Methods and apparatus for treatment of obesity with an ultrasound device movable in two or three axes

• US 20050203501A1
• Filed: 02/24/2005
• Published: 09/15/2005
• Est. Priority Date: 03/14/2003
• Status: Active Grant

• Current Assignee: EndoVx, Inc.
• Original Assignee: EndoVx, Inc.
• Inventors: Aldrich, William N., Miller, David
• Granted Patent: US 7,783,358 B2
• Time in Patent Office: Days
• US Class Current: 606/27
• CPC Class Codes: A61B 18/02 by cooling, e.g. cryogenic techniques devices for cooling specific reflex points of the body within cell-life limits A61H39/06
• CPC Class Codes: A61B 18/04 by heating by applying electromagnetic radiation A61B18/18; hyperthermia using electric or magnetic fields, radiation or ultrasound A61N
• CPC Class Codes: A61B 18/1477 Needle-like probes
• CPC Class Codes: A61B 18/1492 having a flexible, catheter-like structure, e.g. for heart ablation A61B18/1477 takes precedence
• CPC Class Codes: A61B 18/18 by applying electromagnetic radiation, e.g. microwaves radiation therapy A61N5/00
• CPC Class Codes: A61B 2017/00026 Conductivity or impedance, e.g. of tissue
• CPC Class Codes: A61B 2017/22051 with an inflatable part, e.g. balloon, for positioning, blocking, or immobilisation A61B2017/22048, A61B2017/3486 take precedence
• CPC Class Codes: A61B 2018/00011 with fluids
• CPC Class Codes: A61B 2018/00482 Digestive system
• CPC Class Codes: A61B 2018/1425 Needle
• CPC Class Codes: A61B 8/12 in body cavities or body tracts, e.g. by using catheters catheters per se A61M25/00
• CPC Class Codes: A61B 8/445 Details of catheter construction
• CPC Class Codes: A61B 8/4461 Features of the scanning mechanism, e.g. for moving the transducer within the housing of the probe
• CPC Class Codes: A61N 7/02 Localised ultrasound hyperthermia hyperthermia in general A61F7/00
• CPC Class Codes: A61N 7/022 intracavitary

Abstract

Method and apparatus for treating obesity by an energy delivery device, such as a high focus ultrasound transducer, mounted for movement along two or three axes relative to the esophagus to deliver transesophageal energy to interrupt the function of vagal nerves. Preferably, movement along a longitudinal axis of the esophagus changes the site to which the energy is directed and movement transversely along a radius of the esophagus focuses the energy on a vagal nerve. The third degree of freedom relative to the esophagus is to rotate the transducer about the longitudinal axis of the esophagus.

Claims

1. A method for reducing obesity comprising:

positioning the energy delivery device within the esophagus;

adjusting the position of the energy delivery device along a first axis and a second axis, the first axis being a longitudinal axis of the esophagus and the second axis being tranversely along a radius of the esophagus; and

energizing the delivery device to deliver energy to the site of at least one vagal nerve branch on the outer wall of the esophagus.

2. The method of claim 1 wherein the adjusting step further comprises adjusting the position of the energy delivery device along the first axis to control the focus of the energy being delivered to the site of the at least one vagal nerve branch.

3. The method of claim 2 wherein the adjusting step further comprises moving the energy delivery device along the first axis closer to the site of the at least one vagal nerve branch.

4. The method of claim 2 wherein the adjusting step further comprises moving the energy delivery device along the first axis further from the site of the at least one vagal nerve branch.

5. The method of claim 1 wherein the adjusting step further comprises adjusting the position of the energy delivery device along the second axis to change the site to which the energy is being delivered.

6. The method of claim 5 wherein the adjusting step further comprises moving the energy delivery device along the second axis distally to change the site to another site closer to the stomach.

7. The method of claim 5 wherein the adjusting step further comprises moving the energy delivery device along the second axis proximally to change the site to another site farther from the stomach.

8. The method of claim 5 wherein the adjusting step further comprises after completing the step of energizing the delivery device to deliver energy to the site, moving the energy delivery device along the second axis to a second site having at least one vagal nerve branch and energizing the delivery device to deliver energy to the second site.

9. The method of claim 1 further comprising rotating the position of the energy delivery device about the second axis of the esophagus.

10. The method of claim 1 wherein the energy is ultrasound.

11. The method of claim 1 wherein the energy of claim 1 is high intensity ultrasound.

13. The method of claim 1 wherein the energy is radio frequency energy.

14. The method of claim 13 wherein the energy is delivered by electrodes which are passed through the wall of the esophagus.

15. The method of claim 14 wherein the electrodes are used to locate the vagal nerve branches.

16. The method of claim 1 wherein the energy delivery device is introduced into the esophagus through the mouth.

17. The method of claim 1 wherein the energy delivery device is delivered to the esophagus through the nose.

12. The method of claim wherein the energy is high intensity focused ultrasound.

18. A device for disrupting a function of a vagal nerve comprising:

an energy delivery device;

a platform adapted to carry the energy delivery device, the platform being adapted to position the energy delivery device along a first axis and a second axis, the first axis being a longitudinal axis of the esophagus and the second axis being a radius of the esophagus; and

an actuator for energizing the energy delivery device such that energy is delivered to a vagal nerve branch.

19. The device of claim 18 wherein the platform adjusts the position of the energy delivery device along the first axis to control the focus of the energy being delivered to the location of the vagal nerve branch.

20. The device of claim 19 wherein the platform moves the energy delivery device along the first axis closer to the vagal nerve branch.

21. The device of claim 19 wherein the platform moves the energy delivery device along the first axis further from the vagal nerve branch.

22. The device of claim 18 wherein the device is adapted to position the energy delivery device along the second axis to change a location relative to the stomach to which the energy is being delivered.

23. The device of claim 22 wherein the device moves the energy delivery device along the second axis distally to change the location to another location closer to the stomach.

24. The device of claim 22 wherein the device moves the energy delivery device along the second axis proximally to change the location to another location farther from the stomach.

25. The device of claim 19 further comprising a position actuator coupled to the platform, the position actuator moving the platform to adjust the position of the energy delivery device along the first axis.

26. The device of claim 25 wherein the platform and the position actuator interact through at least one guide rail.

27. The device of claim 26 further comprising a slot corresponding to the guide rail.

28. The device of claim 26 wherein the guide rail is inclined.

29. The device of claim 27 further comprising a treatment window adapted to pass the energy to the vagal nerve branch.

30. The device of claim 29 further comprising a stop to set a minimum distance between the platform and the treatment window.

31. The device of claim 25 further comprising a forward stop on the position actuator that limits the forward progress of the position actuator.

32. The device of claim 18 further comprising a diagnostic imaging transducer on the platform.

33. The device of claim 18 further comprising a channel in the platform adapted to circulate a fluid adjacent the energy delivery device.

34. The device of claim 18 further comprising a nerve mapping device.

35. The device of claim 34 wherein the nerve mapping device is a constant current impedance grid.

36. The device of claim 18 wherein the platform is adapted to rotate the energy delivery device about the second axis of the esophagus.

37. The device of claim 18 wherein the energy delivery device is an ultrasound transducer.

38. The device of claim 37 wherein the transducer is a high intensity ultrasound transducer.

39. The device of claim 37 wherein the transducer is a high intensity focused ultrasound transducer.

40. The device of claim 18 wherein the energy delivery device is a radio frequency electrode.

41. The device of claim 18 further comprising a positioning member.

42. The device of claim 41 wherein the positioning member is a balloon.

43. The device of claim 41 wherein the positioning member is a vacuum device.

44. A method of disrupting a vagal nerve comprising:

positioning an elongate body near a first vagal nerve in the esophagus, the elongate device having an ablation device;

cooling the esophagus;

ablating the first vagal nerve with the ablation device;

rotating the elongate body to direct the ablation device at a second vagal nerve;

ablating the second vagal nerve with the ablation device.

45. The method of claim 44 further comprising using xray imaging to position or confirm the position of the ablation device near the first vagal nerve before ablating the first vagal nerve.

46. The method of claim 44 further comprising using xray imaging to position or confirm the position of the ablation device near the second vagal nerve before ablating the second vagal nerve.

47. The method of claim 45 wherein xray imaging is used to position the ablation device axially down the esophagus and rotationally toward the first vagus nerve.

48. The method of claim 44 further comprising adjusting the depth of ablation before ablating the first vagal nerve.

49. The method of claim 44 further comprising adjusting the depth of ablation before ablating the second vagal nerve.

50. The method of claim 44 wherein the rotating step rotates the ablation device substantially 180 degrees.

51. The method of claim 44 wherein the first vagal nerve is the anterior vagal nerve and the second vagal nerve is the posterior vagal nerve.

52. The method of claim 44 wherein the first vagal nerve is the posterior vagal nerve and the second vagal nerve is the anterior vagal nerve.