Patent Publication Number: US-10321813-B2

Title: Medical devices including distal chamber

Description:
CROSS-REFERENCE TO RELATED APPLICATION 
     This patent application is a continuation of U.S. application Ser. No. 12/078,963, filed on Apr. 8, 2008, which claims the benefit of priority under 35 U.S.C. § 119 to U.S. Provisional Patent Application No. 60/907,580, entitled ENDOSCOPES INCLUDING DISTAL CHAMBER AND RELATED METHODS OF USE, filed on Apr. 10, 2007, each of which is incorporated herein by reference in its entirety. 
    
    
     DESCRIPTION OF THE INVENTION 
     Field of the Invention 
     Embodiments of the invention include an endoscope including a distal chamber and related methods of use, for example, with an endoscopic instrument. 
     Background of the Invention 
     Endoscopes may be used with endoscopic instruments to treat the body. For example, an endoscope may be advanced into a patient&#39;s body lumen, such as a portion of a gastrointestinal tract like a colon. An endoscopic instrument, for example, a biopsy forceps instrument, may then be advanced down a working lumen of the endoscope, out a distal end of the endoscope, and into the gastrointestinal tract. The endoscope may then be maneuvered to a particular portion of the colon from which a tissue sample is desired, and the biopsy forceps instrument may then obtain a tissue sample from the colon. Once the tissue sample has been acquired, the biopsy forceps instrument may be retracted out of the endoscope, and the tissue sample may then be removed from the biopsy forceps instrument. The tissue sample is then placed in a container and labeled. Once the tissue sample has been removed, the procedure may be repeated by advancing the biopsy forceps instrument back down the working lumen of the endoscope into the gastrointestinal tract. For example, to diagnose inflammatory bowel disease, 20 or more tissue samples may be required from the colon. 
     This procedure is time consuming, especially when using long, flexible endoscopes, such as colonoscopes. Sometimes, multiple samples can be obtained during one passage of the biopsy forceps instrument through the endoscope lumen, by stacking samples inside the biopsy jaws. 
     SUMMARY OF THE INVENTION 
     An embodiment of the invention may include an endoscope. The endoscope may include an elongate member, at least two lumens extending through the elongate member, and a chamber defined by a distal portion of the elongate member. A distal end of each of the at least two lumens may terminate in the chamber. 
     Various embodiments of the invention may include one or more of the following aspects: wherein the chamber is configured to accommodate a distal assembly of a medical instrument; wherein the chamber includes a first seal at a distal end of the chamber and a second seal at a proximal end of the chamber. 
     Another embodiment of the invention may include an endoscope. The endoscope may include an elongate member, an irrigation lumen and an aspiration lumen extending through the elongate member, and a chamber defined by a distal portion of the elongate member. A distal end of each of the irrigation lumen and the aspiration lumen may terminate in the chamber. The chamber may be configured to accommodate a distal assembly of a medical instrument. 
     Various embodiments of the invention may include one or more of the following aspects: wherein the distal ends of each of the irrigation lumen and the aspiration lumen are at an angle relative to a longitudinal axis of the elongate member; wherein the chamber includes a first seal at a distal end of the chamber and a second seal at a proximal end of the chamber; wherein at least one of the irrigation lumen and the aspiration lumen includes a valve configured to selectively provide irrigation or aspiration, respectively, to either the chamber or a body lumen; and wherein a distal end of at least one of the irrigation lumen and the aspiration lumen includes a nozzle-like configuration or a flare-like configuration. 
     A further embodiment of the invention may include an endoscope. The endoscope may include an elongate member, an irrigation lumen extending through the elongate member, and a chamber defined by a distal portion of the elongate member. A distal end of the irrigation lumen may terminate in the chamber. The chamber may be configured to accommodate a distal assembly of a medical instrument. 
     Various embodiments of the invention may include one or more of the following aspects: wherein the chamber includes a first seal at a distal end of the chamber and a second seal at a proximal end of the chamber; wherein the chamber includes a first seal at a distal end of the chamber and a second seal on the medical instrument; wherein the irrigation lumen is configured to selectively provide irrigation to either the chamber or a treatment site; a sensor configured to detect an entrance of the distal assembly into the chamber; and wherein the irrigation lumen is configured to accommodate the medical instrument therethrough. 
     Yet another embodiment of the invention may include an endoscope. The endoscope may include an elongate member, at least two lumens extending through the elongate member, and a chamber defined by a distal portion of the elongate member. A distal end of each of the at least two lumens may terminate in the chamber. A seal may be disposed between a distal end of at least one of the at least two lumens and the chamber. 
     Various embodiments of the invention may include the following aspect: wherein the chamber is configured to accommodate a distal assembly of a medical instrument. 
     A yet further embodiment of the invention may include an endoscope. The endoscope may include an elongate member, at least two lumens extending through the elongate member, and a chamber defined by a distal portion of the elongate member. A distal end of each of the at least two lumens may terminate in the chamber. The chamber may include a first seal at a distal end of the chamber and a second seal at a proximal end of the chamber. 
     Various embodiments of the invention may include the following aspect: wherein the chamber is configured to accommodate a distal assembly of a medical instrument in an open configuration. 
     Still another embodiment of the invention may include a method. The method may include providing an endoscope including an elongate member, the elongate member including an irrigation lumen, an aspiration lumen, a working lumen, and a chamber defined by a distal portion of the elongate member, a distal end of each of the irrigation lumen, the aspiration lumen, and the working lumen terminating in the chamber, providing a medical instrument, advancing the elongate member of the endoscope through a body lumen, advancing the medical instrument through the working lumen of the endoscope, through the chamber, out of a distal end of the endoscope, and into the body lumen, obtaining a tissue sample with the medical instrument, placing the tissue sample in the chamber, and removing the medical instrument and the endoscope from the body lumen. 
     Various embodiments of the invention may include one or more of the following aspects: providing irrigation fluid to the chamber via the irrigation lumen; providing suction to the aspiration lumen so as to aspirate the tissue sample from the chamber; providing irrigation fluid to the chamber via the irrigation lumen; placing the tissue sample in a collection container without removing the medical instrument from the endoscope; wherein the step of placing the tissue sample occurs after the step of providing suction to the aspiration lumen; wherein the distal ends of each of the irrigation lumen and the aspiration lumen are at an angle relative to a longitudinal axis of the elongate member; wherein the chamber includes a first seal at a distal end of the chamber and a second seal at a proximal end of the chamber; advancing the medical instrument through the first seal and the second seal; obtaining a second tissue sample without removing the medical instrument from the endoscope; selectively irrigating at least one of the chamber and the body lumen via the irrigation lumen; selectively aspirating at least one of the chamber and the body lumen via the aspiration lumen; and sensing an entrance of the medical instrument into the chamber. 
     A still further embodiment of the invention may include a method. The method may include providing an endoscope including an elongate member, the elongate member including an aspiration lumen, a working lumen, and a chamber defined by a distal portion of the elongate member, a distal end of each of the aspiration lumen and the working lumen terminating in the chamber, providing a medical instrument including a distal assembly, advancing the elongate member of the endoscope through a body lumen, advancing the distal assembly of the medical instrument through the working lumen of the endoscope, through the chamber, out of a distal end of the endoscope, and into the body lumen, obtaining a tissue sample with the distal assembly, retracting the medical instrument so as to place the distal assembly and the tissue sample in the chamber, and removing the medical instrument and the endoscope from the body lumen. 
     Various embodiments of the invention may include one or more of the following aspects: providing suction to the aspiration lumen so as to aspirate the tissue sample from the chamber; wherein the chamber includes a first seal at a distal end of the chamber and a second seal at a proximal end of the chamber; advancing the distal assembly through the first seal and the second seal; further comprising obtaining a second tissue sample without removing the medical instrument from the endoscope; placing the tissue sample in a collection container without removing the medical instrument from the endoscope; wherein the step of placing the tissue sample occurs after the step of providing suction to the aspiration lumen; selectively aspirating at least one of the chamber and the body lumen via the aspiration lumen; and sensing an entrance of the distal assembly into the chamber. 
     Another embodiment of the invention may include a method. The method may include providing an endoscope including an elongate member, the elongate member including an aspiration lumen, a working lumen, and a chamber defined by a distal portion of the elongate member, a distal end of each of the aspiration lumen and the working lumen terminating in the chamber. The chamber may include a proximal seal disposed between the chamber and the working lumen and a distal seal disposed between the chamber and an outside environment. The method may further include providing a medical instrument including a distal assembly, advancing the elongate member of the endoscope through a body lumen, advancing the distal assembly of the medical instrument through the working lumen of the endoscope, through the proximal seal, through the chamber, through the distal seal, out of a distal end of the endoscope, and into the body lumen, obtaining a tissue sample with the distal assembly of the medical instrument, retracting the distal assembly through the distal seal so as to place the distal assembly of the medical instrument and the tissue sample in the chamber, and removing the medical instrument and the endoscope from the body lumen. 
     Various embodiments of the invention may include one or more of the following aspects: providing suction to the aspiration lumen so as to aspirate the tissue sample from the chamber; placing the tissue sample in a collection container without removing the medical instrument from the endoscope; wherein the step of placing the tissue sample occurs after the step of providing suction to the aspiration lumen; obtaining a second tissue sample without removing the medical instrument from the endoscope; selectively aspirating at least one of the chamber and the body lumen via the aspiration lumen; and sensing an entrance of the distal assembly into the chamber. 
     Additional objects and advantages of the invention will be set forth in part in the description which follows, and in part will be obvious from the description, or may be learned by practice of the invention. The objects and advantages of the invention will be realized and attained by means of the elements and combinations particularly pointed out in the appended claims. 
     It is to be understood that both the foregoing general description and the following detailed description are exemplary and explanatory only and are not restrictive of the invention, as claimed. 
    
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
       The accompanying drawings, which are incorporated in and constitute a part of this specification, illustrate embodiments of the invention and together with the description, serve to explain the principles of the invention. 
         FIG. 1  is a schematic view of an endoscope according to an embodiment of the invention.  FIG. 1  also includes an endoscopic instrument disposed through the endoscope. 
         FIG. 2  is a schematic cross-sectional view of a distal portion of the endoscope of  FIG. 1 . 
         FIG. 3  is a schematic view of a proximal portion of the endoscope of  FIG. 1 . 
         FIG. 4  is a schematic cross-sectional view of a distal portion of the endoscope of  FIG. 1 . 
         FIG. 5  is a schematic view of a distal assembly of an endoscopic instrument disposed in the distal portion of  FIG. 2  of the endoscope of  FIG. 1 . 
         FIG. 6  is a schematic cross-sectional view of a distal portion of an endoscope according to another embodiment of the invention. 
         FIG. 7  is a schematic view of a distal portion of an endoscope according to a further embodiment of the invention. 
         FIG. 8  is a schematic view of an endoscope and a biopsy instrument therein, according to still another embodiment of the invention and the distal portion of  FIG. 7 . 
         FIG. 9  is a schematic view of a handle portion of an endoscope according to yet another embodiment of the invention. 
         FIG. 10  is a schematic view of a distal portion of an endoscope according to a still further embodiment of the invention. 
         FIG. 11  is a schematic cross-sectional view of a distal portion of an endoscope and a distal assembly of an endoscopic instrument according to a yet further embodiment of the invention. 
         FIGS. 12A-12C  are schematic cross-sectional views of a distal portion of an endoscope according to another embodiment of the invention. 
         FIG. 13  is a schematic cross-sectional view of a distal portion of an endoscope and a distal assembly of an endoscopic instrument according to a further embodiment of the invention. 
         FIG. 14  is a schematic cross-sectional view of a distal portion of an endoscope and a distal assembly of an endoscopic instrument according to yet another embodiment of the invention. 
         FIGS. 15A-15C  are schematic cross-sectional views of a distal portion of an endoscope and a distal assembly of an endoscopic instrument according to still another embodiment of the invention. 
         FIG. 16  is a schematic, exploded, cross-sectional view of a distal portion of an endoscope and a distal assembly of an endoscopic instrument according to a yet further embodiment of the invention. 
         FIG. 17  is a schematic cross-sectional view of a distal portion of an endoscope and a distal assembly of an endoscopic instrument according to a still further embodiment of the invention. 
         FIGS. 18A-18B  are schematic cross-sectional views of a distal assembly of an endoscopic instrument according to another embodiment of the invention. 
     
    
    
     DESCRIPTION OF THE EMBODIMENTS 
     Reference will now be made in detail to exemplary embodiments of the invention, examples of which are illustrated in the accompanying drawings. Wherever possible, the same reference numbers will be used throughout the drawings to refer to the same or like parts. 
       FIGS. 1-4  depict an exemplary embodiment of an endoscope  1 . Endoscope  1  may include a handle portion  10 , an elongate member  20 , and a distal portion  100 , however, endoscope  1  may have any other suitable endoscopic components and/or configurations. 
     Elongate member  20  may have a plurality of lumens  21  running therethrough, for example, an irrigation lumen, an aspiration lumen, and a working lumen. Each lumen  21  may have a proximal end  22  and a distal end  23 . Elongate member  20  may be configured to have an endoscopic instrument  30  extending therethrough, for example, through lumen  21  between proximal end  22  and distal end  23 . Each lumen  21  within elongate member  20  may mate with a corresponding portion of distal portion  100 . Distal portion  100  may be integrally formed with elongate member  20 . 
     Endoscopic instrument  30  may include distal assembly  31 , for example, a biopsy forceps device having a pair of jaws for obtaining a tissue sample. 
     Endoscope  1  may also including a viewing lumen  221 , as shown in  FIG. 4 , extending through elongate member  20  and extending to handle portion  10 . Viewing lumen  221  may be configured, for example, to allow an operator to view an operative site through distal end  23  using any suitable visual apparatus and/or method. 
     An exemplary longitudinal cross-section of distal portion  100  of endoscope  1  is shown in  FIG. 2 . Distal portion  100  may be removable from elongate portion  20  of endoscope  1  or may be integrally formed with elongate member  20 . Distal portion  100  may include one or more of working lumen  121   a , irrigation lumen  121   b , and aspiration lumen  121   c . In various embodiments, the functions of any irrigation lumen and any aspiration lumen set forth in this application may be interchangeable (e.g., irrigation and/or aspiration may be conducted through any irrigation lumen, and irrigation and/or aspiration may be conducted through any aspiration lumen). Each of working lumen  121   a , irrigation lumen  121   b , and aspiration lumen  121   c  may include a respective distal end  123   a ,  123   b ,  123   c  that terminates in a distal chamber  130 . Distal chamber  130  may be bounded by a first seal  110  and a second seal  120 , for example, on its distal and proximal ends, respectively. Distal portion  100  may also include a sensor  140 . Any portion of distal portion  100  may be made of any suitable biocompatible materials, for example, rigid materials configured to resist deformation in a body lumen and without damaging the body lumen. 
     Working lumen  121   a  may be substantially parallel to a longitudinal axis of elongate member  20  and/or distal portion  100 . Working lumen  121   a  may be configured to allow endoscopic instrument  30  to be advanced therethrough, for example, a distal assembly  31  including a biopsy forceps device. Working lumen  121   a  may be have a substantially circular cross-section, however, working lumen  121   a  may have any suitable shape, size, and/or configuration. Distal assembly  31  of endoscopic instrument  30  may be inserted through a proximal end  122   a  of working lumen  121   a  and emerge in distal chamber  130  via distal end  123   a.    
     Although the illustrated embodiment of endoscope  1  is depicted as having one working lumen  121   a , those having ordinary skill in the art will readily appreciate that endoscope  1  may include a plurality of working lumens or channels. For example, it is contemplated that endoscope  1  may be configured as a two-channel endoscope, so as to facilitate simultaneous insertion of a plurality of endoscopic instruments  30 . In those embodiments where endoscope  1  includes a plurality of working lumens or channels, distal chamber  130  may be appropriately configured to be in communication with each of the plurality of working lumens or channels. For example, in those embodiments where endoscope  1  is configured as a two-channel endoscope, distal chamber  130  may be made larger to be in communication with both working channels. 
     Most of each of irrigation lumen  121   b  and aspiration lumen  121   c  may be substantially parallel to a longitudinal axis of elongate member  20 , distal portion  100 , and/or working lumen  121   a . Most of each of irrigation lumen  121   b  and aspiration lumen  121   c  may also be substantially parallel to each other. Each of irrigation lumen  121   b  and aspiration lumen  121   c  may have a substantially circular cross-section, however, each of irrigation lumen  121   b  and aspiration lumen  121   c  may have any suitable shape, size, and/or configuration. 
     Irrigation lumen  121   b  may be configured to facilitate fluid flow therethrough, for example, from a proximal end  122   b  to distal end  123   b  and into distal chamber  130 . Proximal end  122   b  may be configured to be attached to a source of fluid  40 , for example, as shown in  FIG. 3 . A portion of irrigation lumen  121   b  proximal to distal end  123   b  may be curved so that lumen  121   b  leads to chamber  130 . A line normal to a plane defining distal end  123   b  may form an angle with a longitudinal axis of one or more of elongate member  20 , distal portion  100 , and/or working lumen  121   a , for example, substantially a right angle. Distal end  123   b  of irrigation lumen  121   b  may have a narrow exit, be configured in the shape of a nozzle (e.g., decreasing in cross-sectional diameter closer to chamber  130 ), and/or have any other configuration to alter fluid flow, for example, into chamber  130 . 
     Aspiration lumen  121   c  may be configured to facilitate suction and/or fluid flow therethrough, for example, to remove a tissue sample  32  and/or fluid from distal chamber  130 , through distal end  123   c , and to a proximal end  122   c . Proximal end  122   c  may be configured to be attached to a source of suction  50  and/or a container  60  configured, for example, to collect tissue samples  32 , for example, as shown in  FIG. 3 . Source of suction  50  and container  60  may be arranged in any suitable configuration. A portion of aspiration lumen  121   c  proximal to distal end  123   c  may be curved so that lumen  121   c  leads to chamber  130 . A line normal to a plane defining distal end  123   c  may form an angle with a longitudinal axis of one or more of elongate member  20 , distal portion  100 , and/or working lumen  121   a , for example, substantially a right angle. Distal end  123   c  of aspiration lumen  121   c  may be configured to ease fluid flow and/or entry of biopsy sample  32  from chamber  130 , for example, by being flared (e.g., increasing in cross-sectional diameter closer to chamber  130 ). 
     The flow of fluid within irrigation lumen  121   b  and aspiration lumen  121   c  may be in substantially opposite directions. For example, fluid may flow through irrigation lumen  121   b  in a substantially distal direction while fluid and/or tissue samples may flow through aspiration lumen  121   c  in substantially a proximal direction. Fluid flow through irrigation lumen  121   b  and aspiration lumen  121   c  may be independently operated such that they are in operation at the same time, or at different times (e.g., staggered flow). For example, fluid may flow to distal chamber  130  via irrigation lumen  121   b  prior to aspiration being conducted via aspiration lumen  121   c , so as to float tissue sample  32  in fluid and allow it to be more easily aspirated out of distal chamber  130 . The fluid flowing from irrigation lumen  121   b  to aspiration lumen  121   c  may serve as both a carrier to advance tissue sample  32  through aspiration lumen  121   c  to container  60  and a lubricant to reduce friction between a wall of aspiration lumen  121   c  and tissue sample  32 . 
     Distal chamber  130  may have a substantially cylindrical shape, and may be in flow communication with one or more of working lumen  121   a , irrigation lumen  121   b , and aspiration lumen  121   c  via respective distal ends  123   a ,  123   b ,  123   c . For example, distal chamber  130  may be configured to receive endoscopic instrument  30  from working lumen  121   a  via distal end  123   a , fluid from irrigation lumen  121   b  via distal end  123   b , and/or suction from aspiration lumen  121   c  via distal end  123   c . Distal chamber  130  may sized to surround an entirety of distal assembly  31  of endoscopic instrument  30 , for example, a portion of a biopsy forceps device that includes an acquired tissue sample  32 . Distal chamber  130  may also be sized to accommodate distal assembly  31  in an open configuration such that an acquired tissue sample  32  may be removed from endoscopic instrument  30 , for example, as shown in  FIG. 5 . In various embodiments, however, distal chamber  130  may have any suitable shape, size, and/or configuration. For example, at least a portion of distal chamber  130  may have a cross-sectional area substantially the same as endoscopic instrument  30  in a closed configuration. Thus, when endoscopic instrument  30  is withdrawn into distal chamber  130  and contacts the aforementioned portion of distal chamber  130 , such physical contact may provide a tactile indication to a user that endoscopic instrument  30  is disposed in distal chamber  130 . 
     First seal  110  may be disposed between distal chamber  130  and the outside environment (e.g., a treatment site within a body lumen), and may have any suitable configuration and may be made of any suitable biocompatible material. First seal  110  may also be disposed between distal ends  123   a ,  123   b ,  123   c  of respective working lumen  121   a , irrigation lumen  121   b , and/or aspiration lumen  121   c  and the outside environment. Distal assembly  31  of endoscopic instrument  30  may be passed from distal chamber  130  to the outside environment through first seal  110 , for example, via a perforation  111  in first seal  110 , such as slits in an elastomeric seal. When endoscopic instrument  30  is disposed through first seal  110 , first seal  110  may form a substantially fluid tight fit around a portion of endoscopic instrument  30 , for example, to prevent fluid flow into and/or out of distal chamber  130  via first seal  110 . First seal  110  may be configured to inhibit fluid flow between distal chamber  130  and the outside environment, for example, when aspiration lumen  121   c  is performing aspiration on distal chamber  130 , whether or not endoscopic instrument  30  is disposed through first seal  110 . Fluid flowing from irrigation lumen  121   b  into distal chamber  130  may be inhibited from flowing to the outside environment by first seal  110 , also whether or not endoscopic instrument  30  is disposed through first seal  110 . 
     Second seal  120  may be disposed between distal chamber  130  and distal end  123   a  of working lumen  121   a , and may have any suitable configuration and may be made of any suitable biocompatible material. Second seal  120  may also be disposed between distal ends  123   b ,  123   c  of respective irrigation lumen  121   b  and/or aspiration lumen  121   c  and distal end  123   a  of working lumen  121   a . Distal assembly  31  of endoscopic instrument  30  may be passed into distal chamber  130  through second seal  120 , for example, via a perforation  121  in second seal  120 , such as slits in an elastomeric seal. When endoscopic instrument  30  is disposed through second seal  120 , second seal  120  may form a substantially fluid tight fit around a portion of endoscopic instrument  30 , for example, to prevent fluid flow into and/or out of distal chamber  130  via second seal  120 . Second seal  120  may be configured to inhibit fluid flow between distal chamber  130  and working lumen  121   a , for example, when aspiration lumen  121   c  is performing aspiration on distal chamber  130 , whether or not endoscopic instrument  30  is disposed through second seal  120 . Fluid flowing from irrigation lumen  121   b  into distal chamber  130  may be inhibited from flowing into working lumen  121   a  by second seal  120 , also whether or not endoscopic instrument  30  is disposed through second seal  120 . 
     First seal  110  and second seal  120  may be configured to prevent air or other fluids from the outside environment and/or working lumen  121   a  from entering distal chamber  130 , for example, while aspiration lumen  121   c  is removing air, fluid, and/or tissue samples from distal chamber  130 . Accordingly, suction from distal chamber  130  via aspiration lumen  121   c  may be enhanced. First seal  110  and second seal  120  may also or alternatively be configured to prevent fluid and/or biopsy samples from exiting distal chamber  130  to the outside environment and/or working lumen  121   a.    
     First seal  110  and second seal  120  may be made out of any suitable biocompatible material, for example, an elastomer, silicone, or polyurethane. Some examples of seals include RX (Rapid Exchange) LOCKING DEVICE AND BIOPSY CAP SYSTEM™ manufactured by BOSTON SCIENTIFIC CORPORATION™ or any of its subsidiaries. 
     Sensor  140  may be configured to allow a user to determine when distal assembly  31  of endoscopic instrument  30  is no longer disposed in the outside environment, and instead is disposed in distal chamber  130 . For example, sensor  140  may be coupled to one or more of distal chamber  130 , first seal  110 , and second seal  120  to provide audio or visual feedback to the user by detecting the presence of distal assembly  31  in distal chamber  130  using any suitable method. Some suitable sensors  140  may include a sensor which utilizes magnets (e.g., to produce a Hall effect), broken light beams, or RFID sensors. However, any suitable sensor  140  may be used. Sensor(s)  140  may located on any suitable portion of endoscope  1  and/or endoscopic instrument  30  depending on the type of sensor used. 
     In the alternative, the user may be provided with sufficient tactile feedback when the distal assembly  31  enters distal chamber  130  so as to make sensor  140  unnecessary. For example, the user may be able to feel on the proximal end of endoscopic instrument  30  when distal assembly  31  completely enters distal chamber  130  because distal assembly  31  will no longer be disposed through, and hence disengage from, first seal  110 . 
     In a further embodiment where sensor(s)  140  may not be necessary, endoscopic instrument  30  may have visual markers or other indicators on its proximal end. Such visual markers or other indicators may be configured such that when endoscopic instrument  30  is disposed in distal chamber  130 , the visual marker or other indicators emerge from proximal end  122   a  of working lumen  121   a.    
       FIG. 10  depicts an exemplary embodiment of endoscope  1  including one or more valves  70 . Valves  70  may be configured to selectively direct irrigation and/or suction to/from at least one of the outside environment and distal chamber  130 . For example, endoscope  1  may include irrigation valve  70   a  and aspiration valve  70   b.    
     Irrigation valve  70   a  may be disposed in irrigation lumen  121   b  and may be configured to, in a first position, allow fluid flow from irrigation lumen  121   b  to chamber  130  and at least partially prevent fluid flow from irrigation lumen  121   b  to the outside environment via irrigation extension  124   b , and, in a second position, allow fluid flow from irrigation lumen  121   b  to the outside environment via irrigation extension  124   b  and at least partially prevent fluid flow from irrigation lumen  121   b  to chamber  130 . In  FIG. 10 , irrigation valve  70   a  is disposed in the first position. Accordingly, a user may selectively irrigate either chamber  130  or the outside environment depending on the position of irrigation valve  70   a.    
     Aspiration valve  70   b  may be disposed in aspiration lumen  121   c  and may be configured to, in a first position, allow suction from chamber  130  to aspiration lumen  121   c  and prevent suction from the outside environment to aspiration lumen  121   c  via aspiration extension  124   c , and, in a second position, allow suction from the outside environment to aspiration lumen  121   c  via aspiration extension  124   c  and substantially prevent suction from chamber  130  to aspiration lumen  121   c . In  FIG. 10 , aspiration valve  70   b  is disposed in the second position. Accordingly, a user may selectively suction either chamber  130  or the outside environment depending on the position of aspiration valve  70   b.    
     Valves  70  may be any suitable valves and may be selectively and/or independently actuated using any suitable control mechanism. For example, valves  70  may be a poppet or flapper type valve that is connected to an actuation wire that runs along and/or through elongate member  20  to handle portion  10 . In another example, valves  70  may be miniaturized solenoid valves actuated using any suitable method, for example, electrical, infrared, or wireless structures. Handle portion  10  may have suitable actuators for the user to actuate valves  70  into the appropriately desired position. One advantage of valves  70  may be that it may reduce the number of lumens in endoscope  1  by allowing irrigation lumen  121   b  to provide fluid to both the outside environment and chamber  130 . The same is true for aspiration lumen  121   c  and suction. In an alternative embodiment, sliding windows may be used to selectively control fluid flow and/or biopsy sample suction into and out of irrigation lumen  121   b  and/or aspiration lumen  121   c . For example, a sliding window may be configured to slide distally to cover distal end  123   b ,  123   c  of lumen  121   b ,  121   c , and proximally to uncover them. 
     Endoscope  1  and endoscopic instrument  30  may be configured such that endoscopic instrument  30  is disposed at a particular circumferential orientation or range of circumferential orientations relative to endoscope  1 . For example, chamber  130  may have a substantially oval-shape, as shown in  FIG. 11 , such that distal assembly  31  of endoscopic instrument  30  may be placed in an open configuration in a small range of circumferential orientations. This may be desirable, for example, such that irrigation lumen  121   b  and aspiration lumen  121   c  may be most ideally positioned relative to distal assembly  31  to remove tissue sample  32  from chamber  130 . Any suitable configurations and/or structures may be used to achieve this effect. For example, working lumen  121   a  and/or chamber  130  may include a protrusion and the outside of endoscopic instrument  30  may include a groove configured to receive the protrusion such that the protrusion will only fit in the groove in a limited number of circumferential orientations. 
     In another exemplary embodiment depicted in  FIGS. 12A-12C , the endoscope may include distal chamber  630  surrounded by one or more lumens  621   b . Lumens  621   b  may be in flow communication with distal chamber  630  via channels  622   b . One or more of lumens  621   b  may have tubes  623   b ,  623   c  disposed therein that are longitudinally movable relative to distal chamber  630  and lumens  621   b . Tubes  623   b ,  623   c  may be configured to conduct irrigation and/or aspiration, for example, tube  623   b  may be an irrigation tube and tube  623   c  may be an aspiration tube. Tubes  623   b ,  623   c  may include curved portions  624   b ,  624   c  configured, for example, to enter channels  622  and face distal chamber  630  as shown in  FIG. 12B . Curved portions  624   b ,  624   c  may be flexible enough such that when moved proximally (as shown in  FIG. 12A ) or distally (as shown in  FIG. 12C ) relative to channels  622 , curved portions  624   b ,  624   c  become substantially straight. In the configuration shown in  FIG. 12C , tubes  623   b ,  623   c  may be configured to conduct irrigation and/or aspiration with the outside environment. Tubes  623   b ,  623   c  may be jointly and/or independently movable relative to each other, and in some embodiments, only one of tubes  623   b ,  623   c  may be deployed in lumens  621   b , with the other lumen  621   b  conducting irrigation and/or aspiration as necessary. Tubes  623   b ,  623   c  may be actuated to attain a curved shape at portions  624   b ,  624   c  through any suitable means, such as use of a pull wire or through the material used (e.g., shape memory material). 
     In various embodiments, endoscope  1  may have any number of seals on any portion of endoscope  1  and/or endoscopic instrument  30 . For example, as shown in  FIG. 13 , seal  520  may be placed on endoscopic instrument  30  proximal to distal assembly  31 . Seal  520  may cooperate with the interface between working lumen  121   a  and distal chamber  130  to at least partially prevent fluid flow therethrough and/or seal  520  may have a cross-sectional area substantially similar to distal chamber  130  so as to at least partially prevent fluid flow therepast. 
     Any seal set forth herein may have any suitable shape. For example,  FIG. 14  depicts seal  820  having a substantially cup-shaped configuration. Such a configuration may be advantageous, for example, in at least partially preventing fluid flow therethrough from distal chamber  130  into working lumen  121   a.    
     In a further embodiment, endoscopic instrument  930  may be provided in multiple pieces. For example, as shown in  FIGS. 15A-15C , endoscopic instrument  930  may include elongate portion  933  and distal assembly  931  that are detachable from each other. Elongate portion  933  may be disposed in working lumen  121   a . Distal assembly  931  may be introduced through distal end  23  of endoscope  1  and attached to a distal end of elongate portion  933 . Distal assembly  931  may have a cross-sectional area such that it may fit within distal chamber  130 , but would not fit within working lumen  121   a . A proximal end of elongate portion  933  may be configured to be attached to a handle portion configured to manipulate distal assembly  931  via elongate portion  933 . Examples of advantages of endoscopic instrument  930  are set forth in U.S. Patent Application Publication No. 2003/0105488 A1 published on Jun. 5, 2003, the entirety of which is incorporated herein by reference. 
     In another embodiment, endoscopic assembly  800  may include multiple interlocking portions. For example, as shown in  FIG. 16 , endoscopic assembly  800  may include one or more of distal cap  801 , tubes  821   b ,  821   c  configured to accommodate irrigation and/or aspiration, distal assembly  31  of endoscopic instrument  30 , and endoscope  802  defining working lumen  821   a . Distal cap  801  may include seal  810  with slit  811 , outer housing  813  defining distal chamber  830 , and attachment portion  812  configured to attach distal cap  801  to one or more of tubes  821   b ,  821   c  and endoscope  802 . Attachment portion  812  may provide sufficient attachment to tubes  821   b ,  821   c  and/or endoscope  802  so as to prevent detachment due to pressures in distal chamber  830  associated with irrigation and/or aspiration. Tubes  821   b ,  821   c  may include distal portion  824   b ,  824   c  configured to curve inward so as to provide irrigation and/or aspiration to distal chamber  830  when endoscopic assembly  800  is fully assembled. Endoscope  801  may include illumination portion  842  and visualization portion  841  on its distal end that may operate by providing illumination and/or visualization through outer housing  813  of distal cap  801  either through apertures in outer housing  813 , or outer housing  813  being made of a transparent material. 
     In a further embodiment, endoscope  1000  may only include working lumen  1021   a  and aspiration lumen  1021   c  as shown in  FIG. 17 . Endoscopic instrument  30  may include a seal  1020  disposed therearound. Seal  1020  may be configured to have a cross-sectional area substantially similar to a cross-sectional area of working lumens  1021   a . Seal  1020  may be configured to cooperate with inner surface  1070  of endoscope  1000  to form a substantially airtight seal such that when aspiration is conducted through aspiration lumen  1021   c , enough of a vacuum is created in distal chamber  1030  such that tissue sample  32  may be aspirated out of distal chamber  1030  via aspiration lumen  1021   c.    
     An embodiment of the invention may include a method of using an endoscope and endoscopic instrument, for example, endoscope  1  and endoscopic instrument  30  as set forth in  FIGS. 1-4 . 
     In the method, endoscope  1  may be provided, proximal end  122   b  of irrigation lumen  121   b  may be connected to a source of fluid  40 , and proximal end  122   c  of aspiration lumen  121   c  may be connected to source of suction  50  and container  60 , for example, as shown in  FIG. 3 . Using a visual image provided by viewing lumen  221 , shown in  FIG. 4 , elongate member  20  of endoscope  1  may be advanced into a body lumen, for example, a gastrointestinal tract of a patient. Elongate member  20  may be advanced until distal end  23  and/or distal portion  100  may be substantially adjacent to a desired portion of the gastrointestinal tract, for example, a portion to be treated or a portion from which a tissue sample  32  is desired. 
     Once so positioned, distal assembly  31  of endoscopic instrument  30  may be advanced into working lumen  121   a  via proximal end  122   a . Endoscopic instrument  30  may be advanced through working lumen  121   a  until distal assembly  31  reaches distal end  123   a . Distal assembly  31  of endoscopic instrument  30  may then be advanced through second seal  120 , for example, through perforation  121  and into distal chamber  130 . Distal assembly  31  of endoscopic instrument  30  may then be further advanced through distal chamber  130 , through first seal  110  via perforation  111 , and into the gastrointestinal tract. Once disposed in the gastrointestinal tract, endoscope  1  and distal assembly  31  may be repositioned in the gastrointestinal tract, and distal assembly  31  of endoscopic instrument  30  may obtain tissue sample  32 . 
     Once the tissue sample has been obtained, distal assembly  31  of endoscopic instrument  30  may be retracted into distal chamber  130  through perforation  111  of first seal  110 . Once tissue sample  32  is disposed in distal chamber  130 , sensor  140  may detect that distal assembly  31  is completely disposed within distal chamber  130 , and provide audio or visual feedback to the user. Alternatively, the operator may receive a tactile feedback indicating that distal assembly  31  is in distal chamber  130 . Consequently, fluid may flow into distal chamber  130  from fluid source  40  via proximal end  122   b , irrigation lumen  121   b , and distal end  123   b , for example, for about 5 seconds at between about 60 psi and 80 psi. Distal assembly  31  of endoscopic instrument  30  may either release the tissue sample  32 , as shown in  FIG. 5 , or the fluid flowing into distal chamber  130  from irrigation lumen  121   b  may dislodge tissue sample  32  from endoscopic instrument  30 . Tissue sample  32  may be released into any position in distal chamber  130 , for example, substantially adjacent to distal end  123   c  of aspiration lumen  121   c . First seal  110  may substantially prevent fluid from flowing out of distal chamber  130  and into the outside environment, and second seal  120  may substantially prevent fluid from flowing out of distal chamber  130  and into working lumen  121   a , for example, because second seal  120  may form a substantially fluid tight seal around endoscopic instrument  30 , also as shown in  FIG. 5 . 
     Suction may be initiated from suction source  50  such that gas(es), fluid(s), and tissue sample(s)  32  may be removed from distal chamber  130  by flowing through distal end  123   c , aspiration lumen  121   c , and proximal end  122   c  into container  60 , for example, at about 15 in/Hg. First seal  110  may substantially prevent the application of suction to the outside environment, and thereby prevent air from flowing into distal chamber  130  from the outside environment, and second seal  120  may substantially prevent fluid from flowing into distal chamber  130  from working lumen  121   a , for example, because second seal  120  may form a substantially air tight seal around endoscopic instrument  30 . 
     Once the tissue sample(s)  32 , gas(es), and/or fluid(s) have been removed from distal chamber  130 , distal assembly  31  of endoscopic instrument  30  may be advanced back into the outside environment through perforation  111  of first seal  110  and another tissue sample  32  may be acquired. Distal assembly  31  of endoscopic instrument  30  may then again be retracted into distal chamber  130  and tissue sample  32  may be irrigated via fluid from fluid source  40  and aspirated to container  60  using any step or steps set forth herein. Any combination of any of these steps may be repeated as many times as desired to obtain as many tissue samples as desired. 
     Once the desired number of tissue samples  32  have been obtained, endoscopic instrument  30  may be retracted out of first seal  110 , distal chamber  130 , second seal  120 , distal end  123   a , working lumen  121   a , and proximal end  122   a . Elongate member  20  of endoscope  1  may then be removed from the gastrointestinal tract. 
     Endoscope  1  may be used in any suitable medical procedure in any suitable portion of the body. Endoscopic instrument  30  may be any suitable endoscopic instrument to perform any desired endoscopic procedure, whether to obtain tissue samples  32  or otherwise. For example, endoscopic instrument  30  may include any suitable instrument manufactured and/or sold by BOSTON SCIENTIFIC CORPORATION™ or its subsidiaries, for example, a RADIAL JAW 3 BIOPSY FORCEPS™ or RADIAL JAW 4 BIOPSY FORCEPS™. 
     Distal assembly  100  of endoscope  1  may have alternative embodiments. For example,  FIG. 2  shows a distal portion  100  wherein distal ends  123   b ,  123   c  of irrigation lumen  121   b  and aspiration lumen  121   c  are substantially facing each other. However, in distal portion  300  as shown in  FIG. 6 , distal ends  323   b ,  323   c  of lumens  321   b ,  321   c  may be disposed at different portions of distal chamber  130  such that they do not face each other. For example, distal end  323   b  may be disposed at a proximal end (e.g., closer to second seal  120 ) of distal chamber  130  while distal end  323   c  may be disposed at a distal end (e.g., closer to first seal  110 ) of distal chamber  130 . Lumens  321   b ,  321   c  may be any combination of an irrigation lumen and an aspiration lumen. For example, lumen  321   b  may be an irrigation lumen and lumen  321   c  may be an aspiration lumen, such that fluid will flow into distal chamber  130  from distal end  323   b  of irrigation lumen  321   b  and distally push tissue sample  32  to distal end  323   c  of aspiration lumen  321   c.    
     In various embodiments, endoscope  1  may have any number of lumens  21  with any number of distal ends located in any portion of distal chamber  130 . Each distal end of various lumens may have any shape, size, or configuration, and any two distal ends of lumens  21  may have either the same shapes, sizes, and configurations, or different shapes, sizes, and configurations. A single lumen  21  may even have more than one distal end in distal chamber  130 . The distal ends of lumens  21  may enter distal chamber  130  at any suitable angle, in both the axial and radial planes. The distal ends of lumens  21  may be configured about distal chamber  130  to achieve a specific flow profile, for example, turbulent flow or chaotic flow in distal chamber  130 . 
     In another embodiment,  FIGS. 7-8  show a distal portion  400  including an irrigation fluid bypass  421   b  (i.e., irrigation lumen) with a proximal end  422   b  connected to working lumen  421   a  proximal to distal end  423   a . Distal ends  423   b ,  423   c  of irrigation lumen  421   b  and aspiration lumen  421   c  may be connected to and/or be in flow communication with distal chamber  430  in any suitable configuration, for example, between first seal  410  and second seal  420 . Accordingly, fluid source  40  may be connected to a proximal end  122   a  of working lumen  421   a . When in operation, fluid may flow from fluid source  40 , through proximal end  122   a , through working lumen  421   a , and come up against second seal  420 . At this point, second seal  420  may or may not have an endoscopic instrument  30  disposed therethrough. In any case, fluid from working lumen  421   a  may be directed (e.g., by second seal  420 ) through proximal end  422   b  of water bypass  421   b  and into distal chamber  430  via distal end  423   b.    
     As shown in  FIG. 8 , fluid may flow to distal portion  400  via an elongate sheath  440  disposed around an elongate portion of endoscopic instrument  30 . A distal end  441  of elongate sheath  440  may be disposed proximal to distal chamber  430  and second seal  420 , and proximal or adjacent to proximal end  422   b  of irrigation lumen  421   b  such that fluid may flow from elongate sheath  440  into irrigation lumen  421   b  via proximal end  422   b . A proximal portion  442  of elongate sheath  440  may include a Y-connector (e.g., manufactured by QOSINA™) including a plurality of lumens  442   a ,  442   b . Lumen  442   a  may be configured to be connected to a source of fluid  40 . Lumen  442   b  may be configured to receive endoscopic instrument  30  and may include a connector  450  (e.g., a Touhy-Borst connector manufactured by QOSINA™) on a proximal end. 
     Connector  450  may be configured such that in a first configuration, endoscopic instrument  30  may move freely longitudinally relative to elongate sheath  440 , for example, while distal assembly  31  is being moved relative to distal chamber  430  so as to acquire tissue sample  32  and place tissue sample  32  in distal chamber  430 . Connector  450  may be placed in a second configuration so as to prevent endoscopic instrument  30  from longitudinally moving relative to elongate sheath  440 , for example, by locking endoscopic instrument  30  to the portion of elongate sheath  440  defining lumen  442   b . At this time, connector  450  may also form a substantially fluid-tight seal so as prevent fluid from flowing proximally between elongate sheath  440  and endoscopic instrument  30  at proximal portion  442 . Fluid may then be flowed through elongate sheath  440  from a fluid source  40  via lumen  442   a . Fluid may be prevented from flowing proximally past lumen  442   b  by a combination of connector  450 , elongate sheath  440 , and endoscopic instrument  30 . Fluid may thus flow down elongate sheath  440  and out distal end  441  into working lumen  421   a  and/or irrigation lumen  421   b . Fluid may flow from there into distal chamber  430  so as to float and/or carry tissue sample  32  toward distal end  423   c  of aspiration lumen  421   c , and eventually sent to container  60 . An advantage to this configuration may be that space is saved and/or manufacturing of endoscope  1  becomes less complicated due to the elimination of an irrigation lumen running an entire length of the elongate portion  20  of endoscope  1 . 
     In a further embodiment,  FIG. 9  depicts a handle portion  710  configured to be connected to a source of fluid  740  and also including both a source of suction  750  and a container  760  for storing tissue samples  732 . Container  760  may either be removable from handle portion  710 , or container  760  may be configured to allow tissue samples  732  to be removed from container  760 , for example, by including a door or other means to access the samples  732 . Proximal end  722   b  of irrigation lumen  721   b  may be attached to fluid source  740 , and proximal end  722   c  of aspiration lumen  721   c  may be attached to any combination and/or configuration of suction source  750  and container  760 . Other examples of suitable devices and/or configurations for storing and removing tissue samples are set forth in U.S. Pat. No. 6,926,676 B2 issued Aug. 9, 2005 to Vincent TURTURRO et al, the entirety of which is incorporated herein by reference. 
     Any aspects of any of the embodiments set forth herein may be combined in any suitable combination. For example, distal assembly  100  may include a proximal end  22  as set forth in  FIG. 3  and/or a handle portion  710  as set forth in  FIG. 9 . In another example, endoscope  1  may include any of distal portions  100 ,  300 , or  400 . 
     Any suitable part may be used for any aspect set forth herein and may have any suitable size, shape, and/or configuration. For example, the portion of the aspiration lumen disposed in the elongate member of the endoscope proximal to the distal portion may be a ARKEMA PEBAX 7233 SN 01 Polyether Block Amide having an inner diameter of about 0.07 inches, an outer diameter of about 0.09 inches, and a length of about 240 cm. In a further example, the portion of the irrigation lumen disposed in the elongate member of the endoscope proximal to the distal portion may be manufactured by ENDOVATIONS™. In another example, the endoscope may be made of PELLETHANE 55D RESIN and have an inner diameter if about 0.11 inches, an outer diameter of about 0.15 inches, and a length of about 190 cm. In yet another example, the source of suction may be a suction pump manufactured by MEDICAL SPECIFICS. 
     Any suitable device may be used in conjunction with endoscope  1 . For example, endoscopic instrument  30  may be any medical instrument including, but not limited to, biopsy forceps, baskets, graspers, snares, and/or needles. An example of an endoscopic instrument  230  is set forth in  FIGS. 18A-18B . Endoscopic instrument  230  includes distal forceps  231  including apertures  232  extending through distal forceps  231 . Accordingly, in operation, forceps  231  may be used to acquire tissue which then may be disposed in apertures  232 . Forceps  231  may then be placed in distal chamber  130  as set forth in  FIGS. 1-4  in an orientation such that apertures  232  are substantially in line with distal ends  123   b ,  123   c  of irrigation and aspiration lumens  121   b ,  121   c . Fluid may then be run through irrigation lumen  121   b  into distal chamber  130  and through apertures  232  to dislodge the acquired tissue sample. The tissue sample may then be aspirated by aspiration lumen  121   c . In some embodiments, the fluid pressure from irrigation lumen  121   b  and/or vacuum pressure from aspiration lumen  121   c  may be sufficient to dislodge the tissue from forceps  231 , either through apertures  232  or directly from the teeth of forceps  231 , without opening forceps  231  or only partially opening forceps  231 . 
     There are many advantages to the various embodiments set forth in this application. For example, multiple tissue samples may be acquired without removing endoscopic instrument  30  and particularly its distal assembly  31 , from endoscope  1 . As a result, more tissue samples may be acquired in less time. There also is less risk of cross-contamination of samples, as compares to a prior method of stacking multiple samples within the biopsy jaws. In addition, there is less risk of contamination and infection due to continually removing and reinserting endoscopic instrument  30 . 
     In various embodiments, the invention may include providing a kit where an endoscopic instrument  30  is already disposed in endoscope  1 . Distal assembly  31  may be disposed in distal chamber  130  such that a user may purchase the kit with endoscopic instrument  30  already disposed in endoscope  1 , and immediately use the kit by advancing endoscope  1  into the body. Such a kit may be advantageous because it reduces the number of steps in an endoscopic procedure, i.e., the step of advancing the endoscope instrument  30  through endoscope  1 . In some embodiments, distal assembly  31  may be integrated with endoscope  1  in distal chamber  130 , and only pull wires or other actuations means may be disposed the length of endoscope  1 , for example, through working lumen  121   a.    
     Other embodiments of the invention will be apparent to those skilled in the art from consideration of the specification and practice of the invention disclosed herein. It is intended that the specification and examples be considered as exemplary only, with a true scope and spirit of the invention being indicated by the following claims.