Esophageal delivery system and method with position indexing

• US 20050245788A1
• Filed: 04/28/2004
• Published: 11/03/2005
• Est. Priority Date: 04/28/2004
• Status: Abandoned Application

• Current Assignee: Medtronic Incorporated (Medtronic Plc)
• Original Assignee: Medtronic Incorporated (Medtronic Plc)
• Inventors: Gerber, Martin T.
• Application Number:
  US10/833,775
• Publication Number:
  US 20050245788A1
• Time in Patent Office: Days
• US Class Current: 600/115
• CPC Class Codes: A61B 1/00082 Balloons
• CPC Class Codes: A61B 1/00148 using anchoring means
• CPC Class Codes: A61B 1/273 for the upper alimentary canal, e.g. oesophagoscopes, gastroscopes
• CPC Class Codes: A61B 17/12022 Occluding by internal devices, e.g. balloons or releasable wires plugging an opening in the wall of an organ A61B17/0057; occluders for the cervical canal A61F6/146; vas deferens occluders A61F6/20
• CPC Class Codes: A61B 17/12099 characterised by the location of the occluder
• CPC Class Codes: A61B 17/12186 liquid materials adapted to be injected
• CPC Class Codes: A61B 17/1219 expandable in contact with liquids
• CPC Class Codes: A61B 17/3478 Endoscopic needles, e.g. for infusion biopsy needles A61B10/0233; catheters with injection needles A61M25/0067
• CPC Class Codes: A61B 18/1477 Needle-like probes
• CPC Class Codes: A61B 2017/00035 pH
• CPC Class Codes: A61B 2017/00292 mounted on or guided by flexible, e.g. catheter-like, means
• CPC Class Codes: A61B 2017/00867 shape memory effect
• CPC Class Codes: A61B 2017/22069 Immobilising; Stabilising
• CPC Class Codes: A61B 2017/3488 Fixation to inner organ or inner body tissue
• CPC Class Codes: A61B 2018/00494 Stomach, intestines or bowel
• CPC Class Codes: A61B 2018/1425 Needle
• CPC Class Codes: A61B 2018/143 multiple needles
• CPC Class Codes: A61B 5/073 Intestinal transmitters
• CPC Class Codes: A61B 5/14539 for measuring pH
• CPC Class Codes: A61B 5/4211 Diagnosing or evaluating reflux
• CPC Class Codes: A61B 5/4233 : oesophagus
• CPC Class Codes: A61B 5/6853 : with a balloon
• CPC Class Codes: A61B 5/6859 : with multiple distal splines
• CPC Class Codes: A61M 2210/105 : Oesophagus
• CPC Class Codes: A61M 2210/106 : Small intestine

Abstract

An esophageal delivery system includes features that facilitate the precise positioning of a medical device within the gastrointestinal tract. The system supports indexed positioning without relying solely on endoscopic viewing or external imaging equipment to identify the location of the medical device. A fixation element holds an elongated delivery device at a selected position within the gastrointestinal tract. The medical device is carried at a position that is a fixed and known distance away from the fixation element. Once the fixation element is positioned at a known location, precise positioning of the medical device within the esophagus can be achieved with greater certainty. As an illustration, the fixation element may take the form of a balloon an expandable frame or other device capable of engaging the lower esophageal sphincter (LES) to provide a reference position for a medical device to be placed at a precise distance above the LES.

Claims

1. An esophageal delivery system comprising:

an elongated delivery device sized for introduction into an esophagus of a patient;

a fixation element, disposed adjacent a distal end of the elongated delivery device, to engage a first selected portion of the esophagus and thereby fix the elongated delivery device against substantial upward movement within the esophagus; and

a medical device for placement within the esophagus of the patient, wherein the medical device is carried by the elongated delivery device at a fixed position relative to the fixation element such that the medical device is positioned adjacent a second selected portion of the esophagus.

2. The system of claim 1, wherein the fixation element comprises an expandable balloon that, upon expansion, is sized larger than a passage defined by a lower esophageal sphincter of the patient.

3. The system of claim 1, wherein the fixation element comprises an expandable frame that, upon expansion, is sized larger than a passage defined by a lower esophageal sphincter of the patient.

4. The system of claim 1, wherein the fixation element comprises one or more expandable tines that, upon expansion, are oriented to engage tissue in the vicinity of the lower esophageal sphincter.

5. The system of claim 1, wherein the medical device is disposed at a side of the fixation element opposite a distal tip of the elongated delivery device.

6. The system of claim 1, wherein the medical device comprises a gastro-esophageal reflux sensor.

7. The system of claim 1, wherein the gastro-esophageal reflux sensor comprises a pH sensor.

8. The system of claim 1, wherein the medical device comprises a device for introducing a bulking agent into a wall of the esophagus.

9. The system of claim 8, wherein the medical device comprises one or more endoscopic members to prepare the wall of the esophagus for introduction of the bulking agent and introduce the bulking agent.

10. The system of claim 8, wherein the bulking agent comprises an expandable hydrogel implant.

11. The system of claim 1, wherein the medical device comprises a heating element to heat tissue adjacent a lower esophageal sphincter of the patient.

12. The system of claim 11, wherein the heating element comprises an electrically conductive probe to deliver radio frequency energy to the tissue.

13. The system of claim 1, wherein the medical device comprises an electrical stimulator or a drug delivery device.

14. A gastrointestinal delivery system comprising:

an elongated delivery device sized for introduction into a small intestine of a patient via an esophagus of the patient;

a fixation element, disposed adjacent a distal end of the elongated delivery device, to engage tissue adjacent a pyloric sphincter of the patient, and thereby fix the elongated delivery device against substantial downward movement within the small intestine; and

a medical device for placement within the small intestine of the patient, wherein the medical device is carried by the elongated delivery device at a fixed position relative to the fixation element such that the medical device is positioned adjacent a selected portion of the small intestine below the pyloric sphincter.

15. The system of claim 14, wherein the fixation element comprises an expandable balloon that, upon expansion, is sized larger than a passage defined by the pyloric sphincter of the patient.

16. The system of claim 14, wherein the fixation element comprises an expandable frame that, upon expansion, is sized larger than a passage defined by the pyloric sphincter of the patient.

17. The system of claim 14, wherein the fixation element comprises one or more expandable tines that, upon expansion, are oriented to engage tissue in the vicinity of the pyloric sphincter.

18. The system of claim 14, wherein the medical device is disposed at a side of the fixation element adjacent a distal tip of the elongated delivery device.

19. The system of claim 14, wherein the medical device comprises a diagnostic sensor.

20. The system of claim 14, wherein the medical device comprises a device for introducing a bulking agent into a wall of the small intestine.

21. The system of claim 14, wherein the medical device comprises a heating element to heat tissue adjacent a pyloric sphincter of the patient.

22. An esophageal delivery system comprising:

a medical device;

means for introducing the medical device into an esophagus of a patient; and

means for engaging a first selected portion of the esophagus to fix the introducing means against substantial upward movement within the esophagus, wherein the medical device is carried by the introducing means at a fixed position relative to the engaging means such that the medical device is positioned adjacent a second selected portion of the esophagus.

23. The system of claim 22, wherein the engaging means comprises an expandable balloon that, upon expansion, is sized larger than a passage defined by a lower esophageal sphincter of the patient.

24. The system of claim 22, wherein the engaging means comprises an expandable frame that, upon expansion, is sized larger than a passage defined by a lower esophageal sphincter of the patient.

25. The system of claim 22, wherein the engaging means comprises one or more expandable tines that, upon expansion, are oriented to engage tissue in the vicinity of the lower esophageal sphincter.

26. The system of claim 22, wherein the medical device comprises means for sensing gastro-esophageal reflux.

27. The system of claim 22, wherein the medical device comprises means for introducing a bulking agent into a wall of the esophagus.

28. The system of claim 22, wherein the medical device comprises means for heating tissue adjacent a lower esophageal sphincter of the patient.

29. The system of claim 22, wherein the medical device comprises one of a means for electrically stimulating tissue within the esophagus and a means for delivering a drug.

30. A gastro-intestinal delivery system comprising:

a medical device;

means for introducing the medical device into a small intestine of a patient via an esophagus of the patient; and

means for engaging tissue adjacent a pyloric sphincter of the patient to fix the introducing means against substantial downward movement within the small intestine, wherein the medical device is carried by the introducing means at a fixed position relative to the engaging means such that the medical device is positioned adjacent a selected portion of the small intestine below the pyloric sphincter.

31. The system of claim 30, wherein the engaging means comprises an expandable balloon that, upon expansion, is sized larger than a passage defined by the pyloric sphincter of the patient.

32. The system of claim 30, wherein the engaging means comprises an expandable frame that, upon expansion, is sized larger than a passage defined by the pyloric sphincter of the patient.

33. The system of claim 30, wherein the engaging means comprises one or more expandable tines that, upon expansion, are oriented to engage tissue in the vicinity of the pyloric sphincter.

34. The system of claim 30, wherein the medical device comprises a diagnostic sensor.

35. The system of claim 30, wherein the medical device comprises a device for introducing a bulking agent into a wall of the small intestine.

36. The system of claim 30, wherein the medical device comprises a heating element to heat tissue adjacent a pyloric sphincter of the patient.

37. A method for esophageal delivery of a medical device, the method comprising:

introducing an elongated delivery device into an esophagus of a patient;

engaging a first selected portion of the esophagus with a fixation element carried by the elongated delivery device to thereby fix the elongated delivery device against substantial upward movement within the esophagus; and

placing a medical device within the esophagus of the patient, wherein the medical device is carried by the elongated delivery device at a fixed position relative to the fixation element such that the medical device is positioned adjacent a second selected portion of the esophagus.

38. The method of claim 37, further comprising extending the fixation element to a position below the lower esophageal sphincter, and pulling the elongated delivery device upward to engage the fixation element with the lower esophageal sphincter.

39. The method of claim 38, wherein the fixation element comprises an expandable balloon that, upon expansion, is sized larger than a passage defined by a lower esophageal sphincter of the patient, the method further comprising:

extending the fixation element to a position below the lower esophageal sphincter;

expanding the balloon; and

pulling the elongated delivery device upward to engage the expanded balloon with the lower esophageal sphincter

40. The method of claim 38, wherein the fixation element comprises an expandable frame that, upon expansion, is sized larger than a passage defined by a lower esophageal sphincter of the patient, the method further comprising:

extending the fixation element to a position below the lower esophageal sphincter;

expanding the frame; and

pulling the elongated delivery device upward to engage the expanded frame with the lower esophageal sphincter.

41. The method of claim 38, wherein the fixation element comprises one or more expandable tines that, upon expansion, are oriented to engage tissue in the vicinity of the lower esophageal sphincter, the method further comprising:

extending the fixation element to a position below the lower esophageal sphincter;

expanding the tines; and

pulling the elongated delivery device upward to engage the expanded tines with the lower esophageal sphincter.

42. The method of claim 37, wherein the medical device is disposed at a side of the fixation element opposite a distal tip of the elongated delivery device.

43. The method of claim 37, wherein the medical device comprises an gastro-esophageal reflux sensor.

44. The method of claim 37, wherein the medical device comprises a device for introducing a bulking agent into a wall of the esophagus.

45. The method of claim 44, wherein the bulking agent comprises an expandable hydrogel implant.

46. The method of claim 37, wherein the medical device comprises a heating element to heat tissue adjacent a lower esophageal sphincter of the patient.

47. The method of claim 37, wherein the medical device comprises one of an electrical stimulator and a drug delivery device.

48. A method for gastro-intestinal delivery of a medical device, the method comprising:

introducing an elongated delivery device sized into a small intestine of a patient via an esophagus and a stomach of the patient;

engaging tissue adjacent a pyloric sphincter of the patient with a fixation element to fix the elongated delivery device against substantial downward movement within the small intestine; and

placing a medical device within the small intestine of the patient, wherein the medical device is carried by the elongated delivery device at a fixed position relative to the fixation element such that the medical device is positioned adjacent a selected portion of the small intestine below the pyloric sphincter.

49. The method of claim 48, further comprising extending the fixation element to a position above the pyloric sphincter, and pushing the elongated delivery device downward o engage the fixation element with the pyloric sphincter.

50. The method of claim 49, wherein the fixation element comprises an expandable balloon that, upon expansion, is sized larger than a passage defined by a pyloric sphincter of the patient, the method further comprising:

extending the fixation element to a position above the pyloric sphincter;

expanding the balloon; and

pushing the elongated delivery device downward to engage the expanded balloon with the pyloric sphincter

51. The method of claim 49, wherein the fixation element comprises an expandable frame that, upon expansion, is sized larger than a passage defined by the pyloric sphincter of the patient, the method further comprising:

extending the fixation element to a position above the pyloric sphincter;

expanding the frame; and

pushing the elongated delivery device downward to engage the expanded frame with the pyloric sphincter.

52. The method of claim 49, wherein the fixation element comprises one or more expandable tines that, upon expansion, are oriented to engage tissue in the vicinity of the pyloric sphincter, the method further comprising:

extending the fixation element to a position above the pyloric sphincter;

expanding the tines; and

pushing the elongated delivery device downward to engage the expanded tines with the pyloric sphincter.

53. The method of claim 48, wherein the medical device is disposed at a side of the fixation element adjacent a distal tip of the elongated delivery device.

54. The method of claim 48, wherein the medical device comprises an gastro-esophageal reflux sensor.

55. The method of claim 48, wherein the medical device comprises a device for introducing a bulking agent into a wall of the esophagus.

56. The method of claim 48, wherein the medical device comprises a heating element to heat tissue adjacent a lower esophageal sphincter of the patient.

57. The method of claim 48, wherein the medical device comprises one of an electrical stimulator and a drug delivery device.

58. An esophageal delivery system comprising:

an elongated delivery device sized for introduction into an esophagus of a patient;

a fixation element, disposed adjacent a distal end of the elongated delivery device, to engage a first selected portion of the esophagus and thereby fix the elongated delivery device against substantial upward movement within the esophagus; and

a deployment point formed in the elongated delivery device to deploy a medical device within the esophagus of the patient, wherein the deployment point is formed in the elongated delivery device at a fixed position relative to the fixation element such that the medical device is deployable to a second selected portion of the esophagus.

59. The system of claim 59, wherein the fixation element comprises an expandable balloon, an expandable frame, or one or more expandable tines that, upon expansion, is oriented to engage tissue in the vicinity of the lower esophageal sphincter.

60. A gastrointestinal delivery system comprising:

an elongated delivery device sized for introduction into a small intestine of a patient via an esophagus of the patient;

a fixation element, disposed adjacent a distal end of the elongated delivery device, to engage tissue adjacent a pyloric sphincter of the patient, and thereby fix the elongated delivery device against substantial downward movement within the small intestine; and

a deployment point formed within the elongated delivery device to deploy a medical device within the small intestine of the patient, wherein the deployment point is formed in the elongated delivery device at a fixed position relative to the fixation element such that the medical device is deployable to a selected portion of the small intestine below the pyloric sphincter.

61. The system of claim 60, wherein the fixation element comprises an expandable balloon that, upon expansion, is sized larger than a passage defined by the pyloric sphincter of the patient.