US20200289804A1

US20200289804A1 - Flora treatment

Info

Publication number: US20200289804A1
Application number: US16/790,831
Authority: US
Inventors: Yumiko AWAU; Takeo Suzuki
Original assignee: Olympus Corp
Current assignee: Olympus Corp
Priority date: 2019-02-21
Filing date: 2020-02-14
Publication date: 2020-09-17
Also published as: US12447320B2; WO2020170982A1; WO2020170981A1; US20210379346A1

Abstract

A flora treatment of the invention includes a step (A) in which an instrument is introduced into a lumen; a step (B) in which the instrument is made to reach an intestinal cecum; a step (C) in which an appendico is recognized; and a step (D) in which probiotics is supplied to the appendico.

Description

CROSS REFERENCE TO RELATED APPLICATION

This application is based upon and claims the benefit of priority from the U.S. Provisional Patent Application No. 62/808,365 filed in the U.S.A. on Feb. 21, 2019, the entire contents of which are incorporated herein by reference.

BACKGROUND OF THE INVENTION

1. Field of the Invention

The present invention relates to a flora treatment of improving an intestinal environment by oral ingestion of probiotics.

2. Description of the Related Art

A method of improving an intestinal environment by oral ingestion of probiotics has been known. Such a method is disclosed in US2018/0000875, for example.
In addition, a method of supplying probiotics into the intestine through an endoscope is disclosed in Japanese Unexamined Patent Application Publication No. 2013-505289.

SUMMARY OF THE INVENTION

Simply, a flora treatment according to the present invention includes: a step (A) in which an instrument is introduced into a lumen; a step (B) in which the instrument is made to reach an intestinal cecum; a step (C) in which an appendico is recognized; and a step (D) in which probiotics is supplied to the appendico.
The above and other objects, features and advantages of the invention will become more clearly understood from the following description referring to the accompanying drawings.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 is a diagram of a flow for supplying probiotics to an appendico, which includes all embodiments and modified examples in a flora treatment according to the present invention.

FIG. 2 illustrates the step (A) in FIG. 1.

FIG. 3 illustrates the step (B) in FIG. 1.

FIG. 4 illustrates the step (C) in FIG. 1.

FIG. 5 illustrates the step (D) in FIG. 1.

FIG. 6 illustrates the step (Q) in FIG. 1.

FIG. 7 is a partial perspective view illustrating, together with an endoscope, a spoon-shaped mucus removal tool for removing an appendico mucus.

FIG. 8 is a partial perspective view illustrating, together with the endoscope, a stick-shaped mucus removal tool for removing the appendico mucus.

FIG. 9 is a partial perspective view illustrating, together with the endoscope, a spatula-shaped mucus removal tool for removing the appendico mucus.

FIG. 10 is a partial perspective view illustrating, together with the endoscope, a brush-shaped mucus removal tool for removing the appendico mucus.

FIG. 11 is a partial perspective view illustrating, together with the endoscope, a mucus removal fluffy tool for removing the appendico mucus.

FIG. 12 illustrates a state where a thin-diameter endoscope inserted into the endoscope channel in FIG. 2 is inserted in the appendico.

FIG. 13 illustrates a state where the mucus removal fluffy tool is inserted from the endoscope channel into the appendico.

FIG. 14 illustrates a state where the probiotics is jetted (applied) to the appendico, with a position of the endoscope fixed by inflating the balloon in FIG. 6.

FIG. 15 illustrates the step (J) in FIG. 1.

FIG. 16 illustrates a configuration of the step (J) in FIG. 1, which is different from the configuration of the step (J) in FIG. 15.

FIG. 17 illustrates an example in which the probiotics is supplied to the appendico through a catheter inserted into the endoscope channel in FIG. 2.

FIG. 18 illustrates a funnel-shaped indwelling body.

FIG. 19 illustrates a tuft-like indwelling body.

FIG. 20 illustrates a thread-like indwelling body.

FIG. 21 illustrates a fluff impregnated with the probiotics and a bar holding the fluff, as an example of a treatment instrument to be used in the step (L) in FIG. 1.

FIG. 22 illustrates a state where an incision is made on a part of the intestinal cecum.

FIG. 23 illustrates forming of the appendico by suturing the incision in FIG. 22.

DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENT(S)

Hereinafter, embodiments of the present invention will be described with reference to drawings.
Note that, in the present invention, probiotics indicates at least one kind of microorganism that provides a beneficial effect to a living body. The beneficial effect here includes, for example, improvement of an intestinal bacterial flora, an effect to an intestinal immune, and the like.
Even if bacteria, as a simple substance, are called as bad bacteria or opportunistic bacteria, the bacteria that provide a beneficial effect is included in the probiotics.
Furthermore, the probiotics is not specifically limited, but includes the bacteria that belong to Bacteroidetes phylum, Firmicutes phylum, Actinobacteria phylum, Proteobacteria phylum, and the like.
When using the above-described bacteria, the bacteria may be used as a simple substance as described above, or a plurality of kinds of bacteria may be used.
When a plurality of kinds of bacteria are used, the kinds, amounts, and ratio of the bacteria can be appropriately selected depending on purposes for production, storage, and treatment.
There is a possibility that a colonization ratio of main purpose bacteria to a subject can be increased by adding symbiotic bacteria capable of producing mucus decomposing enzyme to the main purpose bacteria, for example.
Bacteria that produce the mucus decomposing enzyme include, for example, B. bifidum, C. perfringens, B. longum subsp. Longum, and B. breve, etc.
Note that artificially-cultured bacteria have such a benefit that impurities are not likely to be included.

First Embodiment

FIG. 1 is a diagram of a flow for supplying probiotics to the appendico, which includes all embodiments and modified examples in a flora treatment according to the present invention, FIG. 2 illustrates the step (A) in FIG. 1, FIG. 3 illustrates the step (B) in FIG. 1, FIG. 4 illustrates the step (C) in FIG. 1, and FIG. 5 illustrates the step (D) in FIG. 1.
As illustrated in FIG. 1, when probiotics 100 (see FIG. 5) is supplied to an appendico 19, the procedure is performed as follows: the steps (A)→(B)→(C)→(D)→(M) in the present embodiment.
Note that it is needless to say that the flow in FIG. 1 shown below is not performed in the alphabetical order.
First, in the step (A), an endoscope 1, as an instrument, is introduced into a lumen, as illustrated in FIG. 2.
Note that, as illustrated in FIG. 2, a large intestine 10 to which the endoscope 1 reaches through the lumen is generally composed of, in the following order from the anus 11: the lower rectum 12; the upper rectum 13; the sigmoid colon 14, the descending colon 15, the transverse colon 16; the ascending colon 17; the intestinal cecum 18, the appendico 19, and the ileum 20.

(Step (A): With Regard to Introduction of Endoscope 1 Into Lumen)

In the present invention, the route for introducing the endoscope 1 into a body may be oral or transanal (through anus 11) as illustrated in FIGS. 2 to 5.
In addition, the endoscope 1 may be a flexible endoscope or a capsule endoscope in the present invention.
The flexible endoscope may be an endoscope for the upper digestive tract or an endoscope for the lower digestive tract. In addition, the diameter of the flexible endoscope may be appropriately selected depending on a subject.
Although details will be described in the modified examples shown below, the endoscope 1 may be used individually, a sheath and an endoscope 1 insertable into a channel of the sheath may be used in combination, or a mother endoscope and a baby endoscope configured to be insertable into a channel of the mother endoscope may be used in combination.
In addition, the endoscope 1 and a treatment instrument configured to be insertable into a channel 2 of the endoscope 1 may be used in combination, or the endoscope 1 and a treatment instrument configured to be fittable to the distal end of the endoscope 1 may be used in combination.
Furthermore, when a capsule endoscope is used, a guiding apparatus configured to control the movement and indwelling of the capsule endoscope from outside the body may be used with the capsule endoscope.
Next, in the step (B), the endoscope 1 is made to reach the intestinal cecum 18, as illustrated in FIG. 3.

(Step (B): With Regard to Reaching to the Intestinal Cecum 18)

Confirmation is made that the endoscope 1 has reached the intestinal cecum 18, with the illumination light being supplied from an illumination portion 4, for example, by using the field of view of an observation portion 3 of the endoscope 1.
When the endoscope 1 is advanced in the lumen from the mouth or the anus 11 to the intestinal cecum 18, a gas may be introduced into the lumen, to expand the lumen.
In addition, when anaerobic bacteria are used as the probiotics 100, it is preferable to use a non-oxygen gas, as the gas, to purge the atmosphere with the non-oxygen gas at the latest immediately before the supply of the probiotics 100 to the appendico 19. Note that the non-oxygen gas includes a carbon dioxide gas, a nitrogen gas, or a noble gas.
At the stage of inserting the endoscope 1 from the anus 11 to advance the endoscope 1 to the intestinal cecum 18, an oxygen-containing gas or the non-oxygen gas may be used.
Using the oxygen-containing gas has such an advantage that the number of indigenous bacteria in the large intestine 10 can be reduced. The oxygen-containing gas includes air. Using the non-oxygen gas has such an advantage that there is no need for switching the kinds of gases.
Next, in the step (C), an orifice 19i of the appendico 19 (hereinafter, referred to as the appendico orifice 19 i) is recognized, as illustrated in FIG. 4.

(Step (C): With Regard to Recognition of the Appendico Orifice 19 i)

The position of the appendico orifice 19 i is confirmed by using the field of view of the observation portion 3 of the endoscope 1.
After that, in the step (D), the probiotics 100 is supplied to the appendico 19, as illustrated in FIG. 5. Specifically, in the step (S), the probiotics 100 is jetted to the appendico orifice 19 i. Note that the probiotics 100 is supplied into a mucus 64 of the appendico 19 (see FIG. 15).

(Step (D): With Regard to Supply of the Probiotics 100 to the Appendico 19/Step (S): With Regard to Jetting of the Probiotics 100 Toward the Appendico Orifice 19 i)

FIG. 5 illustrates the step (S): jetting of the probiotics 100 toward the appendico orifice 19 i as a specific example of the step (D): supply of the probiotics 100 to the appendico 19.
The jetting of the probiotics 100 may be performed with an air/water feeding conduit of the endoscope 1, with the endoscope channel 2, or with a channel of a sheath, when the sheath is used in combination with the endoscope 1.
When the endoscope 1 is used in combination with a baby endoscope or a treatment instrument, the step (R) in FIG. 1: leading out from the channel, which will be described later, may be performed to jet the probiotics 100 from the treatment instrument or tube inserted in the endoscope channel 2.
Note that the strength of the jetting may be appropriately selected depending on the closing state of the appendico orifice 19 i.
The probiotics 100 to be jetted is preferably a powder or a fluid. The powder includes the freeze-dried probiotics 100. The fluid includes the culture solution of the probiotics 100, a liquid in which the probiotics 100 is mixed, or liposome having at least a single layer containing the probiotics 100.
Furthermore, the viscosity of the fluid can be appropriately set. The liquid includes degassed water, carbonic water, mucin, collagen, or hyaluronic acid.
When the step (F): removal of the appendico mucus in FIG. 1, to be described later, is performed in advance, it is preferable to use mucin as the liquid for supplementing the removed mucus.
Furthermore, the powder or the fluid may contain components for growing the probiotics 100. The components include bacteria, iron, dietary fiber, or oligosaccharide. The bacteria as the components for growing the probiotics 100 may be live bacteria or dead bacteria.
Lastly, in the step (M), the endoscope 1 is extracted from the inside of the body.
(Step (M): With Regard to Extraction from Inside of Body)
When a flexible endoscope is used, the endoscope 1 is extracted from the inside of the body by being pulled out.
When the capsule endoscope is used, the capsule endoscope may be excreted by spontaneous passage, or may be guided to the colon, the rectum, or the anus by using the guiding apparatus located outside the body.
By using such a method, the probiotics 100 is surely supplied to the mucus 64 of the appendico 19, which improves the colonization of the probiotics 100 in the mucus 64.

FIRST MODIFIED EXAMPLE OF THE FIRST EMBODIMENT

In addition to a series of flow including the steps (A), (B), (C), (D/S), and (M) in FIG. 1 according to the present embodiment, at least one of the steps (Q), (R), (E), or (F) may be performed. When the step (F) is performed, step (G) may be further performed.
(Step (Q): With Regard to P ositioning)
FIG. 6 illustrates the step (Q) in FIG. 1.
At the stage when the appendico orifice 19 i is recognized with the endoscope 1 in the step (C), the endoscope 1 may be positioned in the step (Q) as illustrated in FIG. 6.
As exemplified in FIG. 6, the positioning is performed by inflating a balloon 8 provided to a sliding tube 7, to thereby enable the distance between the endoscope 1 and the appendico 19 to be stabilized.
Another method for the positioning includes a method of discharging the gas in the lumen to bring the inside of the lumen into a negative pressure state, to thereby cause the endoscope 1 to stick to the intestinal tract. When the gas in the intestine is discharged, the gas can be discharged by using the air/water feeding conduit of the endoscope 1, for example.

(Step (E): With Regard to Cleaning of the Inside of the Appendico 19)

Before the step (D): supply of the probiotics 100 to the appendico 19, cleaning of the inside of the appendico 19 in the step (E) may be performed.
The cleaning of the inside of the appendico 19 is performed by supplying a fluid to the inside of the appendico 19. When gas is used as the fluid, if the bacteria inside the appendico, which are desired to be removed, are anaerobic, it is preferable to supply oxygen-containing gas. When a liquid is used as the fluid, it is preferable to use normal saline or mucin.
In addition, as the method of supplying the fluid, similarly as in the step (S) in FIG. 1, the fluid may be supplied through the air/water feeding conduit of the endoscope 1 or the endoscope channel 2. When a sheath is used in combination with the endoscope 1, the fluid may be supplied from the channel of the sheath. Or, the fluid may be supplied from the treatment instrument or the tube inserted into the endoscope channel 2, or from a catheter inserted independently from the endoscope 1.

(Step (F): With Regard to Removal of the Mucus of the Appendico 19)

Before the step (D): supply of the probiotics 100 to the appendico 19, the removal of the mucus 64 of the appendico 19 (hereinafter, referred to as the appendico mucus 64) in the step (F) may be performed.
The removal of the mucus 64 in the step (F) may be performed on the entirety or only a part of the appendico 19.
In addition, both an outer mucus layer 61 and an inner mucus layer 62 (for both, see FIG. 15) of the appendico mucus 64 may be removed, but more preferably, the outer mucus layer 61 is removed with the inner mucus layer 62 remained.
FIG. 7 is a partial perspective view illustrating, together with the endoscope, a spoon-shaped mucus removal tool for removing the appendico mucus. FIG. 8 is a partial perspective view illustrating, together with the endoscope, a stick-shaped mucus removal tool for removing the appendico mucus. FIG. 9 is a partial perspective view illustrating, together with the endoscope, a spatula-shaped mucus removal tool for removing the appendico mucus. FIG. 10 is a partial perspective view illustrating, together with the endoscope, a brush-shaped mucus removal tool for removing the appendico mucus. FIG. 11 is a partial perspective view illustrating, together with the endoscope, a mucus removal fluffy tool for removing the appendico mucus.
The removal of the appendico mucus 64 may be performed with a mucolytic agent, a normal saline containing an abrasive, an abrasive, laser, or water pressure. Alternatively, mucus removal tools 31 to 35 such as a spoon, a stick, a spatula, a brush, or a fluffy member, as illustrated in FIGS. 7 to 11 may be used.
These agents and tools can be used in combination. For example, a sharp curette, a brush, a spatula, or a fluffy member, each of which includes an abrasive disposed on the surface thereof, can be used. Alternatively, a brush, a spatula, or a fluff, each of which impregnates a mucolytic agent, can be used.
In the case where only the outer mucus layer 61 of the appendico mucus 64 is removed, each of the sharp curette, the brush, the spatula, and the fluffy member is preferably made of a member which is more flexible than the inner mucus layer 62 and harder than the outer mucus layer 61.
When only the outer mucus layer 61 of the appendico mucus 64 is removed, it is preferable that roughness, which has a thickness thinner than the thickness of the outer mucus layer 61, is formed on the surface of the spatula, as illustrated in FIG. 9. The thickness of the roughness is preferably equal to or smaller than 1 mm, or more preferably equal to or less than 0.7 mm.
When only the outer mucus layer 61 of the appendico mucus 64 is removed, the length of the bristles of the brush as illustrated in FIG. 10 is smaller than the thickness of the outer mucus layer 61. The length of the bristles is preferably equal to or less than 1 mm, or more preferably equal to or less than 0.7 mm.
The step (F): removal of the appendico mucus 64 may be performed in combination with the step (E): cleaning of the inside of the appendico 19.
The order of the steps in this case is not specifically limited, but can be appropriately selected depending on the state of the appendico 19 of a patient. In addition, at least one of the steps may be performed plurality of times. For example, the steps may be performed as follows: the step (E)→the step (F)→the step (E), for example.
FIG. 12 illustrates a state where a thin-diameter endoscope inserted into the endoscope channel in FIG. 2 is inserted into the appendico.
As illustrated in FIG. 12, after a thin-diameter endoscope 40 is inserted into the appendico 19 in advance to observe the inside of the appendico 19 in step (R) and the thin-diameter endoscope 40 is extracted from the appendico 19 and the endoscope 1, cleaning of the inside of the appendico 19 in the step (F) or the removal of the appendico mucus 64 in the step (F) may be performed. Furthermore, before inserting the thin-diameter endoscope 40 into the appendico 19 in the step (R), the positioning of the endoscope 1 in the step (Q) may be performed.
The appendico 19 differs in the shape, the thickness, and the length depending on a living body. Therefore, only the observation of the appendico orifice 19 i with the observation portion 3 is not sufficient for accurately recognizing the shape and the depth of the appendico 19. Using the thin-diameter endoscope 40 makes it easier to perform the cleaning of the inside of the appendico 19 in the step (E) and the removal of the appendico mucus 64 in the step (F).
FIG. 6, and FIGS. 12 to 14 exemplify the flow of the step (Q)→the step (R)→the step (O)→the step (F)→the step (D)/(S). FIG. 13 illustrates a state where the mucus removal fluffy tool is inserted from the endoscope channel into the appendico, and FIG. 14 illustrates a state where the probiotics is jetted (applied) to the appendico, with the position of the endoscope fixed by inflating the balloon in FIG. 6.

(Step (G): With Regard to Dyeing of the Appendico Mucosa)

Before the removal of the appendico mucus 64 in the step (F) illustrated in FIG. 13, dyeing of the appendico mucus 64 in step G may be performed. Dyeing of the mucus 64 makes it easier to confirm the thickness of the mucus 64 and the removed amount of the mucus 64.
The mucus dyeing agent is not specifically limited, but includes Alcian blue, for example.
As the dyeing method of the appendico mucus 64, dyeing may be performed with the mucus dyeing agent carried by the mucus removal tool, or the mucus dyeing agent may be sprayed using the channel of the mucus removal tool, the endoscope channel 2, and the channel of the sheath.

SECOND MODIFIED EXAMPLE OF THE FIRST EMBODIMENT

In addition to a series of flow including the steps (A), (B), (C), (D/S), and (M) in FIG. 1 according to the present embodiment, the flow of step (P) may be performed. Or, at least one of the steps (Q), (R), (E), or (F) shown in the first modified example of the first embodiment may be performed.

(Step (P): With Regard to Capturing of the Probiotics in a Protective Form)

In step (f) to be described later, the probiotics 100 in the protective form, which have been orally ingested in advance and reached inside the lumen, are captured with the endoscope 1, the sheath of the endoscope, or the treatment instrument in the step (R).
After that, the probiotics 100 is discharged from the protective form of the probiotics, when the appendico orifice 19 i is recognized in the step (C), or the endo scope 1 or the like contacts the appendico 19 in the step (O).
The method of capturing can be appropriately selected depending on the tool to be used and the protective form. The method includes a suction by bringing the channel into the negative pressure state, or capturing with a grasping forceps, for example.
The method of discharging can be appropriately selected depending on the protective form. For example, the protective form is a capsule and the probiotics is contained in the capsule, the method of discharging the probiotics includes opening of the capsule or dissolution of the capsule.
When the protective form is a tablet surface coating and the probiotics is in the form of tablet, for example, the method of discharging the probiotics includes dissolution or cutting of the coating, or crushing of the tablet. When the protective form is a bag, for example, the method of discharging the probiotics includes dissolution, cutting, puncturing, or pressing of the bag.

Second Embodiment

As illustrated in FIG. 1, when the probiotics 100 is supplied to the appendico 19, the procedure is performed as follows: steps (A)→(B)→(C)→(O)→(D)/(J)→(M) in the present embodiment.
Note that the steps (A), (B), (C), and (M) are the same as those recited in the first embodiment.
(Step (O): With regard to contact with the appendico 19)
When a flexible endoscope is used, the distal end of the endoscope 1 is brought into contact with the appendico orifice 19 i or the distal end of the endoscope 1 is inserted into the lumen of the appendico 19.
When a treatment instrument is used, the distal end of the treatment instrument is brought into contact with the appendico orifice 19 i, the distal end of the treatment instrument is inserted into the lumen of the appendico 19, or the distal end of the treatment instrument is separated and inserted into the lumen of the appendico 19.
When a capsule endoscope is used, the surface of the capsule endoscope is brought into contact with the appendico orifice 19 i, a part of the capsule endoscope is inserted into the lumen of the appendico 19, or the entirety of the capsule endoscope is inserted into the lumen of the appendico 19.
When the capsule endoscope is used, the capsule endoscope may be indwelled inside the body to enable the probiotics to be supplied periodically from the capsule endoscope for a predetermined period.

(Step (J): With Regard to Introduction of the Probiotics 100 Into the Mucus 64)

FIG. 15 illustrates the step (J) in FIG. 1, and FIG. 16 illustrates a configuration of the step (J) in FIG. 1, which is different from the configuration illustrated in FIG. 15.
When the probiotics 100 is introduced into the mucus 64 on a cross section of the appendico 19 including the mucus 64 and the mucosa 63, the probiotics 100 may be introduced into the inside of the outer mucus layer 61, may be introduced between the outer mucus layer 61 and the inner mucus layer 62, may be introduced into the inside of the inner mucus layer 62, or may be introduced between the inner mucus layer 62 and the epithelial cells. Alternatively, the introduction may be performed in combination of these.
Note that “introduction” in the present embodiment means disposing the probiotics 100 directly on the mucus 64.
The probiotics 100 to be introduced is the same as described above (Step (S): Jetting of the probiotics 100 toward the appendico orifice 19 i).
The treatment instrument for introducing the probiotics 100 into the mucus 64 can be appropriately selected depending on the form of the probiotics 100 to be introduced and the introducing position.
When a tubular treatment instrument 42 including inside thereof a flow path 42 k as illustrated in FIG. 15 is used, for example, a hole 42 h may be open on a side surface of the tube. Forming the hole on the side surface of the tube makes it easier to introduce the probiotics 100 into the mucus 64 located at the position apart from the sensitive mucosa 63.
Thus, in the present embodiment, the probiotics 100 is introduced into the mucus 64, which improves the colonization of the probiotics 100 in the mucus 64.

FIRST MODIFIED EXAMPLE OF THE SECOND EMBODIMENT

In addition to the second embodiment, similarly as in the first modified example of the first embodiment, at least one of the steps (Q), (R), (E), or (F) may be performed.
When the step (F) is performed, as illustrated in FIG. 16, a spoon-shaped treatment instrument 44 for removing the appendico mucus, which is used in the step (F), is used, for example, and the probiotics 100 may be introduced into the mucus 64 in the step (J).
In this case, the treatment instrument for removing the appendico mucus may include a channel for supplying the probiotics or a structure for carrying the probiotics. Such a configuration enables the number of inserting and extracting the treatment instrument into and from the channel to be reduced.
FIG. 16 exemplifies the treatment instrument 44 for removing the appendico mucus, as described above. The treatment instrument 44 includes, in the spoon, a flow path 44 k and a hole 44 h that are used for supplying the probiotics.

SECOND MODIFIED EXAMPLE OF THE SECOND EMBODIMENT

Instead of the introduction of probiotics 100 into the mucus 64 in the step (J), introduction of the probiotics 100 into the lumen of the appendico 19 in the step (K) or application of the probiotics 100 to a removed part of the mucus 64 in the step (L) may be performed as illustrated in FIG. 14. Alternatively, at least two of the steps (J), (K), and (L) may be performed.

(Step (K): With Regard to Introduction of the Probiotics 100 Into the Lumen of the Appendico 19)

FIG. 17 illustrates an example in which the probiotics is supplied to the appendico through a catheter inserted into the endoscope channel in FIG. 2.
When the probiotics 100 to be introduced is in a fluid form, the introduction is performed toward the appendico orifice 19 i in the step (K) in the same way as the jetting of the probiotics in the step (S).
Note that, when the endoscope 1 and the appendico 19 are apart from each other, as illustrated in FIG. 17, the step (K) may be performed with the distal end of the endoscope 1 being brought into contact with the appendico 19 in the step (O).
An indwelling body for indwelling the probiotics 100 in the appendico 19 may be used in combination with the endoscope 1.
The indwelling body may be a capsule containing the probiotics 100, or a tablet made by solidifying the probiotics 100 by an excipient, or a thread, a sheet, a fluff, or a sponge, each of which is impregnated with or containing the probiotics 100.
When the sheet containing the probiotics 100 is used, the shape of the sheet may be flat or three-dimensional. FIG. 18 illustrates a funnel-shaped indwelling body, FIG. 19 illustrates a tuft-like indwelling body, and FIG. 20 illustrates a thread-like indwelling body. The three-dimensional sheet such as the funnel-shaped indwelling body 17 as illustrated in FIG. 18, the tuft-like indwelling body 72 as illustrated in FIG. 19, and the string-like indwelling body 73 as illustrated in FIG. 20 may be used.
The material of the indwelling body is not specifically limited. However, the material is preferably decomposed or absorbed in the body, or excreted outside the body, and the material includes starch, collagen, mucin, bioabsorbable polymer, or human hair, a botanical thread, or an animal thread, for example.
The botanical thread includes a cotton thread or a hemp thread. The animal thread includes a silk thread, a wool thread, or a spider's thread. The time until the indwelling body is decomposed, the time until the indwelling body is absorbed in the living body, and the time until the indwelling body is excreted outside the body are appropriately determined.
When the thread, sheet, or fluff, each containing the probiotics 100, is used, a part of the thread or the like may be exposed to the intestinal cecum, the colon, or the ileum. FIGS. 18 to 20 exemplify the three-dimensional sheets exposed to the outside the appendico.
When the capsule endoscope is used, a thread, a sheet, a fluff, a sponge, a powder, or a gel, each of which contains the probiotics, may be arranged on the outer surface of the capsule endoscope.

(Step (L): With Regard to Application of the Probiotics 100 to the Removed Part)

The method of removing the mucus 64 and the treatment instrument for removing the mucus 64 are the same as recited in the above-described step (F).
The treatment instrument for applying the probiotics 100 to the part where the mucus 64 is removed may be any instrument as long as the instrument can be impregnated with the probiotics 100. For example, the treatment instrument includes a brush, a non-woven cloth, a fluff, a sponge, or a solid substance including a surface on which roughness is formed.
FIG. 21 illustrates a fluff impregnated with the probiotics and a bar holding the fluff, as an example of a treatment instrument to be used in the step (L) in FIG. 1. Specifically, a treatment instrument 47 includes at the distal end thereof a fluff and a fluff 47 w, and includes inside thereof a conduit 47 k for supplying the probiotics 100 to the fluff and the fluff 47 w.
The probiotics 100 may be impregnated to the fluff before the treatment instrument is inserted into the endoscope channel 2, or the bar is provided with a tube and a hole for supplying the probiotics 100 in the liquid form. The bar can be combined with the brush, the non-woven cloth, the sponge, and the solid substance.

Third Embodiment

When the probiotics 100 is supplied to the appendico 19 as illustrated in FIG. 1, the procedure is performed as follows: steps (A)→(B)→(C)→(O)→(E)→(M) in the present embodiment.
The flow according to the present embodiment is a flow for removing the bacteria harmful to a living body from the appendico.
The steps (A), (B), (C), (O), (E), and (M) are the same as those recited in the first and second embodiments and the modified examples of the embodiments.
With also such a method, the same effects as those of the first and second embodiments described above can be obtained.

MODIFIED EXAMPLE OF THE THIRD EMBODIMENT

Instead of the cleaning of the inside of the appendico 19 in the step (E), the removal of the appendico mucus 64 in the step (F) may be performed.
The removal of the appendico mucus 64 in the step (F) is the same as described in the first modified example of the first embodiment.
Both of the cleaning of the inside of the appendico 19 in the step (E) and the removal of the appendico mucus 64 in the step (F) may be performed.
The order of the steps in this case is not specifically limited, but can be appropriately selected depending on the state of the appendico of a patient. In addition, the number of times of performing each of the steps is not limited, and at least one of the steps (E) or (F) may be performed plural times in such an order of (E)→(F)→(E), for example.

(Execution Scenes of the First to Third Embodiments)

The first to third embodiments may be performed singly, in combination with an endoscopic examination, or in combination with an endoscopic treatment such as polyp resection.

(Post-Treatment of the First to Third Embodiments)

(Step (H): With Regard to Warming of the Appendico from a Body Surface and Step (I): Application of Vibration to the Appendico from the Body Surface)
After the supply of the probiotics 100 to the appendico 19 in the step (D), the warming of the appendico 19 from the body surface in the step (H) or the application of vibration to the appendico 19 from the body surface in the step (I) may be performed.
The step (H) or the step (I) may be performed before or after the extraction of the endoscope 1 from the inside of the body in step (M).
As the method of warming the appendico 19 from the body surface in the step (H), a known method of warming the entirety or a part of the body can be employed. For example, the known method includes bathing, warming with a compress, a hot-water bottle, a hot stone, far infrared irradiation, or hyperthermia.
As the method of vibrating the appendico 19 from the body surface in the step (I), a known method can be employed. For example, the known method includes hyperthermia, a massager, or a jet bath.
There is a possibility that the probiotics 100 is diffused in the appendico 19 or permeates in the mucus 64 by performing the step (H) or the step (I).

(Step Z: Ingestion of Probiotics 100 or Probiotic Nourishment)

It is preferable to perform the step (Z): the ingestion of the probiotics 100 after performing the step (M), (H), or (I).
Ingestion of the probiotics 100 in the state where the existing number of the bacteria in the appendico 19 is decreased will increase the possibility that flora formulated with the probiotics 100 is formed in the appendico 19.
Note that the step (Z) may be performed orally or through a suppository.
In the step (Z), the ingesting form of the probiotics 100 includes a powder including the probiotics 100, a tablet including the probiotics 100, and a capsule containing the probiotics 100, or a fluid including the probiotics 100. The fluid includes degassed water, carbonic water, mucin, collagen, hyaluronic acid, yogurt, milk, or a juice.
The nourishment of the probiotics 100 includes a chemical compound such as ferrous sulfate, manganese sulphate, magnesium sulfate, sodium acetate, ammonium citrate, potassium dihydrogenphosphate, glucose, or tripton, or yeast, lactic acid bacteria, butyrate-producing bacteria, Bifidobacteria, or the like. When the yeast, lactic acid bacteria, butyrate-producing bacteria, or Bifidobacteria is used, it is preferable to use dead bacteria, or live bacteria weaker than the probiotics 100 which is desired to be colonized in the appendico, or weakened live bacteria.

(Step (V): With Regard to Intestinal Environment Restoration Process)

After the execution of the first to third embodiments, the intestinal environment restoration treatment for restoring the intestinal environment to the environment before the execution of the first to third embodiments.
For example, as described later in the section of the execution target of the present invention, it can be considered that absorption rate of nutrition is increased in a healthy body to withstand a harsh living environment, and thereafter in accordance with a change in the living environment, the intestinal environment restoration process in the step (V) is performed.
As a specific method of the intestinal environment restoration process in the step (V) includes dietary restriction, medicinal agent ingestion, intestine cleaning, or intestinal mucus removal. These specific methods are the same as pre-treatment steps (b), (c), (d), and (e) to be described later.
As another specific method of the intestinal environment restoration process in the step (V) includes fecal transplantation of intestinal substances of a near relative or a housemate of a subject, or the intestinal substances of the subject himself or herself collected before the execution of the first to third embodiments. The fecal transplantation may be performed in combination with the dietary restriction, the medicinal agent ingestion, the intestine cleaning, or the intestinal mucus removal.

(Pre-Treatment of the First to Third Embodiments)

(Step (a): With Regard to Appendico Forming)

A plastic surgery of appendico for forming the appendico 19 may be performed on a person whose appendico 19 has been removed due to appendico hypoplasia or appendicitis or a person with aging-related weakened immune system of the appendico 19, prior to the execution of the first to third embodiments.
FIG. 22 illustrates a state where an incision is made on a part of the intestinal cecum, and FIG. 23 illustrates forming of the appendico by suturing the incision in FIG. 22.
The forming of the appendico may be performed by abdominal operation or using a laparoscope.
The method of forming the appendico 19 is not specifically limited, but as exemplified in FIGS. 21, 22, the method includes “a method of forming the appendico 19′ by making an incision 18 c on a part of the intestinal cecum 18 to suture the cut surface”, “a method of transplanting a diverticulum formed in the intestinal tract”, “a method of excising a part of the jejunum and closing one end of the excised part and then transplanting the excised part to the intestinal cecum”, “a method of indwelling an appendico forming instrument in the intestinal cecum 18 to make the appendico 19 gradually grow in the body”, or “a method of transplanting the intestine including at least the appendico 19”. As the appendico forming instrument, an instrument to be used in the tissue expander method may be applied, for example.
In the method of making the incision 18 c on a part of the intestinal cecum 18 and suturing the cut surface 18 n, or the method of transplanting a part of the jejunum, the muscle layer may be partially removed. In the case where suturing is performed in the forming of the appendico, the suturing may be performed with a needle and a thread, with a clip, with a stapler, or with heat sealing, or suturing may be performed with a combination of heat sealing and ultrasound vibration.
A flexible endoscope may be inserted into a body prior to the forming of the appendico, to confirm the site suitable for forming the appendico. In this case, locations where the Peyer's patches are present in the intestine may be confirmed, for example, and the site including a predetermined percentage of the Peyer's patches may be a candidate for the site at which the appendico is formed.

(Step (b): With Regard to Dietary Restriction)

The number of bacteria in the intestine may be decreased by dietary restriction prior to the execution of the first to third embodiments.
The period of the dietary restriction can be appropriately set.
The dietary restriction may be performed by starvation, restriction of caloric intake, or intake of food which is less likely to be the nutrition for the bacteria.

(Step (c): With Regard to Medicinal Agent Ingestion)

Prior to the execution of the first to third embodiments, ingestion of a medicinal agent for reducing the number of bacteria in the intestine may be performed.
The medicinal agent inoculation may be performed by hypodermic injection, oral ingestion, a suppository, or inhalation through the bronchi.
The medicinal agent may be an antibiotic or allicin that acts directly on the bacteria, or a purgative that acts on the intestine.

(Step (d): With Regard to Intestinal Cleaning)

Prior to the execution of the first to third embodiments, intestinal cleaning may be performed by introducing a liquid from the anus 11.
The liquid to be used for the intestinal cleaning is not specifically limited, but includes normal saline, oxygenated water, or degassed water, for example. The liquid may include a medicinal agent for reducing the number of bacteria in the intestine.
The intestinal cleaning may be performed by using a plurality of kinds of liquids. For example, after the cleaning using the liquid including the medicinal agent for reducing the number of bacteria, rinsing and cleaning may be performed with normal saline, for example.

(Step (e): With Regard to Intestinal Mucus Removal)

Prior to the execution of the first to third embodiments, at least a part of the mucus of the large intestine 10 or the mucus of the small intestine may be removed.
The removal of the appendico mucus in the step (H) is diverted to the method of removing the mucus.

(Step (f): With Regard to Oral Ingestion of the Probiotics 100 in Protective Form)

Prior to the execution of the first to third embodiments, the probiotics 100 in a protective form may be orally ingested.
The protective form referred to here indicates protecting and housing the probiotics 100 so as not to be killed by the digestive juice until the probiotics 100 reaches the intestinal tract.
The protective form includes, for example, a capsule, a tablet coating, or a bag with which the probiotics 100 are protected. With regard to the probiotics 100 referred to here, the ingestion of the probiotics 100 in the above-described step (Z) can be diverted.
The timing of the oral ingestion of the probiotics 100 in the protective form is not specifically limited, and the timing of the oral ingestion is any timing as long as the probiotics 100 in the protective form reaches the intestinal tract when the procedure using the endoscope 1 is performed. The timing of the oral ingestion can be appropriately selected depending on the protective form, the body condition, the body size, the age, the type of procedure, the timing of performing the procedure, or the like.
The ingestion quantity and the number of ingestions of the probiotics 100 in the protective form are not specifically limited, but can be appropriately selected depending on the protective form, the body condition, the body size, the age, the type of procedure, the timing of performing the procedure, or the like.
The above-described steps (b), (c), (d), (e), and (f) may be performed in combination.

(Other Pre-Treatment)

Prior to the execution of the first to third embodiments, indigenous bacteria in the intestine may be collected, cultured, and analyzed. Based on the result of the analysis, insufficient bacteria or bacteria that are good match with the indigenous bacteria may be selected, and the selected bacteria may be used as the probiotics in the present invention.

(With Regard to Execution Target of the Present Invention)

The flora treatment according to the present invention is applicable to all ages, but the age of the appendico 19 is preferably under 30 years.
Since fibrosis has not progressed in the appendico 19 under 30 years, and lymphocytes in the appendico 19 are active, the treatment is likely to take effect. In addition, the age of the intestinal tract including the appendico 19 is 10 years or older.
The intestinal tract of 10 years or older has a sufficient tissue strength, which makes it easier for endoscope 1 to reach the intestinal cecum 18.
The present invention can be applied to allergy treatment. The allergy includes a hay fever, an atopic dermatitis, an animal allergy, a food allergy, a sick house syndrome, an ulcerative enteritis, or a Crohn disease.
The present invention can be applied to treatment of drug-induced enterocolitis. In addition, the present invention can be applied to immunity reinforcement before endoscopic examination and endoscopic treatment.
The present invention can be applied to health care. The health care includes an obesity treatment, cholesterol lowering, or metabolic rate enhancement.
The present invention can be applied to an inborn error of metabolism. Furthermore, the present invention can be applied to malabsorption syndrome treatment, improvement of absorption rate of nutrition in a healthy body. The malabsorption syndrome includes a postgastrectomy syndrome, a short bowel syndrome, a celiac disease, or an amyloidosis.
The present invention can be applied to enhancement of the absorption rate of nutrition in a healthy body. People having healthy body that requires such treatment includes people withstand harsh living environments such as athletes, alpinists, or people in military service.
Note that the present invention is not limited only to the above-described embodiments and modified examples of each of the embodiments, but various modifications can be made within a range without departing from the gist of the invention.
Having described the preferred embodiments of the invention referring to the accompanying drawings, it should be understood that the present invention is not limited to those precise embodiments and various changes and modifications thereof could be made by one skilled in the art without departing from the spirit or scope of the invention as defined in the appended claims.

Claims

What is claimed is:

1. A flora treatment comprising:

a step (A) in which an instrument is introduced into a lumen;

a step (B) in which the instrument is made to reach an intestinal cecum;

a step (C) in which an appendico is recognized; and

a step (D) in which probiotics is supplied to the appendico.

2. The flora treatment according to claim 1,

wherein the instrument is an endoscope, and

an orifice of the appendico is recognized using a field of view of the endoscope in the step (C).

3. The flora treatment according to claim 1, wherein the probiotics is supplied into a mucus of the appendico in the step (D).

4. The flora treatment according to claim 3, further comprising, before the step (D), a step (E) in which an inside of the appendico is cleaned.

5. The flora treatment according to claim 3, further comprising, before the step (D), a step (F) in which at least a part of the mucus of the appendico is removed.

6. The flora treatment according to claim 5, further comprising, before the step (F), a step (G) in which the mucus of the appendico is dyed.

7. The flora treatment according to claim 3, wherein, in the step (D), the probiotics is applied to a part where the mucus has been removed in the step (F).

8. The flora treatment according to claim 1, further comprising, after the step (D), a step (H) in which heat is applied to the appendico for a predetermined time period, or comprising, after the step (D), a step (I) in which vibration is applied to the appendico for a predetermined time period.

9. The flora treatment according to claim 1, wherein an age of the appendico is under 30 years.