external tube  208 . 
       FIG. 8A  shows rearward positioning of endoscope tool  210  in which the balloon  216  is located just ahead of the distal end of endoscope  201 . The rearward positioning is preferably accomplished by pulling the proximal portion  223  of guiding tube  212  rearwardly relative to the proximal end  224  of external tube  208 . 
       FIG. 8B  shows forward positioning of endoscope tool  210  in which the balloon  216  is located a substantial distance forward of the distal end of endoscope  201 . The forward positioning is preferably accomplished by pushing the proximal portion  223  of guiding tube  212  forwardly relative to the proximal end  224  of external tube  208 . 
     It is appreciated that controlled positioning of the endoscope tool  210  at desired distances forward of the distal end of endoscope  201  may be achieved by suitable controlled positioning of the proximal portion  223  of guiding tube  212  relative to the proximal end  224  of external tube  208 . 
     It is appreciated that in accordance with a preferred embodiment of the present invention useful for in vivo inspection of a generally tubular body portion having a variable cross-sectional diameter, balloon  216  may be controllably positioned in a range of 0-45 centimeters forward of the distal end of endoscope  201 . 
     As seen in  FIGS. 8A-8D , balloon  216  is fixed to guiding tube  212  via a forward balloon sleeve portion  244  and a rear balloon sleeve portion  246 . As seen in  FIG. 8C , the cross sectional diameters of balloon  216  in a deflated state and of rear sleeve portion  246  are smaller than the inner cross sectional diameter of external tube  208  and of tubular passageway  209 , thereby allowing balloon  216  to be inserted through tubular passageway  209  and through external tube  208 . It is appreciated that the distal portion of endoscope tool  210 , including balloon  216  and tip portion  219 , may be entirely or partially positioned within tubular passageway  209  and external tube  208 . It is further appreciated that endoscope tool  210  may be partially or entirely pulled out and be extracted from external tube  208  if applicable. It is yet further appreciated that endoscope tool  210  may be inserted or re-inserted through external tube  208  if applicable, such as for positioning or re-positioning of balloon  216  forward of the distal end of endoscope  201 . 
     As seen in  FIG. 8D , an accessory  250  may be inserted through external tube  208  for medical interaction with a location in the generally tubular body portion forward of the distal end of endoscope  201 . 
     The term “medical interaction” includes for example, inspection, treatment, diagnosis, sampling, removal, marking and any other suitable medical activity. 
     Accessory  250  may include any conventional accessory such as biopsy forceps, polyp cutter, injection needle, or ultrasound device. It is appreciated that accessory  250  may be inserted instead of or alongside endoscope tool  210 . It is further appreciated that accessory  250  may be inserted through an additional external tube (not shown) in case that endoscopy auxiliary assembly  202  comprises more than one external tube  208 . 
     Reference is now made to  FIGS. 9-12C , which are respectively a simplified pictorial illustration of an endoscopy system constructed and operative in accordance with a preferred embodiment of the present invention and respective simplified pictorial and sectional view illustrations of an auxiliary assembly constructed and operative in accordance with a preferred embodiment of the present invention. 
     As seen in  FIGS. 9-12C  a conventional endoscopy system  300 , such as a console including a CV-100 video system center, a CLV-U20 light source, a SONY PVM-2030 video monitor, and an OFP flushing pump, all commercially available from Olympus America Inc. of 2 Corporate Center Drive, Melville, N.Y. 11747, USA, is being employed. The system preferably includes a conventional endoscope  301 , which forms part of conventional endoscopy system  300  such as a CIF-100 video enteroscope or a CF-Q160AL video colonoscope which is commercially available from Olympus America Inc. of 2 Corporate Center Drive, Melville, N.Y. 11747, USA. 
     In accordance with a preferred embodiment of the invention, an endoscopy auxiliary assembly  302  comprising a peripheral balloon  303  may be mounted onto endoscope  301  as shown, by means of a tubular sleeve  304  which is fixed over the distal portion of endoscope  301 , and is associated with peripheral balloon  303 . 
     It is appreciated that the tubular sleeve  304  may be constructed of a flexible and stretchable material, such as flexible and stretchable silicon, latex or rubber, thereby enabling it to conform with bending of endoscope  301 . It is further appreciated that tubular sleeve  304  may have an untensioned inner diameter slightly smaller than the diameter of endoscope  301 , thereby allowing it to be pulled and slid over the endoscope  301  when being stretched, while ensuring firm positioning at the desired location on the distal end of endoscope  301 . 
     Alternatively, tubular sleeve  304  may be constructed of a less stretchable material, such as polyurethane or nylon, and of an inner diameter slightly larger than that of endoscope  301 , thereby allowing it to be pulled and slid over the endoscope  301 . Preferably tubular sleeve  304  is formed with a relatively thin wall allowing it to be compliant with the bending of endoscope  301 . It is appreciated that once positioned at a desired location, tubular sleeve  304  may be fastened to endoscope  301  by any suitable conventional means, such as a medical adhesive tape. 
     As illustrated in  FIGS. 9-12C , peripheral balloon  303  at least partially overlays tubular sleeve  304 , and is fixed thereon at both edges by any suitable conventional means such as an adhesive in order to define a sealed volume therebetween. Preferably inflation and deflation of peripheral balloon  303  is provided via a tube  306  communicating with the interior thereof. Tube  306  may be attached to endoscope  301  at multiple locations along its length by any suitable conventional means such as a medical adhesive tape. Alternatively, tube  306  may be detached from endoscope  301 . 
     It is appreciated that in accordance with a preferred embodiment of the present invention peripheral balloon  303  is generally stretchable, and can be inflated to a diameter about 3-10 times larger than its diameter when not inflated. In accordance with a preferred embodiment of the present invention, useful for small intestine endoscopy, the diameter of peripheral balloon  303  when fully inflated is in the range of 3-4 centimeters. 
     In a specific embodiment, useful for small intestine endoscopy, the diameter of the peripheral balloon when it is fully inflated is four centimeters. Preferably, inflation of the peripheral balloon  303  to a diameter less than four centimeters may be achieved using relatively low pressure, such as in the range of 30-70 millibars. 
     In another specific embodiment, useful for large intestine endoscopy, the diameter of the peripheral balloon when it is fully inflated is in the range of 4-6 centimeters. In a further embodiment, also useful for large intestine endoscopy, diameter of the peripheral balloon when it is fully inflated is six centimeters. Preferably, inflation of the peripheral balloon  303  to a diameter less than six centimeters may be achieved using relatively low pressure, such as in the range of 30-70 millibars. 
     It is appreciated that in accordance with a preferred embodiment of the present invention useful for in vivo inspection of a generally tubular body portion having a variable cross-sectional diameter, the expansion diameter range of peripheral balloon  303  is larger than the maximum cross-sectional diameter of the generally tubular body portion, thereby enabling engagement of expanded peripheral balloon  303  with the interior surface of the generally tubular body portion, and anchoring of the endoscope  301  thereto. Preferably, peripheral balloon  303  is a relatively soft, highly compliant balloon, operative to at least partially conform to the shape of the interior surface of the generally tubular body portion when in engagement therewith. 
     It is appreciated that peripheral balloon  303  may be formed of suitable well-known stretchable materials such as latex, flexible silicon, or highly flexible nylon. Alternatively, peripheral balloon  303  may be formed of polyurethane, which is less stretchable and conforming than latex, flexible silicon or highly flexible nylon. Preferably, the diameter of peripheral balloon  303  is sufficient to ensure tight anchoring at any part of the generally tubular body portion. 
     In a preferred embodiment of the present invention, endoscopy auxiliary assembly  302  may comprise at least one external tube  308 . External tube  308  may be attached to the endoscope  301  at multiple locations along its length by any suitable conventional means such as a medical adhesive tape. Alternatively, external tube  308  may be detached from the endoscope  301 . 
     It is appreciated that external tube  308  may be flexible and highly bendable, allowing it to be compliant with the bending of endoscope  301 . It is further appreciated that external tube  308  may be constructed of a low friction material, such as TEFLON®. 
     In a preferred embodiment of the present invention, external tube  308  may be inserted through a tubular passageway  309  which extends longitudinally within tubular sleeve  304 . Alternatively, the tubular passageway may be located interiorly of the sleeve but external to the endoscope  301 . External tube  308  may be inserted fully or partially through tubular passageway  309 , and may be fixed to tubular sleeve  304  by any conventional means, such as by friction or by use of a suitable adhesive. Alternatively, external tube  308  may be slidable with respect to tubular passageway  309 . 
     An endoscope tool  310 , constructed and operative in accordance with a preferred embodiment of the present invention, extends through external tube  308 . Endoscope tool  310  preferably comprises a guiding tube  312 , which includes at least a first lumen  314  for inflation and deflation of a balloon  316  via an inflation aperture  318 . Preferably, the cross-sectional area of guiding tube  312  is sufficiently smaller than that of external tube  308 , so as to allow generally free passage of guiding tube  312  through external tube  308 , particularly when the external tube  308  is in a bent or curved state, and to allow supply of fluid for inflation or other uses and draining of fluid therethrough. 
     It is appreciated that guiding tube  312  may be flexible and highly bendable, so as to allow its compliance with the bending of endoscope  301  and with the curves of the intestine. It is further appreciated that guiding tube  312  may be constructed of a low friction material, such as TEFLON®. 
     Preferably, guiding tube  312  is sealed at its distal end forward of balloon  316  in any suitable manner such as by mechanical sealing or use of an appropriate adhesive, to facilitate inflation and deflation of balloon  316  through guiding tube  312 . 
     Preferably, endoscope tool  310  may comprise a tip portion  319  located distally of balloon  316 . The tip portion  319  may be made of a highly flexible tube, such as a TYGON® tube, with a diameter of 1.5 millimeters. The tip portion  319  may be connected to the distal end of guiding tube  312  by any conventional means such as a suitable adhesive. In a preferred embodiment of the present invention the length of tip portion  319  is 20-30 millimeters. 
     It is appreciated that the high bendability of tip portion  319  prevents endoscope tool  310  from getting stuck in obstacles and bends as it advances through the generally tubular body portion, forward of endoscope  301 . 
     It is appreciated that in accordance with a preferred embodiment of the present invention the endoscope tool  310  and the guiding tube  312  are substantially more flexible than endoscope  301 . 
     It is further appreciated that in accordance with a preferred embodiment of the present invention the tube  306  is generally more flexible than endoscope  301 . 
     It is appreciated that in accordance with yet another preferred embodiment of the present invention the external tube  308  is substantially more flexible than endoscope  301 . 
     It is appreciated that in accordance with a preferred embodiment of the present invention balloon  316  is generally stretchable, and can be inflated to a diameter about 5-20 times larger than its diameter when not inflated. In a specific embodiment, useful for small intestine endoscopy, the balloon diameter when fully inflated is in the range of 3-4 centimeters. In a specific embodiment, useful for small intestine endoscopy, the balloon diameter when fully inflated is four centimeters. Preferably, inflation of the balloon  316  to a diameter less than four centimeters may be achieved using relatively low pressure, such as in the range of 30-70 millibars. 
     In another preferred embodiment of the present invention, useful for large intestine endoscopy, the balloon diameter when fully inflated is in the range of 4-6 centimeters. In another specific embodiment, useful for large intestine endoscopy, the balloon diameter when fully inflated is six centimeters. Preferably, inflation of the balloon  316  to a diameter less than six centimeters may be achieved using relatively low pressure, such as in the range of 30-70 millibars. 
     It is appreciated that in accordance with a preferred embodiment of the present invention which is particularly useful for in vivo inspection of a generally tubular body portion having a variable cross-sectional diameter, the expansion range of the diameter of balloon  316  is larger than the maximum cross-sectional diameter of the generally tubular body portion, thereby enabling engagement of expanded balloon  316  with the interior surface of the generally tubular body portion, and anchoring of the endoscope tool  310  thereto. Preferably, balloon  316  is a relatively soft, highly compliant balloon, operative to at least partially conform to the shape of the interior surface of the generally tubular body portion when in engagement therewith. 
     It is appreciated that balloon  316  may be formed of well-known stretchable materials such as latex, flexible silicon, or highly flexible nylon. Alternatively, balloon  316  may be formed of polyurethane, which is less stretchable and conforming than latex, flexible silicon or highly flexible nylon. Preferably, the diameter of balloon  316  is sufficient to ensure tight anchoring at any location in the generally tubular body portion. 
     As seen in  FIG. 9 , the endoscope tool  310  preferably includes a balloon inflation/deflation control interface  322  which communicates with guiding tube  312  at a proximal portion  323  thereof which extends outwardly of a proximal end  324  of external tube  308  and governs inflation and deflation of balloon  316 . Additionally, there is preferably provided a peripheral balloon inflation/deflation control interface  325 , which communicates with tube  306  and governs inflation and deflation of peripheral balloon  303 . 
     Preferably, proximal end  324  of external tube  308  is fixed to the proximal portion of endoscope  301  adjacent to an operator control  329  of endoscope  301 , by a band  332  or by any other suitable conventional means, such as a clips or medical adhesive tape. 
     Preferably, the operator positions balloon  316  at a desired location forward of the distal end of endoscope  301  within the generally tubular body portion, by controlled pulling or pushing of the proximal portion  323  of guiding tube  312 , relative to the proximal end  324  of external tube  308 . 
       FIG. 12A  shows rearward positioning of endoscope tool  310  in which the balloon  316  is located just ahead of the distal end of endoscope  301 . The rearward positioning is preferably accomplished by pulling the proximal portion  323  of guiding tube  312  rearwardly relative to the proximal end  324  of external tube  308 . 
       FIG. 12B  shows forward positioning of endoscope tool  310  in which the balloon  316  is located a substantial distance forward of the distal end of endoscope  301 . The forward positioning is preferably accomplished by pushing the proximal portion  323  of guiding tube  312  forwardly relative to the proximal end  324  of external tube  308 . 
     It is appreciated that controlled positioning of the endoscope tool  310  at desired distances forward of the distal end of endoscope  301  may be achieved by suitable controlled positioning of the proximal portion  323  of guiding tube  312  relative to the proximal end  324  of external tube  308 . 
     It is appreciated that in accordance with a preferred embodiment of the present invention useful for in vivo inspection of a generally tubular body portion having a variable cross-sectional diameter, balloon  316  may be controllably positioned in a range of 0-45 centimeters forward of the distal end of endoscope  301 . 
     As seen in  FIGS. 12A-12C , balloon  316  is fixed to guiding tube  312  via a forward balloon sleeve portion  344  and a rear balloon sleeve portion  346 . As seen in  FIG. 12C , the cross sectional diameter of rear sleeve portion  346  is larger than the inner cross sectional diameter of external tube  308 , thereby preventing balloon  316  from being inserted through external tube  308 . As further seen in  FIG. 12C , the cross sectional diameters of balloon  316  in a deflated state and of rear sleeve portion  346  are smaller than the inner cross sectional diameter of tubular passageway  309 , thereby allowing balloon  316  to be inserted through tubular passageway  309 . It is appreciated that the distal portion of endoscope tool  310 , including balloon  316  and tip portion  319 , may be entirely or partially positioned within tubular passageway  309 . 
     It is appreciated that rear sleeve portion  346  may function as a stopper that prevents further pulling of guiding tube  312  when rear sleeve portion  346  is in contact with external tube  308 , inside tubular sleeve  309 . 
     Reference is now made to  FIGS. 13-16B , which are respectively a simplified pictorial illustration of an endoscopy system constructed and operative in accordance with a preferred embodiment of the present invention and respective simplified pictorial and sectional view illustrations of an auxiliary assembly constructed and operative in accordance with a preferred embodiment of the present invention. 
     As seen in  FIGS. 13-16B  a conventional endoscopy system  400 , such as a console including a CV-100 video system center, a CLV-U20 light source, a SONY PVM-2030 video monitor, and an OFP flushing pump, all commercially available from Olympus America Inc. of 2 Corporate Center Drive, Melville, N.Y. 11747, USA, is being employed. The system preferably includes a conventional endoscope  401 , which forms part of conventional endoscopy system  400 , such as a CIF-100 video enteroscope or a CF-Q160AL video colonoscope which is commercially available from Olympus America Inc. of 2 Corporate Center Drive, Melville, N.Y. 11747, USA. 
     In accordance with a preferred embodiment of the invention, an endoscopy auxiliary assembly  402  comprising a peripheral balloon  403  may be mounted onto endoscope  401  as shown, by means of a tubular sleeve  404  which is fixed over the distal portion of endoscope  401 , and is associated with peripheral balloon  403 . It is appreciated that the tubular sleeve  404  may be constructed of a flexible and stretchable material, such as flexible and stretchable silicon, latex or rubber, thereby enabling it to conform with bending of endoscope  401 . It is further appreciated that tubular sleeve  404  may have an untensioned inner diameter slightly smaller than the diameter of endoscope  401 , thereby allowing it to be pulled and slid over the endoscope  401  when being stretched, while ensuring firm positioning at the desired location on the distal end of endoscope  401 . 
     Alternatively, tubular sleeve  404  may be constructed of a less stretchable material, such as polyurethane or nylon, and of an inner diameter slightly larger than that of endoscope  401 , thereby allowing it to be pulled and slid over endoscope  401 . Preferably tubular sleeve  404  is formed with a relatively thin wall allowing it to be compliant with the bending of endoscope  401 . It is appreciated that once positioned at a desired location, tubular sleeve  404  may be fastened to endoscope  401  by any suitable conventional means, such as a medical adhesive tape. 
     As illustrated in  FIGS. 13-16B , peripheral balloon  403  at least partially overlays tubular sleeve  404 , and is fixed thereon at both edges by any suitable conventional means such as an adhesive in order to define a sealed volume therebetween. Preferably inflation and deflation of peripheral balloon  403  is provided via a tube  406  communicating with the interior thereof. Tube  406  may be attached to endoscope  401  at multiple locations along its length by any suitable conventional means such as a medical adhesive tape. Alternatively, tube  406  may be detached from endoscope  401 . 
     It is appreciated that in accordance with a preferred embodiment of the present invention peripheral balloon  403  is generally stretchable, and can be inflated to a diameter about 3-10 times larger than its diameter when not inflated. In accordance with a preferred embodiment of the present invention, useful for small intestine endoscopy, the diameter of peripheral balloon  403  when fully inflated is in the range of 3-4 centimeters. 
     In a specific embodiment, useful for small intestine endoscopy, the diameter of the peripheral balloon diameter when it is fully inflated is four centimeters. Preferably, inflation of the peripheral balloon  403  to a diameter less than four centimeters may be achieved using relatively low pressure, such as in the range of 30-70 millibars. 
     In another specific embodiment, useful for large intestine endoscopy, the diameter of the peripheral balloon when it is fully inflated is in the range of 4-6 centimeters. In a further embodiment, also useful for large intestine endoscopy, diameter of the peripheral balloon when it is fully inflated is six centimeters. Preferably, inflation of the peripheral balloon  403  to a diameter less than six centimeters may be achieved using relatively low pressure, such as in the range of 30-70 millibars. 
     It is appreciated that in accordance with a preferred embodiment of the present invention useful for in vivo inspection of a generally tubular body portion having a variable cross-sectional diameter, the expansion diameter range of peripheral balloon  403  is larger than the maximum cross-sectional diameter of the generally tubular body portion, thereby enabling engagement of expanded peripheral balloon  403  with the interior surface of the generally tubular body portion, and anchoring of the endoscope  401  thereto. Preferably, peripheral balloon  403  is a relatively soft, highly compliant balloon, operative to at least partially conform to the shape of the interior surface of the generally tubular body portion when in engagement therewith. 
     It is appreciated that peripheral balloon  403  may be formed of suitable well-known stretchable materials such as latex, flexible silicon, or highly flexible nylon. Alternatively, peripheral balloon  403  may be formed of polyurethane, which is less stretchable and conforming than latex, flexible silicon or highly flexible nylon. Preferably, the diameter of peripheral balloon  403  is sufficient to ensure tight anchoring at any part of the generally tubular body portion. 
     In a preferred embodiment of the present invention, endoscopy auxiliary assembly  402  may comprise at least one external tube  408 . External tube  408  may be attached to the endoscope  401  at multiple locations along its length by any suitable conventional means such as a medical adhesive tape. Alternatively, external tube  408  may be detached from the endoscope  401 . 
     It is appreciated that external tube  408  may be flexible and highly bendable, allowing it be compliant with the bending of endoscope  401 . It is further appreciated that external tube  408  may be constructed of a low friction material, such as TEFLON®. 
     In a preferred embodiment of the present invention, external tube  408  may be inserted through a tubular passageway  409  which extends longitudinally within tubular sleeve  404 . Alternatively, the tubular passageway may be located interiorly of the sleeve but external to the endoscope  401 . External tube  408  may be inserted fully or partially through tubular passageway  409  and may be fixed to tubular sleeve  404  by any conventional means, such as by friction or by use of a suitable adhesive. Alternatively, external tube  408  may be slidable with respect to tubular passageway  409 . 
     An endoscope tool  410 , constructed and operative in accordance with a preferred embodiment of the present invention extends through the external tube  408 . Endoscope tool  410  preferably comprises a guiding tube  412 , which includes at least a first lumen  414  for inflation and deflation of a balloon  416  via an inflation aperture  418 . Preferably, the cross-sectional area of guiding tube  412  is sufficiently smaller than that of external tube  408 , so as to allow generally free passage of guiding tube  412  through external tube  408 , particularly when the external tube  408  is in a bent or curved state, and to allow supply of fluid for inflation or other uses and draining of fluid therethrough. 
     Preferably, a plurality of short hollow cylinders  420  may be disposed longitudinally within tubular passageway  409 , as shown in  FIGS. 16A and 16B . Adjacent hollow cylinders  420  may be separated by spaces  421 . 
     It is appreciated that hollow cylinders  420  may be relatively flexible and bendable, so as to comply with the bending of endoscope  401  and of tubular sleeve  404 . Alternatively, hollow cylinders  420  may be relatively rigid. It is appreciated that hollow cylinders  420  may be constructed of a low friction material, such as TEFLON®. 
     Preferably, hollow cylinders  420  lead guiding tube  412  within tubular passageway  409  and allow smooth and low friction passage of guiding tube  412 . 
     It is appreciated that hollow cylinders  420  support the inner walls of tubular passageway  409  and prevent the collapse of the inner walls of tubular passageway  409  towards guiding tube  412 , especially in a bent state of endoscope  401  and tubular sleeve  404 . 
     In accordance with a preferred embodiment of the present invention, the length of hollow tubes  420  may be in the range of 5-25 millimeters, and the length of spaces  421  may be in the range of 2-10 millimeters. 
     It is appreciated that guiding tube  412  may be flexible and highly bendable, so as to allow its compliance with the bending of endoscope  401  and with the curves of the intestine. It is further appreciated that guiding tube  412  may be constructed of a low friction material, such as TEFLON®. 
     Preferably, guiding tube  412  is sealed at its distal end forward of balloon  416  in any suitable manner such as by mechanical sealing or use of an appropriate adhesive, to facilitate inflation and deflation of balloon  416  through guiding tube  412 . 
     Preferably, endoscope tool  410  comprises a tip portion  419  located distally of balloon  416 . The tip portion  419  may be made of a highly flexible tube, such as a TYGON® tube with a diameter of 1.5 millimeters. The tip portion  419  may be connected to the distal end of guiding tube  412  by any conventional means such as a suitable adhesive. In a preferred embodiment of the present invention the length of tip portion  419  is 20-30 millimeters. 
     It is appreciated that the high bendability of tip portion  419  prevents endoscope tool  410  from getting stuck in obstacles and bends as it advances through the generally tubular body portion, forward of endoscope  401 . 
     It is appreciated that in accordance with a preferred embodiment of the present invention the endoscope tool  410  and the guiding tube  412  are substantially more flexible than endoscope  401 . 
     It is further appreciated that in accordance with a preferred embodiment of the present invention the tube  406  is substantially more flexible than endoscope  401 . 
     It is appreciated that in accordance with yet another preferred embodiment of the present invention the external tube  408  is substantially more flexible than endoscope  401 . 
     It is appreciated that in accordance with a preferred embodiment of the present invention balloon  416  is generally stretchable, and can be inflated to a diameter about 5-20 times larger than its diameter when not inflated. In a specific embodiment, useful for small intestine endoscopy, the balloon diameter when fully inflated is in the range of 3-4 centimeters. In a specific embodiment, useful for small intestine endoscopy, the balloon diameter when fully inflated is four centimeters. Preferably, inflation of the balloon  416  to a diameter less than four centimeters may be achieved using relatively low pressure, such as in the range of 30-70 millibars. 
     In another preferred embodiment of the present invention, useful for large intestine endoscopy, the balloon diameter when fully inflated is in the range of 4-6 centimeters. In another specific embodiment, useful for large intestine endoscopy, the balloon diameter when fully inflated is six centimeters. Preferably, inflation of the balloon  416  to a diameter less than six centimeters may be achieved using relatively low pressure, such as in the range of 30-70 millibars. 
     It is appreciated that in accordance with a preferred embodiment of the present invention which is particularly useful for in vivo inspection of a generally tubular body portion having a variable cross-sectional diameter, the expansion range of the diameter of balloon  416  is larger than the maximum cross-sectional diameter of the generally tubular body portion, thereby enabling engagement of expanded balloon  416  with the interior surface of the generally tubular body portion, and anchoring of the endoscope tool  410  thereto. Preferably, balloon  416  is a relatively soft, highly compliant balloon, operative to at least partially conform to the shape of the interior surface of the generally tubular body portion when in engagement therewith. 
     It is appreciated that balloon  416  may be formed of well-known stretchable materials such as latex, flexible silicon, or highly flexible nylon. Alternatively, balloon  416  may be formed of polyurethane, which is less stretchable and conforming than latex, flexible silicon or highly flexible nylon. Preferably, the diameter of balloon  416  is sufficient to ensure tight anchoring at any location of the generally tubular body portion. 
     As seen in  FIG. 13 , the endoscope tool  410  preferably includes a balloon inflation/deflation control interface  422  which communicates with guiding tube  412  at a proximal portion  423  thereof which extends outwardly of a proximal end  424  of external tube  408  and governs inflation and deflation of balloon  416 . Additionally, there is preferably provided a peripheral balloon inflation/deflation control interface  425 , which communicates with tube  406  and governs inflation and deflation of peripheral balloon  403 . 
     Preferably, proximal end  424  of external tube  408  is fixed to the proximal portion of endoscope  401  adjacent to an operator control  429  of endoscope  401 , by a band  432  or by any other suitable conventional means, such as a clips or medical adhesive tape. 
     Preferably, the operator positions balloon  416  at a desired location forward of the distal end of endoscope  401  within the generally tubular body portion, by controlled pulling or pushing of the proximal portion  423  of guiding tube  412 , relative to the proximal end  424  of external tube  408 . 
       FIG. 16A  shows rearward positioning of endoscope tool  410  in which the balloon  416  is located just ahead of the distal end of endoscope  401 . The rearward positioning is preferably accomplished by pulling the proximal portion  423  of guiding tube  412  rearwardly relative to the proximal end  424  of external tube  408 . 
       FIG. 16B  shows forward positioning of endoscope tool  410  in which the balloon  416  is located a substantial distance forward of the distal end of endoscope  401 . The forward positioning is preferably accomplished by pushing the proximal portion  423  of guiding tube  412  forwardly relative to the proximal end  424  of external tube  408 . 
     It is appreciated that controlled positioning of the endoscope tool  410  at desired distances forward of the distal end of endoscope  401  may be achieved by suitable controlled positioning of the proximal portion  423  of guiding tube  412  relative to the proximal end  424  of external tube  408 . 
     It is appreciated that in accordance with a preferred embodiment of the present invention useful for in vivo inspection of a generally tubular body portion having a variable cross-sectional diameter, balloon  416  may be controllably positioned in a range of 0-45 centimeters forward of the distal end of endoscope  401 . 
     As seen in  FIGS. 16A and 16B , balloon  416  is fixed to guiding tube  412  via a forward balloon sleeve portion  444  and a rear balloon sleeve portion  446 . As seen in  FIG. 16A , the cross sectional diameter of rear sleeve portion  446  is larger than the inner cross sectional diameter of external tube  408  and larger than the inner cross sectional diameter of tubular passageway  409 , thereby preventing balloon  416  from being inserted through external tube  408  and through tubular passageway  409 . 
     It is appreciated that rear sleeve portion  446  may function as a stopper that prevents further pulling of guiding tube  412  when rear sleeve portion  446  is in contact with tubular sleeve  404  or with external tube  408 . 
     In accordance with a preferred embodiment of the present invention useful for in vivo inspection of a generally tubular body portion, an additional accessory  450  may be inserted through an instrument channel  460  of endoscope  401  for medical interaction with the generally tubular body portion at a location forward of the distal end of endoscope  401 . Accessory  450  may incorporate any conventional accessory such as biopsy forceps, polyp cutter, injection needle, or ultrasound device. 
     It is appreciated that accessory  450  may be provided instead of or in addition to endoscope tool  410 . Accessory  450  may be operative within the generally tubular body portion at the same time or alternating with the operation of endoscopy auxiliary assembly  402  and endoscope tool  410 . 
     Reference is now made to  FIGS. 17A, 17B, 17C, 17D, 17E, 17F, 17G, 17H, 17I and 17J , which are simplified illustrations of the endoscopy auxiliary assembly  402  and endoscope tool  410  of  FIGS. 13-16B  in various operative orientations within an intestine. In the illustrated embodiment, desired orientation of the forward end of the endoscope tool  410  is obtained by suitable axial displacement of the tool through the external tube  408  of endoscopy auxiliary assembly  402 . 
     As seen in  FIG. 17A , endoscope tool  410  is located adjacent the distal end of the endoscope  401 , and balloon  416 , in a deflated state, protrudes a short distance forward of the distal end of endoscope  401 . As seen, peripheral balloon  403  is in a deflated state. 
       FIG. 17B  shows peripheral balloon  403  in an inflated state in engagement with an interior wall of the intestine, thereby anchoring the endoscope  401  thereat. 
       FIG. 17C  shows forward progress of the endoscope tool  410  through the intestine resulting from pushing of the tool forward relative to the endoscope in a conventional manner. 
       FIG. 17D  shows inflation of the balloon  416 . In accordance with a preferred embodiment of the invention, this inflation anchors the forward end of the endoscope tool  410  to the intestine at the location of the balloon  416 . 
       FIG. 17E  shows tensioning the guiding tube  412  of the endoscope tool  410  by pulling on the guiding tube  412 . 
       FIG. 17F  shows deflation of peripheral balloon  403 . 
       FIG. 17G  shows the endoscope  401  having been pushed forward along the guiding tube  412 , using the guiding tube  412  as a guide wire in a conventional manner. Alternatively to pushing endoscope  401  or in parallel to pushing endoscope  401 , endoscope tool  410  may be pulled by pulling on the guiding tube  412  while balloon  416  is in an inflated state and thereby anchored to the intestine. 
       FIG. 17H  shows inflation of peripheral balloon  403  into engagement with an interior wall of the intestine, thereby anchoring the endoscope  401  thereat. 
     Thereafter, as shown in  FIG. 17I , the endoscope  401  and the endoscope tool  410  may be pulled together, while anchored to interior walls of the intestine. This pulling action may bunch together a portion of the intestine over part of the endoscope  401 , as shown. 
     Thereafter, as shown in  FIG. 17J , the balloon  416  may be deflated. 
     Further forward progress of the endoscope through the intestine, preferably to a position where the distal end of endoscope  401  lies just behind the balloon  416 , similarly to the orientation shown in  FIG. 17B , may be achieved by repeating some or all of the steps described hereinabove with reference to  FIGS. 17B-17J , as required by the geometries encountered. 
     Similarly, backward progress of the endoscope through the intestine may be achieved by repeating some or all of the steps described hereinabove with reference to  FIGS. 17B-17J  in a different order and preferably in a reversed order, as required by the geometries encountered. 
     It is appreciated that air for inflation may be supplied to the interior of the intestine intermediate peripheral balloon  403  and balloon  416  in some or all of the operative orientations which are described hereinabove, corresponding to  FIGS. 17A-17J . Specifically, air for inflation may be supplied to the interior of the intestine intermediate peripheral balloon  403  and balloon  416  in operative orientations corresponding to  FIGS. 17D, 17E, 17H and 17I , in which the intestine is generally sealed intermediate the two inflated balloons. Air for inflation may be supplied to the interior of the intestine intermediate peripheral balloon  403  and balloon  416  in operative orientations corresponding to  FIGS. 17B, 17C, 17F, 17G and 17J , in which the intestine is generally partially sealed intermediate the two balloons. 
     It is appreciated that inflation of the intestine in the region between the two balloons may assist in realization of the operative orientations which are described hereinabove, corresponding to  FIGS. 17A-17J , and in the overall propagation of endoscope  401  and endoscope tool  410  within the intestine. 
     Air flow may be provided to the intestinal volume between the two balloons through the instrument channel  460  of endoscope  401  as well known and commonly practiced in conventional endoscopy, or via the external tube  408 , through the volume between the guiding tube  412  and external tube  408 . Alternatively, endoscopy auxiliary assembly  402  may include more than one external tube  408  and in such a case air flow may be provided to the intestinal volume between the two balloons through an additional external tube (not shown). 
     It is appreciated that in any apparatus comprising two inflatable balloons which propagate relative to each other along a generally tubular body portion and specifically within an intestine, inflation of the generally tubular body portion and specifically the intestine intermediate the two balloons may assist in the propagation of the balloons. 
     It is appreciated that any other fluid may be supplied to the intestine intermediate the two balloons. For example, a liquid may be supplied intermediate the two balloons while the balloons are inflated and engaging the interior walls of the intestine, as seen in  FIGS. 17D, 17E, 17H and 17I , thereby confining the liquid within the volume of the intestine intermediate the two balloons. Such a liquid may be a medicine or other treatment liquid, a rinsing solution, a marking agent, an ultrasound medium, or another suitable type of liquid. 
     It is appreciated that vacuum may be applied to the intestine intermediate the two balloons instead of a fluid, if applicable, such as for suctioning a previously inserted fluid, for assisting in the propagation of endoscope  401  or endoscope tool  410 , or for cleaning body fluids during an endoscopy procedure. 
     Reference is now made to  FIGS. 18A and 18B , which are simplified illustrations of the embodiment of  FIGS. 13-16B  in a mode of operation useful for in-vivo inspection, diagnosis, sampling or treatment of a generally tubular body portion. As seen in  FIG. 18A , peripheral balloon  403  is inflated and engaged with an interior wall of the generally tubular body portion, thereby anchoring the endoscope  401  thereat. Similarly, balloon  416  is inflated and engaged with an interior wall of the generally tubular body portion, thereby anchoring the endoscope tool  410  thereat. 
       FIG. 18A  further shows a target location  470  at an interior wall of the generally tubular body portion, located intermediate peripheral balloon  403  and balloon  416 . As seen in  FIG. 18B , endoscope tool  410  may be pulled while still anchored to the interior wall of the generally tubular body portion by pulling guiding tube  412 , thereby relocating the generally tubular body portion intermediate peripheral balloon  403  and balloon  416  towards the distal end of endoscope  401 . This movement is operative to facilitate access of accessory  450  to target location  470 , thereby enabling accessory  450  to perform medical interaction with target location  470 , as applicable. 
     It will be appreciated by persons skilled in the art that the present invention is not limited to what has been particularly shown and described hereinabove. Rather the scope of the present invention includes both combinations and subcombinations of various features described hereinabove as well as modifications thereof which would occur to persons skilled in the art upon reading the foregoing specification and which are not in the prior art.