Patent Publication Number: US-2009221870-A1

Title: Endoscopic treatment instrument

Description:
TECHNICAL FIELD 
     The present invention relates to an endoscopic treatment instrument used for endoscopic surgery and endoscopy for pancreaticobiliary ducts. 
     The present application is based on patent application No. 2005-0019346 filed Jan. 27, 2005, in Japan, the content of which is incorporated herein by reference. 
     BACKGROUND ART 
     A drainage tube (drainage tube) is retained in a human body through an endoscope inserted into the human body during a manipulation conducted for secretory fluid drainage from a bile duct and a pancreatic duct. 
     In order to retain the drainage tube in the bile duct or the pancreatic duct through a channel of the endoscope, the drainage tube retainer proposed as an endoscopic treatment instrument includes a guide tube that can be extended and retracted along an elastic guidewire previously inserted in the human body; and an elastic pusher tube for pushing the drainage tube fit to the guide tube toward a distal end of the guide tube (see Patent documents 1 and 2 as follows). 
     First, to retain the drainage tube in the bile duct with the foregoing drainage tube retainer, the distal end of the guidewire is inserted through a treatment instrument insertion channel formed in the endoscope. The distal end of the guide tube is inserted next into the bile duct along the guidewire inserted through the treatment instrument insertion channel. By fitting the guide tube to the drainage tube and pushing the drainage tube at the distal end of the pusher tube while guiding with the guide tube, the drainage tube moves into the bile duct, thereby causing the drainage tube to protrude above the guidewire. The pusher tube, the guide tube, and the guidewire are retracted; thus, the drainage tube is eventually retained in the bile duct. 
     The guide tube of the foregoing conventional endoscopic treatment instrument must be maintained at a certain fixed position relative to the endoscope. However, an attempt to slide the pusher tube along the guide tube moves the guide tube together with the pusher tube because of a frictional force between the guide tube and the pusher tube; therefore, the position of the guide tube inevitably changes relative to the endoscope. In order to avoid the positional change of the guide tube relative to the endoscope, the movement of the pusher tube toward a distal end of the guide tube must be carried out simultaneously by the same amount as the movement of the guide tube toward a manipulation side. Since these movements cannot be carried out by the endoscopist alone, the endoscopist and a supporter will meet difficulty due to such a complex cooperation. 
     Patent document 1: Japanese Unexamined Patent Application, First Publication No. H11-76412 
     Patent Document 2: Japanese Unexamined Patent Application, First Publication No. 2000-152985 
     DISCLOSURE OF INVENTION 
     Problems to be Solved by the Invention 
     The present invention was conceived in consideration of the foregoing circumstances, and an object thereof is to provide an endoscopic treatment instrument with which an endoscopist alone can slide a hollow section along an elongated section that is inserted in the hollow section such that the elongated section is retained at a certain fixed position. 
     Means for Solving the Problems 
     An endoscopic treatment instrument according to the present invention inserted through a channel of an endoscope from a endoscope port includes: an elongated section for slidably supporting a retainer retained in a live organ through the channel; a hollow section disposed in the exterior of the elongated section and slidably supported by the elongated section; and a connecting section provided to the hollow section for positioning the hollow section relative to the endoscope so that a direction in which the hollow section is inserted through the channel substantially coincides with a direction in which the hollow section is retracted from the hollow section. 
     Since the endoscopic treatment instrument positions the hollow section relative to the endoscope via the connecting section, the direction in which the hollow section is inserted through the channel of the endoscope substantially coincides with the direction in which the elongated section is retracted from the channel; therefore the operations to insert the hollow section through the channel and to retract the elongated section from the hollow section can be carried out simultaneously by one-handed manipulation. Carrying out these two operations simultaneously permits the hollow section to be inserted through the channel. On the other hand, the elongated section is retracted from the hollow section by the length equal to an insertion length of the hollow section. To be more specific, apparently the elongated section remains at a predetermined position in the channel and only the hollow section is inserted through the channel along the elongated section. Since the present invention allows an endoscopist alone to carry out the above operations, complex manipulation can be avoided. 
     In the endoscopic treatment instrument according to the present invention, it is preferable that the elongated section be capable of sliding along a guidewire inserted through the channel. 
     The endoscopic treatment instrument according to the present invention allows the direction in which the elongated section previously inserted through the endoscope port is inserted through the channel along the guidewire to coincide with the direction in which the guidewire is retracted from the elongated section after the elongated section is fitted to the guidewire so that the guidewire previously inserted through the channel is inserted in the interior of the elongated section; therefore, the operations to insert the elongated section through the channel and to retract the guidewire from the elongated section can be carried simultaneously one-handed. Carrying out these two operations simultaneously permits the elongated section to be inserted through the channel. On the other hand, the guidewire is retracted from the hollow section by the length equal to an insertion length of the elongated section. To be more specific, apparently the guidewire remains at a predetermined position in the channel and only the elongated section is inserted through the channel along the guidewire. Since the present invention allows an endoscopist alone to carry out the above operations, complex manipulation can be avoided. 
     In the endoscopic treatment instrument according to the present invention, it is preferable that the connecting section be provided with an elastically deformable, approximately C-shaped engagement member. 
     Since the round surface of the operation section, etc., of the endoscope permits the connecting section to be positioned and engaged at a certain position of the endoscope by elastically deforming the approximately C-shaped engagement member of the endoscopic treatment instrument according to the present invention. In addition, the connecting section can be rotated relative to the endoscope in a direction along an arch of the substantially C-shaped engagement member. 
     In the endoscopic treatment instrument according to the present invention, it is preferable that the connecting section attached to the endoscope via an endoscope adapter attached to an operation section of the endoscope for rotatively supporting the connecting section be detachable. 
     The endoscopic treatment instrument according to the present invention allows the proximal end of the hollow section to be fixed in a direction toward the endoscope port separately by a predetermined distance from the operation section of the endoscope by attaching the endoscope adapter to the operation section of the endoscope and attaching the connecting section to the adapter. 
     It is preferable that the endoscopic treatment instrument according to the present invention further include a cap disposed at a proximal end of the elongated section so that the cap is detachable from the connecting section. 
     The endoscopic treatment instrument according to the present invention allows the elongated section and the hollow section to be simultaneously inserted through the channel of the endoscope along the guidewire if the cap is previously attached to the connecting section. Also, detaching the cap from the connecting section permits the hollow section to be moved longitudinally along the elongated section. 
     It is preferable that the endoscopic treatment instrument according to the present invention further include a cap disposed at a proximal end of the elongated section so that the cap is detachable from the elongated section. 
     The endoscopic treatment instrument according to the present invention allows the hollow section to be fitted to the elongated section not only from the distal end but also from the proximal end if the cap is detached from the elongated section. 
     In the endoscopic treatment instrument according to the present invention, it is preferable that the cap be provided with an elastically deformable, approximately C-shaped engagement member. 
     The round surface of the operation section, etc., of the endoscope permits the cap to be positioned and engaged at a certain position of the endoscope by elastically deforming the approximately C-shaped engagement member of the endoscopic treatment instrument according to the present invention. In addition, the cap can be rotated relative to the endoscope in a direction along an arch of the substantially C-shaped engagement member. 
     In the endoscopic treatment instrument according to the present invention, it is preferable that the cap attached to the endoscope via an endoscope adapter attached to an operation section of the endoscope so as to rotatively support the cap be detachable. 
     The endoscopic treatment instrument according to the present invention allows the proximal end of the elongated section to be fixed in a direction toward the endoscope port separately by a predetermined distance from the operation section of the endoscope by attaching the endoscope adapter to the operation section of the endoscope and attaching the cap to the adapter. 
     EFFECTS OF THE INVENTION 
     The endoscopic treatment instrument according to the present invention allows an endoscopist alone to slide a hollow section along an elongated section so that the elongated section that is inserted in the hollow section is retained at a certain position. 
    
    
     
       BRIEF DESCRIPTION OF DRAWINGS 
         FIG. 1  is a plan view illustrating a drainage tube retainer according to a first embodiment of the present invention. 
         FIG. 2  is a cross-section illustrating a drainage tube retainer according to the first embodiment of the present invention in detail. 
         FIG. 3  is a plan view illustrating a drainage tube retained in a human body by the drainage tube retainer according to the first embodiment of the present invention. 
         FIG. 4  is a schematic diagram illustrating how to use the drainage tube retainer according to the first embodiment of the present invention. 
         FIG. 5  is a schematic diagram illustrating how to use the drainage tube retainer according to the first embodiment of the present invention. 
         FIG. 6  is a schematic diagram illustrating how to use the drainage tube retainer according to the first embodiment of the present invention. 
         FIG. 7  is a schematic diagram illustrating how to use the drainage tube retainer according to the first embodiment of the present invention. 
         FIG. 8  is a schematic diagram illustrating how to use the drainage tube retainer according to the first embodiment of the present invention. 
         FIG. 9  is a plan view illustrating a guide catheter constituting the drainage tube retainer according to a second embodiment of the present invention. 
         FIG. 10  is a cross-section illustrating the guide catheter constituting the drainage tube retainer according to the second embodiment of the present invention. 
         FIG. 11  is a plan view illustrating a pusher tube constituting the drainage tube retainer according to a second embodiment of the present invention. 
         FIG. 12  is a schematic diagram illustrating how to use the drainage tube retainer according to the second embodiment of the present invention. 
         FIG. 13  is a schematic diagram illustrating how to use the drainage tube retainer according to the second embodiment of the present invention. 
         FIG. 14  is a schematic diagram illustrating how to use the drainage tube retainer according to the second embodiment of the present invention. 
         FIG. 15  is a schematic diagram illustrating how to use the drainage tube retainer according to the second embodiment of the present invention. 
         FIG. 16  is a schematic diagram illustrating how to use the drainage tube retainer according to the second embodiment of the present invention. 
         FIG. 17  is a schematic diagram illustrating how to use the drainage tube retainer according to the second embodiment of the present invention. 
         FIG. 18  is a schematic diagram illustrating how to use the drainage tube retainer according to the second embodiment of the present invention. 
         FIG. 19  illustrates a first modified example of the drainage tube. 
         FIG. 20  is a schematic diagram for illustrating how to use the drainage tube shown in  FIG. 19 . 
         FIG. 21  illustrates a second modified example of the drainage tube. 
         FIG. 22  is a schematic diagram for illustrating how to use the drainage tube shown in  FIG. 21 . 
         FIG. 23  is a schematic diagram for illustrating an inappropriate usage of the drainage tube. 
         FIG. 24  is a schematic diagram for illustrating an appropriate usage of the drainage tube shown in  FIG. 21 . 
     
    
    
     EXPLANATION OF REFERENCE NUMERALS AND SYMBOLS 
     
         
           1 ,  30 : drainage tube retainer (endoscopic treatment instrument) 
           2 : endoscope 
           3 : endoscope port 
           5 : guidewire 
           10 ,  32 : guide catheter (elongated section) 
           11 : pusher tube (hollow section) 
           13 ,  37 : pusher cap (connecting section) 
           15 ,  31 : cap 
           16 : hook (engagement member) 
           22 : endoscope adapter 
       
    
     BEST MODE FOR CARRYING OUT THE INVENTION 
     A first embodiment of the present invention will be explained with reference to  FIGS. 1 to 8 . 
     As illustrated in  FIGS. 1 to 7 , a drainage tube retainer (endoscopic treatment instrument)  1  according to the present embodiment is an instrument retained in a constriction  8  in a bile duct  7 , etc. The drainage tube retainer  1  can extend and retract in a channel not shown in the drawings along a guidewire  5  inserted in the channel from an endoscope port  3  of an endoscope  2 . Provided to the drainage tube retainer  1  are a guide catheter (elongated section)  10 ; a pusher tube (elongated section)  11 ; a pusher cap (connecting section)  13 ; and a cap  15 . 
     The guide catheter  10  fitted to the drainage tube  6  so as to be inserted in the drainage tube  6  slidably supports the drainage tube  6 . The guidewire  5  is inserted through the guide catheter  10 . 
     The pusher tube  11  fitted to the guide catheter  10  so as to pass the guide catheter  10  therethrough is slidably supported by the guide catheter  10 . 
     The pusher cap  13  provided to a proximal end of the pusher tube  11  positions the proximal end of the pusher tube  11  relative to an operation section  12  of the endoscope  2  so that a direction in which the pusher tube  11  is inserted into the channel substantially coincides with a direction in which the guide catheter  10  is retracted from the pusher tube  11 . 
     The cap  15  is provided to a proximal end of the guide catheter  10 . 
     The guide catheter  10  is considerably longer than the total length of the pusher tube  11  and the drainage tube  6  so that the distal end of the guide catheter  10  protrudes ahead of the drainage tube  6  when the guide catheter  10  is fitted to the pusher tube  11  and further fitted to the drainage tube  6  disposed ahead of the distal end of the pusher tube  11 . 
     Provided to the pusher cap  13  is an approximately C-shaped and elastically deformable hook (engagement member)  16 . The hook  16  is formed to have its distal end directed toward the distal end of the pusher tube  11 . 
     Provided to the proximal end of the pusher cap  13  is a male thread section  17 . Detachably provided to the distal end of the cap  15  is a female thread section  18  that engages with the male thread section  17 . 
     As illustrated in  FIG. 3 , disposed to both ends of the drainage tube  6  are flaps  20 A and  20 B. The flaps  20 A and  20 B expand when retained in the interior of the bile duct  7  and engage to living body organs so as to prevent the drainage tube  6  from misaligning. 
     A mark  21  indicating a manufacturing lot number or a model number, etc., of the drainage tube  6  is printed in the vicinity of one of the flaps  20 A and  20 B, e.g., the flap  20 B, that is disposed nearer to the endoscope  2  when the drainage tube  6  is retained in the body (“4XK” is printed in the example illustrated in  FIG. 3 ). 
     Detachably attached to the operation section  12  of the endoscope  2  is an endoscopic adapter  22  that rotatively supports the hook  16  of the pusher cap  13 . The endoscopic adapter  22  is provided with an adapter body  23 , a cylindrical treatment instrument fixture  25 , and an endoscope fixture  26 . A hook  16  slidably engages to the treatment instrument fixture  25  provided to an end of the adapter body  23 . Provided to the other end of the adapter body  23  is the approximately cylindrical endoscope fixture  26  in which a part of the cylindrical fixture is notched. 
     A method, function, and effect according to the present embodiment will be explained next regarding the retaining of the drainage tube  6  with the drainage tube retainer  1 . 
     As illustrated in  FIG. 4 , an insertion section of the endoscope  2  is first inserted into a body cavity so as to reach the distal end into the vicinity of a duodenal papilla. Consequently the guidewire  5  is inserted into a channel not shown in the drawing from the endoscope port  3  of the endoscope  2  so as to be inserted through the constriction  8  of the bile duct  7 . 
     Consequently, the endoscope fixture  26  of the endoscopic adapter  22  is attached at a predetermined position of the operation section  12  of the endoscope  2 . The distal end of the guide catheter  10  fitted to the drainage tube  6  and the pusher tube  11  is fitted to the guidewire  5  so that the proximal end of the guidewire  5  protruding from the endoscope port  3  is inserted in the guide catheter  10 . Then a part of the drainage tube  6  and a part of the pusher tube  11  are inserted through the channel. 
     As illustrated in  FIG. 4 , the guidewire  5 , the guide catheter  10  fitted to the guidewire  5 , and the pusher tube  11  fitted to the guide catheter  10  are folded together at some midpoints thereof them in the vicinity of the endoscope port  3 . The hook  16  is then hung on the treatment instrument fixture  25  of the endoscopic adapter  22 . Accordingly the hook  16  is adjustably rotated on the treatment instrument fixture  25  so that the cap  15  faces the endoscope port  3  and so that the pusher tube  11  and the guidewire  5  having protruded from the cap  15  are disposed substantially in parallel. Since a direction in which the pusher tube  11  and the guide catheter  10  fitted to the pusher tube  11  are inserted into the channel from the endoscope port  3  substantially coincides with a direction in which the guidewire  5  is retracted from the guide catheter  10 , the endoscopist can conduct an operation of inserting the pusher tube  11  and the guide catheter  10  into the channel from the endoscope port  3  and an operation of retracting the guidewire  5  from the guide catheter  10  simultaneously by a single-handed manipulation. 
     Grasping with the endoscopist&#39;s hand and moving together this state of the pusher tube  11 , the guide catheter  10 , and the guidewire  5  in a direction indicated by an arrow illustrated in the drawing permit the pusher tube  11  and the guide catheter  10  to be inserted through the channel. On the other hand, the guidewire  5  is retracted from the guide catheter  10  by the length equal to an insertion length of the pusher tube  11  and the guide catheter  10 . To be more specific, apparently the guidewire  5  remains at a predetermined position in the channel, and only the pusher tube  11  and the guide catheter  10  are inserted through the channel along the guidewire  5 . As illustrated in  FIG. 5 , repeating the above operations permits the pusher tube  11  and the guide catheter  10  to be inserted through the channel while the distal end of the guidewire  5  remains at the predetermined position and permits the distal end of the guide catheter  10  to move to a desirable position. 
     As illustrated in  FIG. 6 , the cap  15  is rotated relative to the pusher cap  13  so as to remove the cap  15  from the pusher cap  13 . 
     As illustrated in  FIG. 7 , the cap  15  is grasped and the guide catheter  10  and the guidewire  5  fitted to the guide catheter  10  are retracted from the pusher cap  13  so that the guide catheter  10  and the pusher tube  11  that have protruded from the pusher cap  13  are substantially parallel in the vicinity of the endoscope port  3 . Since a direction in which the pusher tube  11  is inserted into the channel from the endoscope port  3  substantially coincides with a direction in which the guide catheter  10  and the guidewire  5  are retracted from the guide catheter  11 , the endoscopist can conduct an operation of inserting the pusher tube  11  into the channel from the endoscope port  3  and an operation of retracting the guide catheter  10  and the guidewire  5  from the pusher tube  11  simultaneously by a single-handed manipulation. 
     Grasping with the endoscopist&#39;s hand and moving together this state of the guide catheter  10 , the guidewire  5 , and the pusher tube  11  in a direction indicated by an arrow illustrated in the drawing permit the pusher tube  11  to be inserted through the channel. On the other hand, the guide catheter  10  and the guidewire  5  are retracted from the pusher tube  11  by the length equal to an insertion length of the pusher tube  11 . To be more specific, apparently the guide catheter  10  and the guidewire  5  remain at predetermined positions in the channel, and only the pusher tube  11  is inserted through the channel along the guide catheter  10 . As illustrated in  FIG. 8 , repeating the above operations permits the pusher tube  11  to be inserted through the channel while the distal end of the guide catheter  10  and the distal end of the guidewire  5  remain at the predetermined positions, and permits the distal end of the pusher tube  11  to move to a desirable position. The drainage tube  11  is pushed toward the distal end of the pusher tube  11  to be inserted through the bile duct  7 . 
     Retracting the guide catheter  10 , the pusher tube  11 , and the guidewire  5  from the bile duct  7  and detaching them from the endoscope  2  eventually allow the drainage tube  6  to be retained in the bile duct  7 . 
     The endoscopic adapter  22  attached to the operation section  12  of the endoscope  2  permits the proximal end of the pusher tube  11  of the above drainage tube retainer  1  to be fixed separately from the operation section  12  of the endoscope  2  by a predetermined distance and to be directed toward the endoscope port  3 . 
     In addition, the pusher cap  13  having the elastically deformable hook  16  can be positioned and engaged at a round surface part of the treatment instrument fixture  25 . Furthermore, the pusher cap  13  can be rotated relative to the endoscope  2  in a direction along an arch of the substantially C-shaped hook  16 . 
     The guidewire  5 , the guide catheter  10 , and the pusher tube  11  can be folded in the vicinity of the endoscope port  3 ; therefore, the guidewire  5  can be disposed substantially in parallel with the guide catheter  10  and the pusher tube  11 . This allows the direction in which the pusher tube  11  and the guide catheter  10  are inserted through the channel from the endoscope port  3  to substantially coincide with the direction in which the guidewire  5  is retracted from the guide catheter  10 . This furthermore allows the direction in which the pusher tube  1  is inserted through the channel from the endoscope port  3  to substantially coincide with the direction in which the guide catheter  10  and the guidewire  5  are retracted from the pusher tube  11 . 
     This results in allowing the endoscopist alone having connected the cap  15  to the pusher cap  13  to conduct the operation of inserting two tubes, i.e., the guide catheter  10  and the pusher tube  11  fitted to the guide catheter  10  into the channel along the guidewire while the distal end of the guidewire  5  is retained at a certain position. Also, the endoscopist alone having detached the cap  15  from the pusher cap  13  can conduct the operation of inserting the drainage tube  6  and the pusher tube  11  through the channel along the guidewire  5  and the guide catheter  10  while the distal end of the guidewire  5  and the distal end of the guide catheter  10  are retained at certain positions. 
     Also, the mark  21  indicating a manufacturing lot number, etc., printed not on a package but directly on the drainage tube  6  allows information including the manufacturing lot numbers, etc. of the drainage tube  6  that has been retained in a body. 
     A second embodiment of the present invention will be explained next with reference to  FIGS. 9 to 18 . Note that elements that are equivalent to those of the above first embodiment will be assigned the same reference symbols, and redundant explanations thereof will be omitted. 
     Provided to a drainage tube retainer  30  according to the present embodiment is a cap  31  detachable from a guide catheter  32 . Provided to the cap  31  are a hub  33 , a plunger  35 , and an O-ring  36 . Provided to the hub  33  is a through-hole  31 A through which a guide catheter  32  can penetrate. Also, provided to the hub  33  is a hook  16 . Provided to a proximal end of the hub  33  is a screw hole  33 A. The inner diameter of the screw hole  33 A is greater than that of the through-hole  31 A. A female thread section  18  is formed on the surface of the screw hole  33 A. Provided to a distal end of the plunger  35  is a protruding screw section  35 A. A male thread section  17  that engages with the female thread section  18  of the screw hole  33 A is formed on an outer surface of the protruding screw section  35 A that protrudes from the plunger  35  toward the screw hole  33 A of the hub  33 . 
     The size of the O-ring  36 , i.e., the outer diameter thereof enables it to be inserted in the screw hole  33 A. The O-ring  36  crushed between a bottom section of the screw hole  33 A in the hub  33  and a distal end of the protruding screw section  35 A elastically deforms so as to engage with the outer surface of the guide catheter  32 . A flange section  38  is provided to the proximal end of the pusher cap  37  in place of the male thread section  17 . 
     A method, function, and effect according to the present embodiment will be explained next regarding the retaining of the drainage tube  6  with the drainage tube retainer  30 . 
     To begin with, as illustrated in  FIG. 13 , an insertion section of the endoscope  2  is inserted into a body cavity so as to reach the distal end into the vicinity of a duodenal papilla. Consequently the guidewire  5  is inserted into a channel not shown in the drawing from a endoscope port  3  of the endoscope  2  so as to be inserted through a constriction  8  of a bile duct  7 . 
     Consequently, the endoscope fixture  26  of the endoscopic adapter  22  is attached at a predetermined position of the operation section  12  of the endoscope  2 . The distal end of the guide catheter  32  is fitted to the guidewire  5  so that the proximal end of the guidewire  5  having protruded from the endoscope port  3  is inserted in the guide catheter  32 ; thus, a part of the guide catheter  32  is consequently inserted in the channel. 
     As illustrated in  FIG. 12 , the guidewire  5  and the guide catheter  32  fitted to the guidewire  5  are folded together at some midpoints thereof in the vicinity of the endoscope port  3 . The hook  16  of the cap  31  is then hung on the treatment instrument fixture  25  of the endoscopic adapter  22 . Accordingly, the hook  16  is adjustably rotated on the treatment instrument fixture  25  so that the cap  31  faces the endoscope port  3  and so that the guide catheter  32  and the guidewire  5  having protruded from the cap  31  are disposed substantially in parallel. Since a direction in which the guide catheter  32  is inserted into the channel from the endoscope port  3  substantially coincides with a direction in which the guidewire  5  is retracted from the guide catheter  32 , the endoscopist can conduct an operation of inserting the guide catheter  32  into the channel from the endoscope port  3  and an operation of retracting the guidewire  5  from the guide catheter  32  simultaneously by a single-handed manipulation. 
     Grasping with the endoscopist&#39;s hand and moving together this state of the guide catheter  32  and the guidewire  5  in a direction indicated by an arrow illustrated in the drawing permit the guide catheter  32  to be inserted through the channel. On the other hand, the guidewire  5  is retracted from the guide catheter  32  by the length equal to an insertion length of the guide catheter  32 . To be more specific, apparently the guidewire  5  remains at a predetermined position in the channel, and only the pusher tube  32  is inserted through the channel along the guidewire  5 . As illustrated in  FIG. 13 , repeating the above operations permits the guide catheter  32  to be inserted through the channel while the distal end of the guidewire  5  remains at the predetermined position, and permits the distal end of the guide catheter  32  to move to a desirable position. 
     Consequently, the hook  16  of the cap  31  is detached from the treatment instrument fixture  25  of the endoscopic adapter  22  as illustrated in  FIG. 16 . The plunger  35  is then separated from the hub  33  by rotating the plunger  35  relative to the hub  33  as illustrated in  FIG. 15 . Separating the plunger  35  from the hub  33  releases the engagement between the guide catheter  32  and the O-ring  36 ; thus, the cap  31  is detached from the guide catheter  32 . 
     Consequently the proximal end of the guide catheter  32  is inserted through the drainage tube  6  and further inserted through the pusher tube  11  as illustrated in  FIG. 16 . The guide catheter  32  and the pusher tube  11  are folded together at some midpoints thereof in the vicinity of the endoscope port  3 . The hook  16  of the pusher cap  37  is then hung on the treatment instrument fixture  25  of the endoscopic adapter  22 . Accordingly the hook  16  is adjustably rotated on the treatment instrument fixture  25  so that, as illustrated in  FIG. 17 , the cap pusher cap  37  faces the endoscope port  3  and so that the pusher tube  11  and the guide catheter  32  having protruded from the pusher cap  37  are disposed substantially in parallel. Since a direction in which the pusher tube  11  is inserted into the channel from the endoscope port  3  substantially coincides with a direction in which the guide catheter  32  is retracted from the pusher tube  11 , the endoscopist can conduct an operation of inserting the pusher tube  11  into the channel from the endoscope port  3  and an operation of retracting the guide catheter  32  from the pusher tube  11  simultaneously by a single-handed manipulation. 
     Grasping with the endoscopist&#39;s hand and moving together this state of the 9 and the guide catheter  32  in a direction indicated by an arrow illustrated in the drawing permit the pusher tube  11  to be inserted through the channel. On the other hand, the guide catheter  32  is retracted from the pusher tube  11  by the length equal to an insertion length of the pusher tube  11 . To be more specific, apparently the guide catheter  32  remains at a predetermined position in the channel, and only the pusher tube  11  is inserted through the channel along the guide catheter  32 . As illustrated in  FIG. 18 , repeating the above operations permits the pusher tube  11  to be inserted through the channel while the distal end of the guide catheter  32  remains at the predetermined position, and permits the distal end of the pusher tube  11  to move to a desirable position. The drainage tube  11  is pushed toward the distal end of the 9 to be inserted through the bile duct  7 . 
     Retracting the guide catheter  32 , the pusher tube  11 , and the guidewire  5  from the bile duct  7  and detaching them from the endoscope  2  eventually allow the drainage tube  11  to be retained in the bile duct  7 . 
     The drainage tube retainer  30  provides the drainage tube  11  and the pusher tube  11  over the guide catheter  32 , detached from the cap  31 , not only from the distal end but also from the proximal end, thereby a wide selection of manipulation can be obtained. 
     In addition, the endoscopic adapter  22  attached to the operation section  12  of the endoscope  2  permits the proximal end of the guide catheter  32  to be fixed separately from the operation section  12  of the endoscope  2  by a predetermined distance and to be directed toward the endoscope port  3  similarly to the first embodiment. 
     The guidewire  5  and the guide catheter  32  can be folded together at some midpoints thereof in the vicinity of the endoscope port  3 ; therefore, the guidewire  5  can be disposed substantially in parallel with the guide catheter  32 . This allows the direction in which the guide catheter  32  is inserted through the channel from the endoscope port  3  to substantially coincide with the direction in which the guidewire  5  is retracted from the guide catheter  32 . This furthermore allows the direction in which the pusher tube  11  is inserted through the channel from the endoscope port  3  to substantially coincide with the direction in which the guide catheter  32  is retracted from the pusher tube  11 . 
     This results in allowing the endoscopist alone to conduct the operation of inserting the guide catheter  32  into the channel along the guidewire  5  while the distal end the guidewire  5  is retained at a certain position. Also, the endoscopist alone having detached the cap  31  can conduct the operation of inserting the drainage tube  6  and the pusher tube  11  through the channel along the guidewire  5  and the guide catheter  32  while the distal end of the guidewire  5  and the distal end of the guide catheter  32  are retained at certain positions. 
     The technical scope of the present invention is not limited to the embodiments described above. Rather, various modifications may be added provided as long as they do not depart from the spirit of the invention. 
     For example, the drainage tube retainers  1  and  30  according to the above embodiments are used while the endoscopic adapter  22  is attached to the operation section  12  of the endoscope  2 . Note that the hook  16  may be attached without using the endoscopic adapter  22 , i.e., directly at a predetermined position of the operation section  12  of the endoscope  2 . 
     Also, as illustrated in  FIG. 19 , the mark  21  of the drainage tube  40  may be printed at the proximal end of the drainage tube  40  disposed nearer to the endoscope  2  when the drainage tube  40  is disposed in the body. As illustrated in  FIG. 19 , the mark after the retention of the drainage tube  40  can be observed by using the endoscope if the proximal end of the drainage tube  40  is previously protruded. 
     Furthermore, as illustrated in  FIG. 21 , the mark  21  of the drainage tube  41  may be disposed in the vicinity of the distal end, e.g., a position indicated by a broken line in the drawing, of the flap  20 B that is disposed nearer to the endoscope  2  when the drainage tube  40  is retained in the body. 
     In ordinary cases, the drainage tube  41  is disposed so that a distal end flap  20 A expands beyond the constriction  8  of the bile duct  7  and a proximal end flap  20 B expands in a duodenum. As illustrated in  FIG. 22 , the proximal end flap  20 B of the drainage tube  41  can be observed when it is extracted from the distal end of the endoscope  2 . Accordingly, the proximal end flap is prevented from being inserted into the bile duct  7  due to the excessively extended drainage tube  41  as illustrated in  FIG. 23 ; thus, the drainage tube  41  can be retained at a predetermined position as illustrated in  FIG. 24 . 
     INDUSTRIAL APPLICABILITY 
     The present invention relates to an endoscopic treatment instrument inserted through a channel of an endoscope from an endoscope port that includes: an elongated section for slidably supporting a retainer retained in a live organ through the channel; a hollow section disposed in the exterior of the elongated section and slidably supported by the elongated section; and a connecting section provided to the hollow section for positioning the hollow section relative to the endoscope so that a direction in which the hollow section is inserted through the channel substantially coincides with a direction in which the hollow section is retracted from the hollow section. The present invention allows an endoscopist alone to slide a hollow section along an elongated section so that the elongated section that is inserted in the hollow section is retained at a certain position.