Patent Publication Number: US-2012046671-A1

Title: Repetitive clipping treatment device

Description:
TECHNICAL FIELD 
     The present invention relates to a repetitive clipping treatment device which manipulates plural clips for endoscope treatment with a manipulating wire, to perform clipping treatment, such as stopping bleeding, closure of an affected part, such as a wound, or the like, in a living body, and particularly, to a repetitive clipping treatment device which can suppress the influence of retraction of a manipulating wire when clipping treatment using the manipulating wire is performed. 
     BACKGROUND ART 
     In recent years, a clipping treatment device for an endoscope has been used which causes a clip to protrude from the forward end of an endoscope inserted into a living body to pinch a bleeding portion or a portion to be treated after removal of a diseased tissue with the clip, thereby stopping bleeding or performing suturing or closure of a wound. 
     In this clipping treatment device for an endoscope, clips are loaded into a sheath and protruding of a clip and pinching of a portion to be treated with the clip is performed by advancing or retreating a manipulating wire. 
     However, since the manipulating wire is thin compared to the inner diameter of the sheath, a relatively large space opens between the sheath and the manipulating wire. For this reason, when the sheath is curved during use of an endoscope, since the manipulating wire passes through the outside of the inner surface of the curved sheath due to this space, a difference occurs in path length between the sheath and the manipulating wire. For this reason, for example, when the sheath is curved after the manipulating wire is made to protrude by a predetermined amount from the forward end of the sheath with a state where the sheath is extended straightly being a reference state, so-called retraction occurs where the forward end of the manipulating wire is located inside the forward end of the sheath. 
     Thus, Patent Literature 1 suggests a treatment device for an endoscope having a flexible sheath which is passed through a treatment device guide pipe of the endoscope, a forward end treatment member which protrudes or retracts from a forward end portion of the flexible sheath, a manipulating wire which has a forward end connected to the forward end treatment member and is slidably passed through the flexible sheath in the axial direction, a first manipulating member which is connected to the proximal end of the flexible sheath, a second manipulating member connected to the proximal end of the manipulating wire. In the treatment device for an endoscope of this Patent Literature 1, the manipulation of relatively moving the first manipulating member and second manipulating member in the axial direction of the flexible sheath and the manipulating wire, whereby the flexible sheath and the manipulating wire slide relatively in the axial direction and the forward end treatment member protrudes or retracts from the forward end portion of the flexible sheath. The treatment device for an endoscope of Patent Literature 1 performs clipping one by one. 
     The treatment device for an endoscope of Patent Literature 1 provides a connection positioning means capable of changing one of the connection position of the proximal end of the flexible sheath to the first manipulating member and the connection position of the proximal end of the manipulating wire to the second manipulating member freely in the axial direction. The relationship in relative length between the manipulating wire and the flexible sheath can be arbitrarily adjusted by this connection positioning means. That is, the relative position between the manipulating wire and the flexible sheath can be arbitrarily adjusted. For this reason, in the treatment device for an endoscope of Patent Literature 1, a user of the treatment device for an endoscope can arbitrarily adjust the relative length relationship between the manipulating wire and the flexible sheath if needed to set and use the forward end treatment member in an optimal state at the forward end portion of the flexible sheath. 
     CITATION LIST 
     Patent Literature 
     
         
         Patent Literature 1: JP 2007-244826 A 
       
    
     SUMMARY OF INVENTION 
     Technical Problems 
     The treatment device for an endoscope of Patent Literature 1 performs one clipping at a time, although a user of the treatment device for an endoscope can arbitrarily perform the adjustment if needed to set and use the forward end treatment member in an optimal state at the forward end portion of the flexible sheath. 
     Here, in a repetitive clipping treatment device continuously using plural clips, even in an optimal state for a first clip, there is a problem that the remaining clips cannot be set in an optimal state due to influence of the above-mentioned retraction. 
     For this reason, in Patent Literature 1, as for one clip, the forward end treatment member can be set and used in an optimal state at the forward end portion of the flexible sheath. However, in the repetitive clipping treatment device using plural clips continuously, there is a problem that each clip cannot necessarily be set in an optimal state at the forward end portion of the flexible sheath. 
     The object of the invention is to solve the problems based on the conventional technique, and provide a repetitive clipping treatment device which suppresses the influence of retraction of a manipulating wire. 
     Solution to Problems 
     To achieve the aforementioned objective, according to an aspect of the present invention, there is provided a repetitive clipping treatment device comprising a clip series made up of plural clips connected by a forward end of a subsequent clip being engaged with a rear end of a previous clip, and a connection member connected to the rearmost clip, a cylindrical sheath loaded with the clip series, a manipulating wire movably arranged in the sheath, and having a forward end detachably connected to the connection member so as to move the clip series in the longitudinal direction of the sheath in the sheath, a handle main body connected to the sheath and having the manipulating wire extending from the sheath arranged therein, a slider mounted on the outer periphery of the handle main body so as to be movable in the axial direction of the handle main body, engaged with the manipulating wire, and moving the manipulating wire in the axial direction of the handle main body, and a slider displacement regulating member mounted on the outer periphery of the handle main body so as to be rotatable in the circumferential direction of the handle main body and regulating the displacement of the slider in the axial direction of the handle main body to plural different displacements, required for clipping treatment of each clip of the clip series, wherein the plural different displacements regulated by the slider displacement regulating member and corresponding to the respective clips is calculated by obtaining an amount of retraction at the position of a clip of the clip series in advance, and determining the displacement on the basis of the length required to cause each clip to protrude, and the respective retraction amounts in each clip. 
     It is preferred that an engagement portion between the previous clip and the subsequent clip in the clip series is covered with a connection ring fitted so as to be able to advance or retreat with respect to the clips, and the connection ring is pressed against the inner surface of the sheath and closed inward in the sheath, and presses and retains at least one of the clips connected in the connection ring, and at least two or more skirt portions opened more widely than the inner diameter of the sheath after passing through a forward end of the sheath to prevent retreating to the inside of the sheath are provided in the circumferential direction of the connection ring at the same position in a movement direction of the clips. 
     Further, it is preferred that an extension portion is provided as a portion of the connection ring on the proximal end side and extends, and the extension portion prevents the clip and the connection ring from coming off of the forward end of the sheath during clipping treatment. 
     Further, it is preferred that the slider displacement regulating member has plural position regulating grooves which is formed according to the plural different displacements, respectively, at predetermined intervals in the circumferential direction of the handle main body, and have different positions at forward end portions thereof on the sheath side. 
     Further, it is preferred that the slider displacement regulating member has position regulating grooves equal to or more than the number of the clips provided in the clip series. 
     Further, it is preferred that the slider displacement regulating member is arranged so that a position regulating groove whose sheath-side forward end portion is nearest to the sheath, and a position regulating groove whose forward end portion is farthest from the sheath are adjacent to each other, and wherein a position regulating groove formed on the side where the position regulating groove whose forward end portion is nearest to the sheath, and the position regulating groove whose forward end portion is farthest from the sheath are not adjacent to each other is formed so that the forward end portion thereof is located at a position near the sheath gradually, as it goes from the position regulating groove whose forward end portion is nearest to the sheath, and the position regulating groove whose forward end portion is farthest from the sheath, on the side where the position regulating groove whose forward end portion is nearest to the sheath, and the position regulating groove whose forward end portion is farthest from the sheath are not adjacent to each other. 
     Further, it is preferred that the position regulating groove whose forward end portion is nearest to the sheath in the slider displacement regulating member is used for loading of the clip series into the sheath. 
     Further, it is preferred that the slider has a guide pin which extends toward the center of the handle main body and has a diameter capable of being inserted through the position regulating grooves, and when the position of one position regulating groove of the plural position regulating grooves overlaps the position of the guide pin, the slider (the slider) moves in the axial direction of the handle main body along the overlapped position regulating groove. 
     Further, it is preferred that the clip series includes three clips, and the slider displacement regulating member has the position regulating grooves at intervals of 90° in the circumferential direction of the handle main body. 
     Also, it is preferred that the clip has at least a claw portion and an arm portion, and the arm portion has a projection. In this case, the projection is wider than the arm portion. 
     Advantageous Effects of Invention 
     According to the invention, plural different displacements of the slider corresponding to plural clips is calculated by obtaining an amount of retraction at the position of a clip of the clip series in advance, and determining the displacement on the basis of the length required to cause each clip to protrude, and the respective retraction amounts in each clip. For this reason, even if the sheath is curved, the influence of retraction of the manipulating wire can be suppressed, and a clip can be reliably caused to protrude from the forward end of the sheath during clipping treatment. As a result, the clipping treatment can be ensured. 
    
    
     
       BRIEF DESCRIPTION OF DRAWINGS 
         FIG. 1  is a schematic perspective view illustrating a repetitive clipping treatment device of an embodiment of the invention. 
         FIG. 2A  is a schematic cross-sectional view illustrating the configuration of a forward end portion of the repetitive clipping treatment device of the embodiment of the invention, and  FIG. 2B  is a schematic cross-sectional view as seen from an angle different from  FIG. 2A  by 90°. 
         FIG. 3  is a perspective view illustrating the schematic configuration of a clip used for a repetitive clipping treatment device of the embodiment of the invention. 
         FIG. 4A  is a front view illustrating an example of a connection ring used together with a clip of the repetitive clipping treatment device of the embodiment of the invention,  FIG. 4B  is a cross-sectional view of the connection ring illustrated in  FIG. 4A , and  FIG. 4C  is a bottom view of the connection ring illustrated in  FIG. 4A . 
         FIG. 5  is a schematic cross-sectional view illustrating a handle portion of a manipulation handle of the repetitive clipping treatment device of the embodiment of the invention. 
         FIG. 6  is a schematic perspective view illustrating a main body rail of the manipulation handle of the repetitive clipping treatment device of the embodiment of the invention. 
         FIG. 7  is a schematic perspective view illustrating a home position mark of the handle portion of the manipulation handle of the repetitive clipping treatment device of the embodiment of the invention. 
         FIG. 8A  is a schematic perspective view illustrating a slider guide of the manipulation handle of the repetitive clipping treatment device of the embodiment of the invention, and  FIG. 8B  is a schematic developed view illustrating a guide portion of the manipulation handle. 
         FIG. 9  is a schematic perspective view illustrating a rotating position regulating member of the handle portion of the manipulation handle of the repetitive clipping treatment device of the embodiment of the invention. 
         FIG. 10  is a graph illustrating differences in the retraction amount depending on the position of a clip, with the retraction amount on the vertical axis and the position of a clip on the horizontal axis. 
         FIG. 11  is a schematic developed view illustrating the slider guide of the repetitive clipping treatment device of the embodiment of the invention. 
         FIGS. 12A to 12G  are schematic cross-sectional views illustrating a gradual state in the clipping manipulation of the repetitive clipping treatment device of the embodiment of the invention. 
         FIG. 13A  is a schematic view illustrating an example of an adjusting mechanism of a manipulating wire of the handle portion of the manipulation handle of the repetitive clipping treatment device of the embodiment of the invention,  FIG. 13B  is a plan view illustrating the example of the adjusting mechanism of the manipulating wire of the handle portion of the manipulation handle of the repetitive clipping treatment device of the embodiment of the invention, and  FIG. 13C  is a cross-sectional view taken along the line G-G of  FIG. 13B . 
     
    
    
     DESCRIPTION OF EMBODIMENTS 
     Below, a repetitive clipping treatment device of the invention illustrated in the accompanying drawings will be described in detail on the basis of embodiments. 
       FIG. 1  is a schematic perspective view illustrating a repetitive clipping treatment device of an embodiment of the invention.  FIG. 2A  is a schematic cross-sectional view illustrating the configuration of a forward end portion of the repetitive clipping treatment device of the embodiment of the invention, and  FIG. 2B  is a schematic cross-sectional view as seen from an angle different from  FIG. 2A  by 90°. 
     The repetitive clipping treatment device (hereinafter referred to as a clipping treatment device)  10  of this embodiment is a repetitive type using plural clips  12 . For example, a clip series A (refer to  FIGS. 2A and 2B ) which includes three clips  12  ( 12 A,  12 B, and  12 C), a dummy clip  18  connected to the rearmost clip  12 C among the clips  12 A to  12 C, and a connecting member  19  connected to the dummy clip  18  is housed at a forward end portion of a sheath  16  of a manipulation handle  48  (hereinafter, referred to as a manipulation handle  48 ) for a clipping treatment device. 
     In addition, the forward end portion is a forward end portion inserted into a living body when a treatment using the clipping treatment device  10  is performed using an endoscope. Hereinafter, the side where the forward end portion is present is referred to as the forward end side, and the side opposite to the forward end portion is referred to as a proximal end side (a manipulation handle  48  side). 
     In this embodiment, the manipulation handle  48  has a manipulating portion  50 , a sheath  16 , a manipulating wire  20  (refer to  FIGS. 2A and 2B ), or the like. 
     The sheath  16  is an ordinary long tubular sheath used in the clipping treatment device for an endoscope, for example, is a flexible coil sheath in which a metal wire is tightly wound. Although the sheath  16  will be described below in detail, the sheath has the clips  12  movably fitted on the forward end side therein, houses the manipulating wire  20  connected to the clip  12  via the dummy clip  18  and the connecting member  19 , and is connected to the manipulating portion  50  on the proximal end side. In addition, the manipulating wire  20  will be described below in detail. 
     As illustrated in  FIGS. 2A and 2B , in the clipping treatment device  10  of the embodiment of the invention, for example, the three clips  12  ( 12 A,  12 B, and  12 C) are connected together, and are accommodated in the sheath  16  as the clip series A. The repetitive clipping treatment device  10  of this embodiment is a three-barreled clipping treatment device  10  which can perform clipping three times continuously, without withdrawing the sheath  16  from the interior of a patient&#39;s body. 
     In addition, the clipping treatment device  10  is not limited to the clipping treatment device loaded with three clips  12 , and two clips may be loaded or four or more clips may be loaded. 
     The clips  12  are respectively connected together by connection rings  14  ( 14 A,  14 B, and  14 C) which covers an engagement portion between the preceding and subsequent clips  12  and maintains a connected state between the clips  12 . Additionally, the dummy clip  18  which is engaged with the manipulating wire  20  is connected to the clip  12 C nearest to the proximal end side. 
     Although described in detail below, the manipulating wire  20  is inserted through the interior of the sheath  16 , is inserted through the manipulation handle  48  which will be described later, and is connected to the slider  62  which performs preparation of clipping and manipulation. 
     In this embodiment, the forward end side is also referred to as “preceding”, and the proximal end side opposite to a part on the forward end side is also referred to as “subsequent” or “next”. Additionally, the clip immediately before a given clip  12  is also referred to as the “previous clip  12 ”, and similarly, the clip  12  immediately after the certain clip is also referred to as the “next clip  12 ” or a “subsequent clip  12 ”. 
       FIGS. 2A and 2B  show the initial state immediately before a clipping treatment operation by the foremost clip  12 A (standby state) is started. 
     As illustrated in  FIGS. 2A and 2B , one clip  12  and one connection ring  14  including one clamping ring  40  which will be described below constitute one bleeding stopping clip body B for an endoscope (hereinafter referred to as a clip body B). In the form of the clip body B, plural clips  12  is loaded into the interior of the forward end of the long sheath  16 . 
     In addition, although  FIGS. 2A and 2B  illustrate a state where the first foremost clip  12 A protrudes from the forward end of the sheath  16 , when the three clips  12 A to  12 C are loaded into the sheath  16 , the first foremost clip  12 A is completely housed inside the sheath  16 . 
       FIG. 3  is a perspective view illustrating the schematic configuration of a clip used for the clipping treatment device illustrated in  FIG. 1 . 
     The clip  12  is obtained by curving a single elongated plate having a resilience by 180° to form a closed end, and then crossing both the pieces thereof to form claw portions  22  and  22  that are bent in directions in which two open ends face each other. With the crossing portion  26  as a border, arm portions  28  and  28  are formed on the open end side, and a turned portion  24  is formed on the closed end side. The arm portions  28  and  28  are respectively provided at predetermined angles at opening-side ends of the turned portion  24  so that the arm portions cross each other at the crossing portion  26  and the distance therebetween becomes gradually larger. For example, the turned portion  24  is obtained by molding one member in a substantial U shape, and a tail portion  24   a  is rounded. The turned portion  24  is open, for example, in a direction orthogonal to a closing direction C of the arm portion  28 . 
     Partially widened projections  30  and  30  are respectively formed at center portions of the arm portions  28  and  28 , and each arm portion  28  is divided by the projection  30  into a distal portion  28   a  on the claw portion  22  side, and a proximal portion  28   b  on the crossing portion  26  side. 
     In the arm portions  28  and  28 , cutouts  31  for reliably fitting the clamping ring  40  are respectively formed on the crossing portion  26  side of the projections  30  and  30 . The clamping ring  40  fixed to the forward end portion of the connection ring  14  fitted to the crossing portion  26  of the clip  12  moves by a predetermined amount toward the claw portions  22  and  22 , that is, toward the projections  30  and  30  while pressing the proximal portions  28   b  and  28   b  of the arm portions  28  and  28  in mutually facing directions, whereby the arm portions  28  and  28  and the claw portions  22  and  22  are closed, and the claw portions  22  and  22  exert a predetermined cusp-fitting force, that is, a gripping force. 
     In order to reliably pinch target portions, such as a bleeding portion or a portion to be treated after the removal of a diseased tissue, the claw portions  22  and  22  are formed into V-shaped male type and female type which are engaged with each other. 
     Additionally, as illustrated in  FIG. 3 , the width of the distal portion  28   a  of the arm portion  28  of the clip  12  remain constant and invariable from the claw portion  22  to the projection  30 , while the width of the proximal portion  28   b  thereof gradually increase from the crossing portion  26  toward the projection  30  and is constant in the vicinity of the projection  30 . This facilitates and ensures the movement of the clamping ring  40 , thereby facilitating and ensuring the opening, closing, and fitting of the claw portion  22  and  22 , and facilitating and ensuring the stopping of bleeding, or the suturing or closure of a wound, and the like in a living body or the like. 
     In addition, a biocompatible metal is preferably used for the clip  12 . For example, it is possible to use JIS SUS630 or JIS SUS631, which is a precipitation-hardened stainless steel. 
     As for the clip  12 , the arm portions  28  are retracted into the connection ring  14  which will be described below, whereby the space between the arm portions  28  becomes narrow, and living body tissue is clipped by the claw portions  22 . 
     Here, the projections  30  have a width larger than the inner diameter of a forward-end-side opening of the connection ring  14  which will be described below, that is, a hole  41  of the clamping ring  40  and a proximal-end-side opening, that is, a hole  43  of a retaining portion  42 . As a result, in the clipping treatment device  10 , the portions of the clip  12  other than the projections  30  can enter the interior of the connection ring  14  due to the clip  12 , but the projections  30  cannot enter the interior either from the forward end side or proximal end side of the connection ring  14 . 
     In this embodiment, as illustrated in  FIGS. 2A and 2B , the claw portions  22  are engaged with the turned portion  24  of the first clip  12 A with the arm portions  28  of the second clip  12 B closed, and the engagement portion is covered with and retained by the connection ring  14 A, whereby the first clip  12 A and the second clip  12 B are brought into a connected state. 
     As illustrated in  FIG. 2A , the claw portions  22  and  22  of the second clip  12 B orthogonally mesh with the turned portion  24  of the first clip  12 A so as to be combined therewith, and the first clip  12 A and the second clip  12 B are connected together in orientations differing by 90 degrees. Hereinafter, the third clip  12 C is also connected to the second clip  12 B in an orientation differing by 90 degrees. In the clip series A, the clips  12 A to  12 C are connected together with their orientations alternately changed every 90°. 
     The connection ring  14  acts as a clamping member of the arm portions  28  when clipping is performed, and is inserted so as to be able to advance or retreat in the longitudinal direction of the sheath  16  with the clips  12  housed. That is, the outer diameter of the connection rings  14  is substantially equal to the inner diameter of the sheath  16  so that the connection rings can smoothly advance or retreat and move within the sheath  16  as the clips  12  move. 
       FIG. 4A  is a front view illustrating an example of a connection ring used together with a clip of the repetitive clipping treatment device of the embodiment of the invention,  FIG. 4B  is a cross-sectional view of the connection ring illustrated in  FIG. 4A , and  FIG. 4C  is a bottom view of the connection ring illustrated in  FIG. 4A . 
     As illustrated in  FIGS. 4A and 4B , the connection ring  14  has the clamping ring  40 , and the retaining portion  42 . In the connection ring  14 , the clamping ring  40  made of metal is fastened to the forward end of the retaining portion  42  made of resin, and these two members are constructed integrally. 
     The retaining portion  42  formed of a resin serves to maintain the connected state of the clip  12  and to retain the clip  12  within the connection ring  14 , and the clamping portion  40  formed of metal serves to clamp the clip  12 . The connection ring  14  may be formed as a single member as long as the connection ring can exhibit the functions of both the clamping ring  40  and the retaining portion  42 . 
     The clamping ring  40  is a cylindrical or ring-shaped metal part attached to the forward end side of the connection ring  14 , and has the hole  41  whose inner diameter is larger than the width of the clip  12  in the vicinity of the crossing portion  26 , and smaller than the width of each of the projections  30 . Accordingly, although the clamping ring  40  can move in the vicinity of the crossing portion  26  of the clip  12  to be retained, the clamping ring does not escape toward the forward end side beyond the projections  30 . That is, the projections  30  function as a stopper for determining the movement limit of the connection ring  14  that advances with respect to the clip  12 . 
     The clamping ring  40  is set at a predetermined position in the vicinity of the crossing portion  26  of the clip  12 . The clamping ring  40  moves from the initial position thereof, that is, from the crossing portion  26  toward the projections  30 , with the arm portions  28  of the clip  12  increasing in width, so as to perform a clamping function of closing both the diverged arm portions  28  and  28  of the clip  12 , and fixing the arm portions. A biocompatible metal is used for the clamping ring  40 . By forming the clamping portion  40  of metal, a frictional force serving as a clamping force can be exerted on the metal clip  12 . 
     The retaining portion  42  is a substantially cylindrical (ring-shaped) part which is resin-molded. The retaining portion  42  has a first region  32  which retains the preceding clip  12  and a second region  34  which is a connection retaining region that retains the next clip  12  while connected to the preceding clip. The retaining portion  42  has the hole  43  which communicates with the hole  41  of the clamping ring  40 , and passes through the first region  32  and the second region  34 . 
     The circular hole  43  is a circular hole which can accommodate the turned portion  24  of the clip  12 , and the proximal portions  28   b  and  28   b  of the arm portions  28  and  28  thereof, and which is larger than the hole  41  of the clamping ring  40 . 
     The peripheral surface of the forward end portion of the first region  32  is provided with a stepped portion for allowing the clamping ring  40  to be fitted thereto. The clamping ring  40  and the retaining portion  42  are fitted to each other by such interference fit as to prevent disengagement therebetween in a state where the clamping ring and the retaining portion are loaded into the sheath  16  and during clipping manipulation. 
     The first region  32  has a skirt portion  38  which inclines and diverges in the shape of a skirt with respect to the axis of the main body (not shown) of the connection ring  14 . 
     In the skirt portion  38 , the forward end side, that is, an upper base portion  38   a  in  FIGS. 4A and 4B  is connected to a main body  42   a  of the retaining portion  42 , and a lower diverging portion  38   b  is partially disconnected from the main body  42   a  by a cut  36  formed in the main body  42   a  so as to be radially diverged or closed. Two skirt portions  38  are formed at two locations on both sides which are separated from each other by 180 degrees at the same position in the pulling direction of the clips  12 , that is, in the vertical direction of  FIGS. 4A and 4B . 
     As illustrated in  FIG. 4A , the diverging portions  38   b  of both the skirt portions  38  and  38  are diverged in the shape of a skirt in a natural state where no external force is imparted thereto. At this time, the interior of the first region  32  of the retaining portion  42  forms a columnar space, as illustrated in  FIG. 4B . 
     On the other hand, when the connection ring  14  is loaded into the sheath  16 , as in the case with, for example, the second connection ring  14 B illustrated in  FIG. 2B , the diverging portions  38   b  of the skirt portions  38  are pressed against the inner surface of the sheath  16  and are inwardly pushed to enter the internal space, and the inner-circumferential-side portions of the diverging portions  38   b  of the skirt portions  38  press the side surface of the turned portion  24  of the second clip  12 B retained by the first region  32  to retain and keep the second clip  12 B from moving in a rotating direction and an advancing/retreating direction within the connection ring  14 B. The skirt portions  38  may press and retain the clip retained by the second region  34 , that is, the subsequent clip. 
     As in the case with the first connection ring  14 A illustrated in  FIG. 2A , on coming out from the forward end of the sheath  16 , the skirt portions  38  and  38  are opened due to the elasticity of the skirt portions  38  and  38  themselves, thus releasing the first clip  12 A from retention, and becoming wider than the inner diameter of the sheath  16  to prevent the connection ring  14 A from retreating into the sheath  16 . In this state, the manipulating wire  20  is pulled, and the first clip  12 A retreats, whereby the connection ring  14 A advances relative to the first clip  12 A to clamp the first clip  12 A by the clamping ring  40  of the forward end portion of the connection ring  14 A. 
     Accordingly, it is necessary for the skirt portions  38  to have elasticity so as to be capable of being inwardly closed within the sheath  16 , and diverged in the shape of a skirt when the skirt portions get out of the forward end of the sheath  16  and released from an external force. At the same time, it is also necessary for the skirt portions  38  to have rigidity which enables the clip  12  to be retained within the sheath  16 , and rigidity which withstands the repulsive force of the clamping force of the clip  12  at the forward end of the sheath  16 . 
     From those viewpoints, a material having biocompatibility and providing elasticity and rigidity required for the skirt portions  38  is used for the retaining portion  42 . In addition, the shape of the retaining portion is determined so as to provide elasticity and rigidity required for the skirt portions  38 . Examples of a material that can be used for the retaining portion  42  include polyphenylsulfone (PPSU), aromatic nylon, and the like. For ease of production, the retaining portion  42  is preferably molded integrally. 
     The second region  34  is provided on the proximal end side of the first region  32 . The second region  34  retains the next clip  12  engaged with the clip  12  retained by the first region  32 , specifically, the claw portions  22  and  22  and the distal portions  28   a  and  28   a  of the arm portions  28  and  28  in a state where the claw portions  22  and  22  are closed with the closed end, that is, tail portion  24   a  of the turned portion  24  of the preceding clip  12  being pinched therebetween. 
     The second region  34  has a length which is substantially equal to the movement distance required for the clamping ring  40  set at the initial position with respect to the clip  12  to move until completing the clamping of the clip  12  as a region length. That is, while the clip  12  retreats relative to the connection ring  14  so as to be clamped, the second region  34  of the connection ring  14  maintains the connection between the two clips  12  and  12  retained therein so as to allow the pulling force of the subsequent clip  12  to be transmitted to the preceding clip  12 , and when the clamping by the clamping ring  40  has been completed, the engagement portion between the two clips  12  and  12  is detached from the second region  34 , thereby releasing the connection between the clips  12  and  12 . 
     The second region  34 , as illustrated in  FIG. 4B , is formed with a hole  43  having the same inner diameter, which extend from the first region  32 . 
     As illustrated in  FIG. 4C , two grooves (recesses)  43   a  are formed in the inner surface of the hole  43  of the retaining portion  42  in the second region  34  so as to be opposed to each other. The grooves  43   a  are formed on the same side as the skirt portions  38 . 
     Additionally, as illustrated in  FIGS. 4B and 4C , slits  46  cut from the proximal end of the second region are formed at two opposed positions which rotate by 90° from the opposed direction of the grooves  43   a  in the second region  34 . 
     In the retaining portion  42 , an extension portion  44  is provided at a position where each groove  43   a  is provided so that a portion of the retaining portion on the proximal end side extends. That is, two extension portions  44  are provided so as to be opposed to each other similarly to the grooves  43   a . The extension portion  44  is constituted by a plate-shaped member which is curved along the outer periphery of the retaining portion  42 . 
     The grooves  43   a  and  43   a  can accommodate therein the distal portions  28   a  and  28   a  of the arm portions  28  and  28  of the clip  12  retained by the second region  34 , with the claw portions  22  and  22  being closed. 
     Plate surfaces of the distal portions  28   a  and  28   a  of the arm portions  28  and  28  of the clip  12  retained by the second region  34  come in contact with inner walls of the grooves  43   a  and  43   a . Additionally, the width of the groove  43   a  is smaller than the width of each of the projections  30  formed in the arm portions  28 . 
     Accordingly, the projections  30  of the clip  12  retained by the second region  34  cannot enter the grooves  43   a.    
     Additionally, the extension portions  44  and  44  are formed so as to extend from the grooves  43   a  and  43   a , and plate surfaces of the distal portions  28   a  and  28   a  of the arm portions  28  and  28  of the clip  12  also come in contact with inner walls of the extension portions  44  and  44 , subsequently to the inner walls of the grooves  43   a  and  43   a . Even if the manipulating wire  20  is pulled during clipping treatment and the claw portions  22  and  22  of the posterior clip  12  reach the extension portions  44  and  44  from the grooves  43   a  and  43   a , the claw portions  22  and  22  of the anterior clip  12  gripping the turned portion  24  of the posterior clip  12  are retained in a closed state. By providing the extension portions  44  and  44  in this way, coming-off of the clips  12  at the forward end  16   a  of the sheath  16  can be reliably prevented. 
     This can prevent, for example, the clip  120  which is the posterior clip  12  from retraction into, for example, the clip  12 B which is the anterior clip  12 . As a result, it is possible to maintain the relative positions of the anterior and posterior (preceding and subsequent) clips  12 , and maintain the manipulation of pushing out the clip  12  by the manipulating wire  20  (refer to  FIG. 5 ). 
     The engagement portion between the two clips  12  and  12  is located in the region of the second region  34  close to the boundary between the second region  34  and the first region  32 . Since the turned portion  24  of the preceding clip  12 , for example, the second clip  12 B in the connection ring  14 B of  FIG. 2B  is retained inside the sheath  16  by the closed skirt portions  38  in the first region  32 , the advancing/retreating movement and the rotating movement of the clip are restrained. Additionally, the next clip  12 , for example, the third clip  12 C in the connection ring  14 B of  FIG. 2B  which is engaged with the preceding clip  12  is retained by the grooves  43   a  of the second region  34  in a direction different from the preceding clip by 90°, whereby the rotating movement thereof is restrained. The next clip  12  is also engaged with the preceding clip  12  whose advancing/retreating movement has been restrained, whereby the advancing/retreating movement thereof is restrained. That is, the engagement portion between the preceding and subsequent clips is retained by the connection ring  14  with very little play. 
     The slits  46  are formed up to positions shallower than the upper end of the second region  34 . In other words, the slits  46  are provided at positions 90-degree shifted from the diverging direction of the clips  12  retained by the second region  34 . 
     By providing the slits  46 , the flexibility of the connection ring  14  can be improved, and the sheath  16  of the clipping treatment device  10  can pass through a curved portion with small curvature. Additionally, by providing the slits  46 , the extension portions  44  and  44  provided at a skirt (proximal end portion) of the connection ring  14  can be expanded. Therefore, when the preceding and subsequent clips  12  and  12  are connected together prior to the loading of the clips  12  into the sheath  16 , easy connection can be made advantageously by expanding the skirt and the extension portions  44  and  44  of the connection ring  14 . 
     The extension portions  44  and  44  are located outside the grooves  43   a  and  43   a , and the arm portions  28  and  28  of the posterior clip  12  are retained, subsequently to the grooves  43   a  and  43   a . Additionally, since the clip body B is retained so as not to fall from the forward end of the sheath  16 , the outer diameter of the extension portions  44  and  44  is smaller than the inner diameter of the sheath  16 , and is larger than the retaining portion  42 . 
     Moreover, since the projections  30  of the clip  12  and the extension portion  44  of the connection ring  12  comes into contact with each other when the clip  12  is rotated in order to change the diverging direction (the closing direction C) of the clip  12 , it is possible to transmit a force in the rotating direction to the clip  12  at a higher efficiency. 
     As illustrated in  FIGS. 2A and 2B , the rearmost third clip  12 C is engaged with the dummy clip  18 , which is not used for clipping treatment. The dummy clip  18  has, at the forward end portion thereof, a resilient portion having a shape similar to that of the open-end-side half portion of the clip  12  extending from the crossing portion  26 . The resilient portion is engaged with the turned portion of the third clip  12 C, with the claw portions thereof being closed, and releases the third clip  12 C when the claw portions are opened. Additionally, the connecting member  19  is attached to the proximal end portion of the dummy clip  18 . The connecting member  19  is detachably connected to the connection member  21  at the forward end of the manipulating wire  20  which will be described below. 
     The manipulating wire  20  moves the clip series A to the forward ends side of the sheath  16  or the proximal end side of the sheath  16  in the longitudinal direction of the sheath  16  inside the sheath  16  in clipping treatment  10 . That is, the manipulating wire  20  advances or retreats the clip series A in the longitudinal direction thereof inside the sheath  16 . The manipulating wire  20  is formed from, for example, a metal wire. 
     The manipulating wire  20  is housed in the sheath  16 , and the connection member  21  is provided at the forward end, that is, at the edge opposite to the manipulating portion  50  as described above as described above. 
     The forward end portion of the manipulating wire  20  is connected by the connection member  21  to the clip  12  via the connecting member  19  and the dummy clip  18 , while the proximal end portion thereof to which the connection member  21  is not attached is connected to the manipulating portion  50 . Additionally, as described above, the proximal end portion  16   c  of the sheath  16  is also attached, together with the manipulating wire  20 , to the manipulating portion  50  which will be described below. 
     The connection member  21  is obtained, for example, by connecting two substantially conical members with their bottom surfaces being opposed to each other, and is constituted by an elastic member, such as rubber. The connecting member  19  is formed with a recess having the same shape as this connection member  21 . The connection member  21  of the manipulating wire  20  is fitted into the connecting member  19  of the dummy clip  18 . As a result, even when the manipulating wire  20  is pulled to the proximal end side and even when the manipulating wire is pushed out to the forward end side, the bottom surface of any conical member of the connection member  21  is caught. Therefore, the connection member  21  can be prevented from being detached from the connecting member  19 , thereby advancing or retreating the clips  12  in the longitudinal direction of the sheath  16 . 
     Next, the configuration of the manipulation handle  48  of the clipping treatment device  10  of the embodiment of the invention will be described. 
       FIG. 5  is a schematic cross-sectional view illustrating a handle portion of the manipulation handle of the repetitive clipping treatment device of the embodiment of the invention. 
     In this embodiment, the manipulation handle  48 , as described above, has the sheath  16 , the manipulating wire  20 , the connecting member  21  at the forward end of the manipulating wire  20 , and the manipulating portion  50 . 
     As illustrated in  FIG. 5 , the manipulating portion (handle portion)  50  of the manipulation handle  48  has a main body rail  52  which constitutes a handle main body, a forward end member  54  which is fixed to the forward end of the main body rail  52 , a finger hook ring  56  which is attached to the proximal end of the main body rail  52 , and a wire fixing member  58  which is provided outside the main body rail  52 , an adjustment dial  60 , a slider  62 , a lock dial  64 , a slider guide (slider displacement regulating member)  66  which is provided outside the forward end member  54 , and a position regulating member  68 . 
     In addition, in this embodiment, the longitudinal direction of the main body rail  52  is referred to as the “axial direction”, and the circumferential direction around this axial direction is referred to as the “circumferential direction”. 
     The proximal end portion  16   c  of the sheath  16  is retained by the forward end of the forward end member  54 , and a proximal end  20   b  of the manipulating wire  20  is fixed so as to coincide with a wire connecting portion  58   a  of the wire fixing member  58  (the central axis of the manipulating portion  50 ). For example, an operator can pass his/her thumb through a ring portion  56   a  of the finger hook ring  56 , hook his/her index finger and middle finger on the slider  62 , and slidingly move the slider  62  in the advancing/retreating direction with respect to the finger hook ring  56 . When the slider  62  moves, the wire fixing member  58  also moves, and the manipulating wire  20  retained by the wire connecting portion  58   a  also moves. On the other hand, the sheath  16  is connected to the finger hook ring  56  via the forward end member  54  and the main body rail  52 . Accordingly, the manipulating wire  20  can be can be moved to advance or retreat the sheath  16  by the movement manipulation of the slider  62  with respect to the finger hook ring  56 . 
     In the main body rail  52 , as illustrated in  FIG. 6 , two rod members  52   b  having a substantially semi-circular cross-section are provided at a columnar proximal end portion  52   a  so that their planar portions are opposed to each other and have a gap  52   c  with a predetermined interval therebetween. For example, the respective rod members  52   b  and  52   b  are formed by shaving off the center of a cylinder that is coaxial with and thinner than the proximal end portion  52   a , by a predetermined width along the axis. In  FIG. 5 , the rod member  52   b  of the main body rail  52 , on the near side of the drawing is removed, and the planar portion of the rod member  52   b  on the far side is shown. 
     The gap  52   c  between the two rod members  52   b  and  52   b  is attached to the wire connecting portion  58   a  of the wire fixing member  58 , and the slider  62 , and is set to a dimension such that a forward end portion of a slider pin  70  extending toward the center of the main body rail  52  can be inserted into the gap. As illustrated in  FIG. 5 , the forward ends of the wire connecting portion  58   a  and the slider pin  70  can be inserted into the gap  52   c  between the two rod members  52   b  and  52   b , and guided by the rod members  52   b  and  52   b , moved in the extension direction of the main body rail  52 . That is, the rod members  52   b  and  52   b  of the main body rail  52  function as rails for the wire connecting portion  58   a  (wire fixing member  58 ) and the slider pin  70  (slider  62 ). 
     The forward end member  54  has an elongated tubular portion  54   a  and a flange portion  54   b  with a large diameter provided at the edge of the tubular portion  54   a , and is formed with a through hole  54   c  which passes through the tubular portion  54   a  and the flange portion  54   b . The forward end of the main body rail  52  is fixed to the proximal end surface of the flange portion  54   b . Additionally, the proximal end portion  16   c  of the sheath  16  is inserted into and retained by the forward end of the tubular portion  54   a . The manipulating wire  20  extends from the proximal end of the sheath  16 , and passes through the through hole  54   c  of the forward end member  54 . The outer diameter of the tubular portion  54   a  of the forward end member  54  is approximately equal to the inner diameter of the forward end portion (grasping portion  76 ) of the slider guide  66  arranged outside the forward end member  54 , and the outer diameter of the flange portion  54   b  is approximately equal to the inner diameter of a rear end portion (guide portion  78 ) of the slider guide  66 . As a result, the slider guide  66  is allowed to slide in the circumferential direction with respect to the forward end member  54 . 
     The finger hook ring  56  has a ring portion  56   a  into which an operator&#39;s finger can be inserted, and is attached to the cylindrical proximal end portion  52   a  of the main body rail  52 . 
     The wire fixing member  58  is a cylindrical member which has an inner diameter approximately equal to the outer diameter of the two rod members  52   b  and  52   b  of the main body rail  52 . The outer peripheral surface of the proximal end portion of the wire fixing member  58  is formed with a male thread  58   b . The wire connecting portion  58   a  which protrudes to the inner surface side is formed substantially at an axial central portion of the wire fixing member  58 . The proximal end  20   b  of the manipulating wire  20  which extends to the proximal end side (rearward) through the forward end member  54  is fixed to the position of the wire connecting portion  58   a  which coincides with the central axis (not illustrated) of the wire fixing member  58 . In addition, the manipulating wire  20  is covered with a reinforcing pipe  72  in a range from a portion which has slightly entered the forward end side (front side) from the proximal end portion  16   c  of the sheath  16 , to the wire connecting portion  58   a , is reinforced so as to maintain a substantially linear shape, without being bent or curved inside the manipulating portion  50 . 
     The adjustment dial  60  is a cylindrical part with a flange which is fitted to the outside of the wire fixing member  58 , and has a cylindrical portion  60   a  and a flange portion  60   b  provided at the proximal end thereof. The inner peripheral surface of the cylindrical portion  60   a  of the adjustment dial  60  is formed with a female thread  60   c , and the female thread  60   c  is screwed to the male thread  58   b  of the wire fixing member  58 . The flange portion  60   b  is rotated by the operator, whereby the adjustment dial  60  advances or retreats together with the male thread  58   b  of the wire fixing member  58  according to the rotating direction of the flange portion. An annular engagement projection  60   d  is formed in the vicinity of the forward end of the outer peripheral surface of the cylindrical portion  60   a  of the adjustment dial  60  over its entire circumference. The engagement projection  60   d  is engaged with an annular engagement recess  62   f  over the entire circumference of the inner peripheral surface of the slider  62  which will be described below. Additionally, as illustrated in  FIG. 7 , the home position mark  60   e  is provided in the adjustment dial  60 . 
     The home position mark  60   e  is formed in the shape of a groove along a generatrix in the outer peripheral surface of the flange portion  60   b  of the adjustment dial  60 . The home position mark  60   e  is aligned with a home position mark  62   g  provided in the shape of a notch in the outer peripheral surface of a larger-diameter portions  62   b  of the slider  62  described next, and thereby positions the wire fixing member  58  at an axial predetermined position with respect to the slider  62 . That is, the home position mark  60   e  on the adjustment dial  60  side is caused to coincide with the home position mark  62   g  on the slider  62  side, whereby the position of the proximal end  20   b  of the manipulating wire  20  is regulated to a predetermined position (home position) with respect to the slider  62 , and eventually the main body rail  52 . 
     Here, the adjustment dial  60  in a state where the home position mark  60   e  is aligned with the home position mark  62   g  on the slider  62  side is rotated in one direction, for example, in the direction of an arrow a of  FIG. 7 , whereby the wire fixing member  58  is moved to the proximal end side, that is, to the rear side (the right side in  FIG. 5 ) to pull the manipulating wire  20  to the proximal end side, and rotating the manipulating wire reversely in the other direction, for example, in the direction of an arrow b in  FIG. 7 ), so that the wire fixing member  58  can be moved to the forward end, that is, the front, side (the left side in  FIG. 5 ) to push out the manipulating wire  20 . That is, the manipulating wire  20  can be pulled or pushed by rotating the adjustment dial  60  with the home position mark  60   e  being aligned, in one direction or in the other direction. In addition, the pulling-side stroke and pushing-side stroke of the manipulating wire  20  are not necessarily caused to coincide with each other. For example, when fine adjustment on the pulling side of the manipulating wire  20  with respect to the sheath  16  is large, the pulling-side stroke may be enlarged. 
     The slider  62  is mounted so as to be axially movable on the outer periphery of the main body rail  52  which constitutes the handle main body, and has a cylindrical portion  62   a , and larger-diameter portions  62   b  formed at both ends of the cylindrical portion  62   a.    
     Additionally, the slider  62  is formed with a hole  63  which passes through the cylindrical portion  62   a  and each of the larger-diameter portions. The slider  62  is formed in the shape of a bobbin as a whole. 
     In the manipulating portion  50  of this embodiment, the operator inserts their thumb into the ring portion  56   a  of the finger hook ring  56 , pinches the cylindrical portion  62   a  lightly with his/her index finger and middle finger, and pushes the proximal surface of the front larger-diameter portions  62   b  with the backs of his/her index finger and middle finger, so that the slider  62  can be moved to the forward end side. On the contrary, the operator pulls the forward-end-side surface of the rear larger-diameter portions  62   b  to the rear end side with the insides of his/her index finger and middle finger, so that the slider  62  can be moved to the proximal end side. 
     On the other hand, in the slider  62 , an enlarged diameter portion  62   e  is formed on the proximal end side of the hole  63 . The annular engagement recess  62   f  is formed in the enlarged diameter portion  62   e  over its entire inner periphery. 
     The wire fixing member  58  and the adjustment dial  60  are inserted through the hole  63  of the slider  62  from the enlarged diameter portion  62   e  side. 
     The wire fixing member  58  is inserted into the hole  63  from the enlarged diameter portion  62   e  side, and the forward end thereof reaches a position exceeding the stepped portion  62   c  of the edge of the enlarged diameter portion  62   e.    
     Additionally, the cylindrical portion  60   a  of the adjustment dial  60  is inserted into the enlarged diameter portion  62   e , with the inner female thread  60   c  being screwed to the male thread  58   b  of the wire fixing member  58 , and the engagement projection  60   d  of the outer peripheral surface of the cylindrical portion  60   a  being engaged with the engagement recess  62   f  of the enlarged diameter portion  62   e . As a result, although the adjustment dial  60  moves integrally with a slider  62  in the axial direction, the adjustment dial can rotate freely with respect to the slider  62  in the circumferential direction. 
     The lock dial  64  is a ring-shaped part in the inner peripheral surface of which a female thread  64   a  to be screwed to the male thread  58   b  of the proximal end portion of the wire fixing member  58  is formed. After the position of the wire fixing member  58  is adjusted by the adjustment dial  60 , the position of the adjustment dial  60  after the adjustment is fixed by fastening the lock dial  64  until the lock dial hits the proximal end surface of the adjustment dial  60 . 
     The slider  62  and the adjustment dial  60  are engaged with each other by their respective engagement recess  62   f  and engagement projection  60   d , and the adjustment dial  60  and the lock dial  64 , and the wire fixing member  58  are screwed together by a threaded portion. For this reason, when the slider  62  is moved to the forward end side of the sheath  16  or the proximal end side of the sheath  16 , these four parts move integrally. 
     In addition, the movement limit of the slider  62  on the proximal end side is regulated by a position where the proximal end surface  64   b  of the lock dial  64  comes into contact with the forward end surface of the cylindrical portion  52   a  of the main body rail  52   
     In the clipping treatment device  10 , the slider  62  is moved to the proximal end side of the sheath  16 , and the position where the proximal end surface  64   b  of the lock dial  64  comes into contact with the forward end surface of the cylindrical portion  52   a  of the main body rail  52  becomes a home position (hereinafter referred to as HP) of the slider  62 . The position of the slider pin  70  at this time, for example, the position P 1  of  FIG. 11  which will be described below, is referred to as being at HP. 
     The slider pin  70  is fixed to the forward end portion of the slider  62  by being inserted into the inside from the outside. The forward end of the slider pin  70  extends toward the center of the main body rail  52 , and arrives at the gap  52   c  between the respective rod members  52   b  of the main body rail  52 . The slider pin  70  can move the gap  52   c  between the two rod members  52   b  in the front-back direction, that is, in the axial direction. 
     The slider guide  66  is mounted on the outer periphery of the main body rail  52  which constitutes the handle main body so as to be rotatable in the circumferential direction of the main body rail  52 , and regulates the displacement of the slider  62  in the axial direction of the main body rail  52  to several different displacements which are required for the clipping treatment of each of the clips  12 A to  12 C of the clip series A. The slider guide  66  is constituted by a substantially cylindrical member provided outside the forward end member  54 . 
     As described above, the inner diameter of the forward-end-side handle portion  76  of the slider guide  66  is approximately equal to the outer diameter of the tubular portion  54   a  of the forward end member  54 , and the inner diameter of the proximal-end-side guide portion  78  of the slider guide  66  is set to be approximately equal to the outer diameter of the flange portion  54   b  of the forward end member  54 , whereby the whole slider guide  66  is slidably supported by the flange portion  54   b . Additionally, the outer diameter of the guide portion  78  of the slider guide  66  is slightly smaller than the inner diameter of the slider  62 , so that when the slider  62  moves to the forward end side, the slider can enter the interior of the slider  62 . Since the slider guide  66  is rotationally moved with respect to the position regulating member  68  at the forward end thereof by operator&#39;s manipulation, the outer surface of the slider guide may be formed with a slope (not illustrated) outside so that the operator easily carry the slider guide. 
     A coiled spring  74  is arranged around the forward end member  54  between the flange portion  54   b  of the forward end member  54 , and the inner surface of the slider guide  66 . The coiled spring  74  is a compression spring, and urges the slider guide  66  to the forward end side with respect to the tubular portion  54   a  of the forward end member  54  which is a fixing member, and presses the slider guide against the position regulating member  68 . The position regulating member  68  is fixed to the forward end member  54  fixed to the main body rail  52 . That is, the finger hook ring  56  is fixed to the proximal end side of the main body rail  52  around the main body rail  52 , the forward end member  54  is fixed to the forward end side of the main body rail  52 , and the position regulating member  68  and the sheath  16  are fixed to the forward end member  54 . That is, the main body rail  52 , the finger hook ring  56 , the forward end member  54 , the position regulating member  68 , and the sheath  16  are constructed integrally. 
       FIG. 8A  is a schematic perspective view illustrating the slider guide of the manipulation handle of the repetitive clipping treatment device of the embodiment of the invention, and  FIG. 8B  is a schematic developed view illustrating the guide portion of the manipulation handle.  FIG. 9  is a schematic perspective view illustrating a rotating position regulating member of the handle portion of the manipulation handle of the repetitive clipping treatment device of the embodiment of the invention. 
     As illustrated in  FIG. 8A , the slider guide  66 , the distal-end-side grasping portion  76  and the proximal-end-side guide portion  78  are formed integrally. A joint portion  76   a  which joins the position regulating member  68  is formed on the forward end side of the grasping portion  76 , and four sawtooth-shaped projections  77   a  in which the inclination angles of two sides are different are formed at intervals of 90° in the circumferential direction at the end surface of the joint portion. In each sawtooth-shaped projection  77   a , one surface becomes a gentle slope  77   b  whose inclination angle is gentle, and the inclination angle of the other surface is substantially a right angle. As illustrated in  FIG. 9 , four projections  69   a  and four gentle slopes (recesses)  69   b  therebetween are also provided in a joint portion  68   a  of the rear end portion of the position regulating member  68  which joins the slider guide  66 , similarly to the joint portion  76   a  of the slider guide  66 . 
     Since the slider guide  66  is pressed against the position regulating member  68  by the coiled spring  74  in a state where the slider guide meshes with the position regulating member  68 , the slider guide  66  does not rotate with respect to the position regulating member  68  unless an external force is exerted thereon from the operator. Additionally, since the position regulating member  68  and the slider guide  66  mesh with each other by sawtooth-shaped irregularities, when the operator tries to turn the slider guide  66  around an axis, the slider guide  66  rotates in a direction in which mutual steep slopes (substantially right-angled surfaces) in the projections  77   a  of the joint portion  76   a  of and the projections  69   a  of the joint portion  68   a  of the position regulating member  68  separate from each other, and does not rotate in a direction in which the opposite steep slopes come into contact with each other. Although the slider guide  66  can rotate counterclockwise as seen from the proximal end side (the right side of  FIG. 8A ) in the illustrated example, the slide guide cannot rotate clockwise. 
     When the gentle slopes  77   b  of the joint portion  76   a  of the slider guide  66  rotate along the gentle slopes  69   b  of the joint portion  68   a  of the position regulating member  68 , rotate by 90°, and rides over mutual peaks, the gentle slopes mesh with each other by the next irregularity. As a result, the slider guides  66  rotate at every 90°. 
     The guide portion  78  of the slider guide  66 , as illustrated in  FIG. 8B  is formed with four slider guide grooves (position regulating grooves)  66 A,  66 B,  66 C, and  66 D which extend along the central axis of the main body rail  52  and extend linearly with different axial lengths in order to switch the displacement of the slider  62  to plural steps, that is, to regulate the displacement of the slider to two or more displacements. The four slider guide grooves  66 A,  66 B,  66 C, and  66 D are formed at predetermined intervals, for example, at intervals of 90° in the circumferential direction in the slider guide  66  so as to match the projections  77   a  of the grasping portion  77 . 
     Additionally, the slider guide  66  is arranged in the positional relationship so that the guide groove  66 A, the guide groove  66 B, the guide groove  660 , and the guide groove  66 D overlaps the gap  52   c  of the main body rail  52  in order as the slider guide is rotated. 
     The slider guide grooves  66 A to  66 D have a function as a guide groove for the slider pin  70 , and the width of the grooves is approximately equal to the diameter of the slider pin  70 . Whenever the slider guide  66  rotates by 90°, any of the slider guide grooves  66 A to  66 D coincides with the rail position of the main body rail  52 , that is, the position of the gap  52   c  between the two rod members  52   b.    
     Additionally, the proximal ends of the four guide grooves  66 A,  66 B,  660 , and  66 D are chamfered in order to easily enter the respective grooves, without being caught in other portions of the slider pin  70  and the slider guide  66 . 
     In this embodiment, when the slider guide groove  66 A overlaps the gap  52   c  of the main body rail  52 , the forward end portion of the slider pin  70  can be guided by the main body rail  52 , and can be moved in the axial direction along the slider guide groove  66 A. That is, the slider  62  can move in the axial direction along the slider guide groove  66 A. 
     In addition, when any of the slider guide grooves  66 B to  66 D does not overlap the gap  52   c  of the main body rail  52 , the slider pin  70  can move in the axial direction along the slider guide grooves  66 B to  66 D, that is, the slider  62  can move in the axial direction along the slider guide grooves  66 B to  66 D. 
     In this embodiment, the displacement of the slider  62  is regulated depending on the length of the slider guide grooves  66 A to  66 D. In other words, the displacement of the slider pin  70  is regulated by forward-end-side ends  67 A to  67 D of the respective slider guide grooves  66 A to  66 D of the sheath  16 . 
     The positions of the forward-end-side ends  67 A to  67 D of the four guide grooves  66 A,  66 B,  66 C, and  66 D, as illustrated in  FIG. 8B , respectively differ. Specifically, the forward-end-side end  67 A of the guide groove  66 A is formed on the foremost side of the sheath  16 , and the positions of the forward ends  67 D,  67 C, and  67 B are nearer the proximal end side, that is, are positions far from the sheath  16  and near the finger hook ring  56 , in order of the guide groove  66 D, the guide groove  66 C, and the guide groove  66 B. 
     As described above, the slider guide grooves  66 A to  66 D have different lengths, respectively. In this embodiment, the slider guide groove  66 B is the shortest, and the slider guide groove  66 C, the slider guide groove  66 D, and the slider guide groove  66 A becomes longer in this order. 
     The longest slider guide groove  66 A and the shortest slider guide groove  66 B are formed adjacent to each other. 
     The slider guide grooves  66 C and  66 D formed on the side where the slider guide groove  66 A and the slider guide groove  66 B are not adjacent to each other are formed in order from a slider guide groove having a shorter length, that is, in order of the slider guide grooves  66 C and  66 D, as they go in the circumferential direction directed to the slider guide groove  66 B from the slider guide groove  66 A on the non-adjacent side. 
     Additionally, in this embodiment, the longest slider guide groove  66 A is used for the loading of the clip series A. The other slider guide grooves  66 B to  66 D are used for clipping treatment. 
     In addition, in the invention, the number of clips which can be loaded (repetitively shot) is not limited to three as mentioned above. Accordingly, when the number of clips  12  which can be located into the clipping treatment device (manipulation handle) is n, according to the number of clips n, the guide portion  78  of the slider guide  66  is formed with slider guide grooves of “n+1” obtained by adding 1 for the loading of the clip series A to this number n. 
     Additionally, since the slider pin  70 , and the end surfaces of the slider guide grooves  66 A to  66 D come into contact with each other and exert a certain degree of force, it is preferable that both the slider pin and the slider guide groove end surfaces be made of materials having good slidability and wear resistance. By making the slider pin and the slider guide groove end surfaces of such materials, the wear of the slider pin and the slider guide end surfaces can be inhibited. 
     Additionally, it is also preferable to form a fluororesin or diamond-like carbon (DLC) film on the slider pin  70  and the end surfaces of the slider guide grooves  66 A to  66 D. Wear resistance and slidability can be improved by forming a film having the above composition. Particularly, the DLC film is formed to reduce friction resistance, that is, friction coefficient μ and increase surface hardness, so that wear resistance can be significantly improved compared to a case where any film is not formed on the slider pin and the slider guide grooves. 
     Here, the sheath  16  is, for example, about 2 m in length. As described above, it is known that, when the sheath  16  is curved after the manipulating wire  20  is caused to protrude by a predetermined amount from the forward end  16   a  of the sheath  16  with a state where the sheath  16  is extended straightly being a reference state, so-called retraction will occur where the manipulating wire  20  does not pass through the vicinity of the central axis of the sheath  16 , and passes through the outside in the sheath  16  and that the forward end of the manipulating wire  20  is located inside the forward end  16   a  of the sheath  16 . 
     When the retraction amount caused by this retraction is large, even if the clips  12  are moved to the forward end side with respect to the sheath  16  by a loading distance, the skirt portions  38  of the clip  12 A cannot protrude completely from the forward end  16   a  of the sheath  16 , and the clip  12 A may not be brought into a state where a clipping treatment operation is possible. In addition, although the above-described retraction amount differs depending on the curved state of the sheath  16 , the retraction amount may become about 6 mm. 
     Moreover, it is considered that this retraction amount is constant irrespective of the number of clips of the clip series A which are loaded if the curving of the sheath  16  is made the same. However, the inventor has further studied and discovered that the retraction amount differs depending on the position (loading distance) of loaded clips, that is, the number of remaining clips, in a clip series including plural clips. 
       FIG. 10  shows a graph illustrating changes in the retraction amount depending on the position of a clip in a case where the number of clips is three. In addition, in  FIG. 10 , the foremost is a first shot clip and the rear end is a state where there is no clip. In  FIG. 10 , when the position of a clip of the horizontal axis increases, the number of remaining clips decreases. 
     As illustrated by a straight line  100  in  FIG. 10 , the retraction amount is smallest in a first shot clip, that is, in a state where three clips are present in the sheath  16 . When clipping treatment is performed sequentially and the number of remaining clips decreases, that is, when the position of a clip changes to a second shot and a third shot, the retraction amount increases in proportion thereto. As such, the inventor has discovered that the number of remaining clips and the retraction amount in a clip series are in a proportional relationship. 
     For this reason, the difference in the retraction amount between a first shot clip and the last shot clip becomes larger as the number of clips in the clip series A increases. As a result, when the retraction amount is set by the first shot clip, in the third shot clip, the protruding of the connection rings  14  may be insufficient, and the skirt portions  38  may not open. On the contrary, when the retraction amount is set to the maximum, as for the first shot clip, the retraction amount is too large, and the clipping manipulation becomes unstable. Although the clip series A which has three clips has been described as an example in the invention, the possibility of the clipping treatment being hindered as described above as the number of clips increases to  4 ,  5 , and  6  becomes high. 
     The reason why the retraction amount differs depending on the position of a clip of the clip series A illustrated in  FIG. 10  is because the friction between the inner surface of the sheath  16  and a member, such as the connection rings  14  in the clip series A may change. For example, the skirt portions  38  press the inner surface of the sheath  16  within the sheath  16  due to the elasticity thereof, and this causes friction. 
     As the number of clips of the clip series A increases, the connection rings  14  increase, the friction caused by the skirt portions  38  increases, and the resistance against the tension to retract the manipulating wire  20  into the sheath  16 , which is produced due to the difference in path length between the manipulating wire  20  and the sheath  16 , becomes larger. For this reason, the retraction amount becomes small. 
     On the other hand, when the number of clips of the clip series A becomes small, the friction between the connection rings  14  and the inner surface of the sheath  16  decreases, and the resistance against the tension to retract the manipulating wire  20  into the sheath  16  also becomes small. For this reason, the retraction amount becomes large. 
     Particularly, since there is no resistance in a state which there is no clip, and only the connection member  21  is present in the manipulating wire  20 , the retraction amount becomes the maximum. 
     Then, the inventor has discovered on the basis of the fact that the retraction amount changes depending on the position of a clip of the above-described clip series A and the number of remaining clips, since the amounts of retraction respectively differ in the respective clips  12 A to clip  12 C, the respective amounts of retraction are calculated in advance, and the respective amounts of retraction are included in the lengths of the respective slider guide grooves  66 B to  66 D. That is, the inventor has discovered that the respective slider guide grooves  66 A to  66 D are determined according to the number of clips of the clip series A on the basis of the respective amounts of retraction which are calculated in advance, and the length required to make a clip protrude from the forward end  16   a  of the sheath  16 . 
     In this embodiment, as illustrated in  FIG. 11 , the length of the clip series A is defined as L, and the length of one clip is defined as C. In addition, the length C of this clip is a distance (loading distance) required to make the clips  12  protrude from the forward end  16   a  of the sheath  16 . In the first shot clip, the length (loading distance) of the clip is C. In the second shot clip, the length (loading distance) of the clip is  2 C. In the third shot clip, the length (loading distance) of the clip is  3 C. 
     Additionally, the retraction amount in a state where there is no clip  12  is set to α 0 , the retraction amount in a state where there are three clips  12 A to  12 C is set to α 1 , the retraction amount in a state where there are two clips  12 B and  12 C is set to α 2 , and the retraction amount in a state where there is one clip  12 C is set to α 3 . 
     In this embodiment, when the length of the slider guide groove  66 A is set to A 0 , A 0  is defined by A 0 =α 0 +L. Additionally, when the length of the slider guide groove  66 B is set to A 1 , A 1  is defined by A 1 =α 1 +C. Additionally, when the length of the slider guide groove  66 C is set to A 2 , A 2  is defined by A 2 =α 2 +2C. Additionally, when the length of the slider guide groove  66 D is set to A 3 , A 3  is defined by A 3 =α 3 +3C. 
     As such, the respective retraction amounts α 0  to α 3  according to the number of clips of the clip series A are calculated, the lengths of the slider guide grooves  66 A to  66 D are determined on the basis of the respective retraction amounts α o  to α 3  and the lengths required to make the clips  12  protrude from the forward end  16   a  of the sheath  16 , so that the respective clips  12 A to  12 C can be caused to protrude from the forward end  16   a  of the sheath  16 , and the skirt portions  38  can be reliably opened. As a result, in the respective clips  12 A to  12 C, clipping treatment can be reliably performed. 
     Additionally, since the connection ring  14  is provided with the extension portions  44 , even if the clips  12  are caused to protrude excessively, the clips  12  is prevented from coming off from the forward end  16   a  of the sheath  16 . 
     In addition, the lengths of the respective slider guide grooves  66 A to  66 D, as illustrated in  FIG. 11 , are respectively distances from the position of the center of the slider pin  70  at the home position to the position of the center of the slider pin  70  in a state where the guide pin butts the forward ends  67 A to  67 D of the respective slider guide grooves  66 A to  66 D. 
     In this embodiment, in the slider guide groove  66 A whose length is defined as described above, when the slider pin  70  is butted against the end  67 A, for example, even when the sheath  16  is wound once and the forward end portion of the sheath is brought close to the proximal end portion, thereby making a large loop (one turn) or even if the sheath  16  is wound twice and two small loops are made (two turns), the connection member  21  provided at the forward end of the manipulating wire  20  protrudes from the forward end  16   a  of the sheath  16  by a predetermined length. 
     Additionally, even in the slider guide grooves  66 B to  66 D whose lengths are defined as described above, when the slider pin  70  is butted against the ends  67 B to  67 D, for example, an initial state (standby state) immediately before clipping treatment operations performed by the clips  12 A to  12 C are brought about. Here, the standby state means a usable state where the claw portions  22  and  22  can open to pinch a living body b or the like, like the clip  12 A illustrated in  FIGS. 2A and 2B . 
     In the above-described manipulation handle  48 , when the sheath  16  is curved after the connection member  21  attached to the manipulating wire  20  is caused to protrude by a predetermined amount from the forward end  16   a  of the sheath  16  in a state where the sheath  16  is extended straightly, the forward end of the manipulating wire  20  will be retracted into the sheath  16  from the forward end  16   a  of the sheath  16  due to a difference in path length between the sheath  16  and the manipulating wire  20 . At this time, when the length from the forward end  16   a  of the sheath  16  to the forward end of the manipulating wire  20  is set to the retraction amount α 0 , this retraction amount α 0  will change variously according to the posture or curving direction of the sheath  16 . For example, the retraction amount α 0  when the sheath  16  is wound twice and two small loops are made (two turns) tend to become larger than that when the sheath  16  is wound once and the forward end portion of the sheath is brought close to the proximal end portion, thereby making a large loop (one turn). For this reason, the retraction amount α 0  is set to the maximum. 
     Additionally the respective retraction amounts α 1  to α 3  are measured under the same conditions as, for example, the conditions under which the retraction amount α 0  is measured. 
     For this reason, it is necessary to set the posture of the sheath  16  so that the measuring conditions of the respective retraction amounts α 0  to α 3  become fixed. In this case, for example, the manipulation handle  48  is provided with an attachment portion (not illustrated) which attaches the sheath  16 , the position of the sheath  16  with respect to this attachment portion is determined, for example, two turns are performed to attach the sheath  16 , and this state is adopted as the measuring conditions. 
     Next, the manipulation of clipping in the clipping treatment device  10  will be described with reference to  FIG. 11  and  FIGS. 12A to 12G . 
       FIGS. 12A to 12G  are schematic cross-sectional views illustrating a gradual state in the clipping manipulation of the repetitive clipping treatment device of the embodiment of the invention. 
     In addition, the position of the slider pin  70  is indicated by circles in  FIG. 11 . 
     Additionally, in the description using  FIG. 11 , moving the slider pin  70  to the position  21  illustrated in  FIG. 11  or the like is described as “moving the slider  62  to the position P 1 ”, “moving the slider  62  to HP”, or the like while the slider pin  70  is omitted. 
     First, the slider guide  66  is rotated to set the slider  62  to the position P 1  illustrated in  FIG. 11  so as to be aligned with the slider guide groove  66 A. At this time, the slider pin  70  is at the position P 1 , and as illustrated in  FIG. 12A , the connection member  21  provided at the forward end of the manipulating wire  20  is located at a position where the connection member is withdrawn from the forward end  16   a  of the sheath  16  more than the length L of the clip series A constituted by the three clips  12 A to  12 C, the three connection rings  14 A to  14 C, the dummy clip  18 , and the connection member  19  (refer to  FIG. 8 ). 
     Next, by moving the slider  62  along the slider guide groove  66 A to butt the slider against the end  67 A, and moving the slider pin  70  to the position P 2  illustrated in  FIG. 11 , as illustrated in  FIG. 12B , the connection member  21  of the manipulating wire  20  protrudes by a predetermined amount from the forward end  16   a  of the sheath  16 . In addition, in this embodiment, the retraction amount α 0  is included in the length A 0  of the slider guide groove  66 A. Thus, even if the sheath  16  is curved, the connection member  21  can be reliably caused to protrude by a predetermined amount from the forward end  16   a  of the sheath  16 . 
     In this case, for example, the clip series A is prepared in which the tail portion  24   a  of the turned portion  24  of the clip  12 A is pinched by the claw portions  22  of the clip  12 B and the engagement portion is covered with the connection ring  14 A, the tail portion  24   a  of the turned portion  24  of the clip  12 B is pinched by the claw portions  22  of the clip  12 C, and the engagement portion is covered with the connection ring  14 B, and the tail portion  24   a  of the turned portion  24  of the clip  12 C is pinched by the claw portions of the dummy clip  18  and the engagement portion is covered with the connection ring  14 C. Then, a clip case (not illustrated) in which the clip series is housed with the skirt portions  38  being closed is prepared. 
     Then, the connecting member  21  of the manipulating wire  20  is fitted into the connecting member  19  of the clip series A. Then, the slider  62  is moved along the slider guide groove  66 A, and the slider pin  70  is moved to the position P 3  illustrated in  FIG. 11 . 
     As a result, as illustrated in  FIG. 12C , the clip series A is loaded into the sheath  16 . As such, the slider guide groove  66 A is used for the loading of the clip series A into the sheath  16 . 
     Thereafter, the sheath  16  is inserted into a forceps port (not illustrated) of an endoscope (not illustrated) inserted into a living body. Then, the forward end of the sheath  16  is caused to reach the forward end of the insert portion of the endoscope, and is then caused to protrude from the forward end of the endoscope. 
     Additionally, if required, the forward end  16   a  of the sheath  16  of the clipping treatment device  10  is moved to a target position through manipulation of the insert portion or the angle portion of the endoscope. 
     After required manipulation is completed, next, the slider guide  66  is rotated by, for example, 90°, and as illustrated in  FIG. 11 , the slider pin  70  is caused to coincide with the position of the slider guide groove  66 B, and is moved to the position P 4 . 
     Next, the slider  62  is moved along the slider guide groove  66 B and butts the end  67 B, whereby the slider pin  70  is moved to a position P 5  (standard protruding position) illustrated in  FIG. 11 . Through this push-out of the slider  62 , that is, the push-out of the manipulating wire  20 , the clip series A moves to the forward end side, and as illustrated in  FIG. 12D , the foremost clip  12 A and the first region  32  of the connection ring  14 A protrudes from the forward end  16   a  of the sheath  16 . As a result, the arm portions  28  of the clip  12 A are opened and the claw portions  22  are automatically separated from each other by a predetermined distance. Moreover, the skirt portions  38  of the connection ring  14 A are opened outward more than the inner diameter of the sheath  16 . As a result, the clip  12 A does not return to the inside of the sheath  16 , and is retained at the forward end  16   a  of a sheath  16  by the second region  34 . 
     Here, in this embodiment, the retraction amount α 1  is included in the length A 1  of the slider guide groove  66 B. Thus, even if the sheath  16  is curved, can be reliably caused to protrude from the forward end  16   a  of the sheath  16  up to a position where the skirt portions  38  of the connection ring  14 A are opened. Moreover, since the connection ring  14  is provided with the extension portions  44 , the clip  12 A coming off is prevented even if the protruding amount is large. 
     Next, for example, while an image of the endoscope is viewed, the endoscope is manipulated to press the claw portions  22  of the diverged clip  12 A against the position of the living body b to be clipped, and the slider  62  is moved to the proximal end side by a clipping stroke, that is, pulled back to a position P 6  (a clipping complete position). 
     At this time, the skirt portions  38  of the connection ring  14 A protruding from the forward end  16   a  of the sheath  16  are opened, and the retention of the first clip  12 A by the pressure of the skirt portions  38  is cancelled. Additionally, since the skirt portions  38  are opened at the forward end  16   a  of the sheath  16 , the connection ring  14 A is prevented from retreating into the sheath  16 . Therefore, the foremost first clip  12 A retreats with respect to the connection ring  14 A. The clamping ring  40  of the forward end of the connection ring  14 A is pushed in to directly below the projections  30  from the crossing portion  26  side along the proximal portions  28   b  of the arm portions  28  of the first clip  12 A, whereby as illustrated in  FIG. 12E , the claw portions  22  and  22  clip the living body b, such as a disease part, and clamping of the first clip  12 A by the clamping ring  40  of the forward end of the connection ring  14 A is completed. 
     At the same time, the engagement portion between the first clip  12 A and the next second clip  12 B comes off from the rear ends of the extension portions  44  and  44  of the connection ring  14 A. When the engagement portion between the first clip  12 A and the second clip  12 B is detached from the extension portions  44  and  44  of the connection ring  14 A, the arm portions  28  are diverged by the resilient force of the second clip  12 B until the arm portions hit the inner surfaces of the sheath  16 , and the claw portions  22  and  22  are opened until the interval therebetween becomes larger than the width of the turned portion  24  of the first clip  12 A, thereby canceling the connection between the first clip  12 A and the second clip  12 B. 
     As a result, as illustrated in  FIG. 12F , the first clip  12 A which has clipped the living body b, and the connection ring  14 A is detached from the forward end  16   a  of the sheath  16 , and the clipping treatment of a diseased part by the first clip  12 A and the clamping ring  40  of the forward end of the connection ring  14 A is completed. 
     After the clipping treatment by the first clip  12 A is completed, as illustrated in  FIG. 11 , the slider  62  is moved to HP. That is, the slider pin  70  is moved to a position P 7  of  FIG. 11 . As a result, as illustrated in  FIG. 12G , the clip  12 B and the clip  12 C are brought into a state where the clips are retracted into the interior of the sheath  16 . At this time, the number of clips of the clip series A decreases by one, and the number of clips in the sheath  16  is two. For this reason, the resistance against the manipulating wire  20  becomes small, and the position U 2  of the clip  12 B after clipping treatment is performed by the first shot clip  12 A may retraction closer to the proximal end side than the position U 1  (refer to  FIG. 12C ) of the clip  12 B when the clip series A is loaded. 
     However, in this embodiment, since the length A 2  of the slider guide groove  66 C is set in consideration of such retraction. Therefore, the clip  12 B can be reliably caused to protrude from the forward end  16   a  of the sheath  16  to a position where the skirt portions  38  of the connection ring  14 B are opened as will be described below. 
     Next, the slider guide  66  is rotated by, for example, 90°, and the slider pin  70  is caused to coincide with the position of the slider guide groove  66 C, and is moved to a position P 8  illustrated in  FIG. 11 . As a result, is moved to the HP corresponding to the slider guide groove  66 C. At this time, the position of the second clip  12 B is still a position illustrated in  FIG. 12G . 
     Then, the slider  62  is moved along the slider guide groove  66 C, and the slider pin  70  butts the forward end portion  67 C of the slider guide groove  66 C. That is, the slider pin is moved to a position P 9  (standard protruding position) illustrated in  FIG. 11 . At this time, when the slider pin is moved to the position P 9 , the connection ring  14 B of the clip  12 B protrudes from the forward end  16   a  of the sheath  16 , and the skirt portions  38  are is brought into an opened state. As a result, the clip  12 B is brought into a preparation state for clipping. 
     Thereafter, the claw portions  22  of the diverged second clip  12 B is pressed against the position of the living body b to be clipped, and the slider  62  is moved to the proximal end side by a clipping stroke, that is, pulled back to a position  210  (a clipping complete position), thereby completing clipping. Then, the slider  62  is moved to the proximal end side, and the slider pin  70  is moved to a position P 11 . 
     At this time, since only the clip  120  is present in the sheath  16 , the resistance against the manipulating wire  20  becomes smaller, and the position of the clip  12 C after clipping treatment is performed by the first shot clip  12 A and the second shot clip  12 B may retraction closer to the proximal end side than the position of the clip  12 C when the clip series A is loaded. 
     However, even in this case, similarly to the clip  12 B, in this embodiment, the length A 3  of the slider guide groove  66 D is set in consideration of such retraction. Therefore, the clip  12 C can be reliably caused to protrude from the forward end  16   a  of the sheath  16  to a position where the skirt portions  38  of the connection ring  14 C are opened as will be described below. 
     Next, the slider guide  66  is rotated by 90°, and the slider pin  70  is caused to coincide with the position of the slider guide groove  66 D, and is moved to a position P 12 . 
     Then, the slider  62  is moved to the forward end side along the slider guide groove  66 D, and the slider pin  70  is moved to a position where the slider pin comes into contact with the forward end portion  67 D of the slider guide groove  66 D. That is, the slider pin is moved to a position P 13  (standard protruding position) illustrated in  FIG. 11 . At this time, when the slider pin is moved to the position P 13 , the connection ring  14 C of the clip  12 C protrudes from the forward end  16   a  of the sheath  16 , and the skirt portions  38  are is brought into an opened state. As a result, the clip  12 C is brought into a preparation state for clipping. 
     Thereafter, the claw portions  22  of the diverged clip  12 C is pressed against the position of the living body b to be clipped, and the slider  62  is moved to the proximal end side by a clipping stroke, that is, pulled back to a position P 14  (a clipping complete position), thereby completing clipping. Then, the slider  62  is moved to the proximal end side, and the slider pin  70  is moved to a position P 15 . As a result, the clipping using the clipping treatment device  10  is completed. 
     If the clipping by three clips  12 A to  12 C is completed, the slider  62  is rotated by 90° toward the slider guide groove  66 A side, and returns to HP corresponding to the position P 1  of  FIG. 11 , that is, the slider guide groove  66 A. Thereafter, the sheath  16  of the clipping treatment device  10  is pulled out of the endoscope. 
     After the sheath  16  has been pulled out, the slider  62  is moved along the slider guide groove  66 A and pushed out to the position P 2 , the connection member  21 , the dummy clip  18  and the connecting member  19  are caused to protrude from the forward end  16   a  of the sheath  16 , and the dummy clip  18  and the connecting member  19  are caused to protrude from the connection member  21  of the forward end of the manipulating wire  20 . 
     The clipping can be performed using the clipping treatment device  10  of this embodiment as described above. 
     Additionally, in this embodiment, when the manipulating wire  20  has elongated for a prolonged period of use, adjustment is made as follows. The lock dial  64  is first loosened and the adjustment dial  60  is then turned, whereby the adjustment dial  60  is moved to the forward end side with respect to the wire fixing member  58 . Since the slider  62  is engaged with the projection of the adjustment dial  60 , the adjustment dial moves in the axial direction together with the slider  62 . Here, since the movement of the adjustment dial  60  and the slider  62  in the rotating direction is free, the circumferential movement of the slider  62  is regulated by the slider pin  70 , whereas only the adjustment dial  60  can be rotated. If the manipulating wire  20  has been moved enough that the loosening of the adjustment dial  60  is eliminated, the lock dial  64  is fastened again to fix the positions of the adjustment dial  60  and the slider  62 . 
     Since the home position of the slider  62  is regulated as the lock dial  64  comes into contact with the cylindrical portion  52   a  of the main body rail  52 , the position of the slider  62  with respect to the main body rail  52  at the home position does not change. On the other hand, by moving the adjustment dial  60  and the slider  62  to the forward end side with respect to the wire fixing member  58 , the wire fixing member  58  moves rearward relative to the slider  62 , and the wire connecting portion  58   a  moves similarly. Accordingly, the proximal end of the manipulating wire  20  at the home position moves rearward, and the loosening equivalent to the elongation of the manipulating wire  20  can be canceled. 
     Next, an adjusting mechanism which finely adjusts the position of the manipulating wire  20  with respect to the sheath  16  will be described with reference to  FIGS. 13A to 13C . 
       FIG. 13A  is a schematic view illustrating an example of the adjusting mechanism of the manipulating wire of the handle portion of the manipulation handle of the repetitive clipping treatment device of the embodiment of the invention,  FIG. 13B  is a plan view illustrating the example of the adjusting mechanism of the manipulating wire of the handle portion of the manipulation handle of the repetitive clipping treatment device of the embodiment of the invention, and  FIG. 13C  is a cross-sectional view taken along the line G-G of  FIG. 13B . 
     In addition, since the configuration other than the adjusting mechanism  84  of the manipulating wire  20  and the slider  85  are the same as the manipulating portion  50  illustrated in  FIG. 5 , the detailed description thereof is omitted. 
     The slider  85  has a substantially cylindrical slider main body  86 , and an inner member  87  fixed to the insider thereof, and is movable along the main body rail  88  as a whole. The manipulating wire  20  is inserted through the inside of the reinforcing pipe  20   d  in the vicinity of the slider  85 . The reinforcing pipe  20   d  extends along the axis of the main body rail  88  and is fixed to the inner member  87 , and the proximal end portion thereof is curved, is changed in direction by 90°, and extends in the radial direction of the larger-diameter portion  86   a  of the slider main body  86 . The proximal end portion of the manipulating wire  20  inserted through the reinforcing pipe  20   d  is exposed from the proximal end of the reinforcing pipe  20   d , and the exposed portion is fixed to the adjustment dial  89 . The adjustment dial  89  is disposed toward the center of the larger-diameter portion  86   a , and the outer peripheral surface thereof is formed with a male thread  89   a . A cylindrical recess is formed in the larger-diameter portion  86   a  from the outer peripheral surface toward the center, and the male thread  89   a  of the adjustment dial  89  is screwed to a female thread  86   b  formed in the inner peripheral surface of this recess. The adjusting mechanism  84  is constituted by the adjustment dial  89 , the female thread  86   b  of the slider main body  86 , the reinforcing pipe  20   d , and the like. 
     According to the adjusting mechanism  84 , when the operator pinches the adjustment dial  89  between his/her thumb and index finger, for example, rotates the adjustment dial in the clockwise direction, the adjustment dial  89  proceeds toward the center of the larger-diameter portion  86   a , and the manipulating wire  20  integral with the adjustment dial  89  is pushed out and the forward end side thereof moves to the proximal end side in the axial direction. On the other hand, when the operator rotates the adjustment dial  89  in the opposite counterclockwise direction, the adjustment dial  89  proceeds in a direction away from the center of the larger-diameter portion  86   a , and the manipulating wire  20  integral with the adjustment dial  89  is pulled and the forward end side thereof moves to the proximal end side in the axial direction. 
     Since the adjustment dial  89  uses a screw mechanism, the axial movement of the adjustment dial to the displacement thereof in the rotating direction is small. That is, the axial displacement on the forward end side of the manipulating wire  20  whose proximal end portion is connected to the adjustment dial  89  can be finely adjusted by rotating the adjustment dial  89  in the clockwise direction or in the counterclockwise direction. 
     According to the adjusting mechanism  84 , since the fingertip of the index finger when the slider  85  is manipulated to advance or retreat can be placed near a head  89   b  of the adjustment dial  89 , the operability of the adjustment dial  89  can be enhanced. That is, when the slider  85  is manipulated, particularly, when the slider  85  is retreated to pull the manipulating wire  20 , the operator nips a smaller-diameter portion  86   c  of the slider main body  86  between his/her index finger and middle finger, and the operator applies the insides of the fingertips of the two fingers to the forward end surface of the proximal-end-side larger-diameter portion  86   a , and pulls the larger-diameter portion  86   a  to the front side (thumb side). Accordingly, when the operator manipulates the slider  85 , the operator can positively apply his/her index finger so as to contact the vicinity of the head  89   b  of the adjustment dial  89  and further the head  89   b  directly. According to this, when the operator turns the adjustment dial  89  to finely adjust the manipulating wire  20 , subsequent to the advance/retreat manipulation of slider  85 , the operator simply removes his/her thumb from the finger hook ring  56  (refer to  FIG. 5 ) to hook his/her thumb on the head  89   b  of the adjustment dial  89 , without moving his/her index finger and middle finger, so that the operator can nip the head  89   b  with his/her index finger and thumb, and rotate the adjustment dial  89  to finely adjust the manipulating wire  20 . That is, the axial push-pull (axial large movement) of the manipulating wire  20  by the advance/retreat manipulation of a slider  85  and the fine adjustment (axial small movement) of the manipulating wire  20  by the rotation manipulation of the adjustment dial  89  can be smoothly performed as a series of manipulations without wasted movement of the fingertip. 
     In addition, if the diameter of the head  89   b  of the adjustment dial  89  is made larger than the axial thickness of the larger-diameter portion  86   a  of the slider main body  86 , and portions of the head  89   b  are caused to protrude from the proximal end surface and forward end surface of the larger-diameter portion  86   a , these protruding portions reliably hit the insides of the fingertips of the index finger and the thumb. Thus, operability can be further improved. Moreover, it is also possible to adopt, for example, a tapered shape or a curved shape taken after the shape of the belly of the fingertip of the index finger instead of the columnar shape as the shape of the outer peripheral surface of the head  89   b . In this case, when the operator grasps (nips) the slider main body  86 , the operator can touch the head  89   b  of the adjustment dial  89  with high/her index finger, thereby positioning the finger during manipulation at the home position. 
     In addition, even in the adjusting mechanism  84 , home positioning may be performed by forming home position marks in the proximal-end-side larger-diameter portion  86   a  of the slider main body  86  and the head  89   b  of the adjustment dial  89 , respectively, and aligning the larger-diameter portion with the head. 
     Even in the adjusting mechanism  84 , it is preferable to provide a loosening stop mechanism equivalent to the lock dial  64  illustrated in  FIG. 5 . Here, for example, when a configuration in which a frictional force with the manipulating wire  20  increases is provided at the curved portion of the reinforcing pipe  20   d , it is also possible to adopt this as the loosening stop mechanism. 
     Although the repetitive clipping treatment device of the invention have been described in detail above, the invention is not limited to the above embodiment, and it is needless to say that various improvements and modifications are possible without departing from the spirit of the invention. 
     REFERENCE SIGNS LIST 
     
         
         
           
               10  clipping treatment device (repetitive clipping treatment device) 
               12 ,  12 A to  12 C clip 
               14 ,  14 A to  14 C connection ring 
               16  sheath 
               18  dummy clip 
               21  connection member 
               20  manipulating wire 
               22  claw portion 
               24  turned portion 
               38  skirt portion 
               40  clamping ring 
               44  extension portion 
               48  manipulation handle 
               50  manipulating portion 
               52  main body rail 
               56  finger hook ring 
               58  wire fixing member 
               60  adjustment dial 
               62  slider 
               64  lock dial 
               66  slider guide (slider displacement regulating member) 
               66   a  to  66   d  slider guide groove 
               68  position regulating member 
               70  slider pin 
               72  reinforcing pipe 
               76  grasping portion