WO1989000407A1 - Apparatus for arrest of bleeding at a duodenal ulcer - Google Patents

Apparatus for arrest of bleeding at a duodenal ulcer Download PDF

Info

Publication number
WO1989000407A1
WO1989000407A1 PCT/GB1987/000522 GB8700522W WO8900407A1 WO 1989000407 A1 WO1989000407 A1 WO 1989000407A1 GB 8700522 W GB8700522 W GB 8700522W WO 8900407 A1 WO8900407 A1 WO 8900407A1
Authority
WO
WIPO (PCT)
Prior art keywords
balloon
endoscope
inflation
line
ulcer
Prior art date
Application number
PCT/GB1987/000522
Other languages
French (fr)
Inventor
Thomas Vincent Taylor
Original Assignee
Thomas Vincent Taylor
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Priority to GB8601015A priority Critical patent/GB2185400B/en
Application filed by Thomas Vincent Taylor filed Critical Thomas Vincent Taylor
Priority to PCT/GB1987/000522 priority patent/WO1989000407A1/en
Publication of WO1989000407A1 publication Critical patent/WO1989000407A1/en

Links

Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B1/00—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor
    • A61B1/31—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor for the rectum, e.g. proctoscopes, sigmoidoscopes, colonoscopes
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B1/00—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor
    • A61B1/00064—Constructional details of the endoscope body
    • A61B1/00071—Insertion part of the endoscope body
    • A61B1/0008—Insertion part of the endoscope body characterised by distal tip features
    • A61B1/00082—Balloons
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B1/00—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor
    • A61B1/00064—Constructional details of the endoscope body
    • A61B1/00071—Insertion part of the endoscope body
    • A61B1/0008—Insertion part of the endoscope body characterised by distal tip features
    • A61B1/00101—Insertion part of the endoscope body characterised by distal tip features the distal tip features being detachable
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B1/00—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor
    • A61B1/273—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor for the upper alimentary canal, e.g. oesophagoscopes, gastroscopes
    • A61B1/2736—Gastroscopes
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/12—Surgical instruments, devices or methods, e.g. tourniquets for ligaturing or otherwise compressing tubular parts of the body, e.g. blood vessels, umbilical cord
    • A61B17/12022—Occluding by internal devices, e.g. balloons or releasable wires
    • A61B17/12099—Occluding by internal devices, e.g. balloons or releasable wires characterised by the location of the occluder
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/12—Surgical instruments, devices or methods, e.g. tourniquets for ligaturing or otherwise compressing tubular parts of the body, e.g. blood vessels, umbilical cord
    • A61B17/12022—Occluding by internal devices, e.g. balloons or releasable wires
    • A61B17/12131—Occluding by internal devices, e.g. balloons or releasable wires characterised by the type of occluding device
    • A61B17/12136—Balloons

Definitions

  • apparatus for arresting the bleeding of a duodenal ulcer by the application of physical pressure to the ulcer from within the duodenum
  • the apparatus comprising an inflatable balloon, means to mount the balloon on the distal end of an endoscope whereby the balloon may be conveyed in a deflated condition to the duodenum by the endoscope during visual inspection of the ulcer, an inflation and traction line communicating with the interior of the balloon and for connection externally of the patient to a source of inflation fluid and to a gripping device to maintain the line in tension.
  • Figure 1 is a schematic vertical section through the stomach 10 and duodenum 11 of a patient. On the wall of the duodenum 11 is an ulcer 12. The ulcer 12 is being inspected by an endoscope 13 which extends from the mouth of the patient (not shown) through the stomach 10 and pyloric sphincter 14 to the duodenum 11. (It is normal practice to perform an endoscopic inspection on duodenal ulcers as a preliminary to surgery.) For clarity, the device according to the invention is not shown in Figure 1.
  • Figure 2 shows the distal end 15 of the endoscope 13, with the usual optical elements 16, which need not be described herein. Gripping the cylindrical surface of the endoscope tube 13 is a rubber band 17 which serves, in a manner described below, as a back-stop collar to the balloon of the present invention.
  • the balloon device 18 is in the form of a sleeve which slides over the distal end 15 of the endoscope tube 13, to be arrested and held in position at the distal end 15 by the collar 17.
  • the sleeve 18 is made up of a relatively stiff rubber tube 19 which is flexible but, at the same time, not easily collapsible. This combination of properties is achieved by embedding within the tube a helical wire reinforcement coil.
  • the tube 19 carries an annular latex or silicone rubber balloon 20.
  • the tube 19 and collar 17 together constitute means for mounting the balloon 20 on the endoscope 13.
  • a tough rubber inflation and traction line 21 which is of small diameter and thin wall thickness and runs (not shown) the full length of the endoscope tube 13 so that it can be manipulated outside the mouth of the patient.
  • the balloon 20 is shown in Figure 2 in its deflated condition, and with exaggerated transverse dimensions. In practice, the balloon device 18 and collar 17 add little to the cross sectional area of the endoscope, so that penetration through the sphincter 14 is not a problem.
  • the collar 17, and then the balloon device 18 is slid onto the distal end 15 of the tube 13.
  • the endoscope is then introduced into the duodenum, in conventional manner, with the inflation and traction line 21 available for manipulation at the mouth of the patient.
  • the ulcer 12 is inspected, in the conventional way.
  • the endoscope tube 13 is manipulated further, in order to bring the balloon device 18 into what is considered to be the optimum position for inflation, for the application of physical pressure to the ulcer 12.
  • inflation fluid is delivered to it along the inflation line 21 and, when the balloon 18 is inflated, the endoscope is withdrawn.
  • the inflation and traction line 21 is gripped at or close to the mouth of the Patient, so that it is in sufficient tension to prevent the balloon 18 from moving downwardly away from the site of the ulcer 12.
  • a hollow sphere 30 of resilient material about 7cm in diameter has a diametral slit 31 extending half way across the sphere.
  • the sphere is of thin, tough and resilient rubber, so it grips the inflation line securely in the slit and seals tht line.
  • the sphere as a whole is, however, soft and deformatle enough to lie pressed to the mouth of the patient with the ball surface against the patient's cheek, to keep the inflation line in tension.
  • Gastro-intestinal continuity is provided through the cylindrical bore at the centre of the balloon device 15, where the endoscope tube 13 was previously.
  • the pressure which the balloon 16 applies to the ulcer 13 may be sufficient to arrest bleeding and avoid the need for surgery. Even if surgery is necessary, the pressure on the ulcer in the period prior to surgery will arrest or substantially reduce bleeding during this period, so that the patient is kept in better condition to survive surgery.
  • the inflation gas is allowed to exit along the line 21, so that the balloon may deflate fully and be drawn upwardly tnrough the sphincter 14 and stomach 10.
  • the cylindrical bore which maintains gastrointestinal continuity may not be absolutely essential but it is desirable since obstruction of the duodenum is likely to produce hyper-secretion.
  • the technique of applying physical pressure to stop bleeding may be considered as a tamponade.
  • the inflation and traction line is likely to have a length of around 70 to 80 cms. Because of their relatively small cross-sectional dimension, paediatric endoscopes may find special application for use with the present invention.
  • the fluid used for inflation may be liquid or gas. Liquid affords easier measurement of the size of the inflated balloon, because it is incompressible. Gas, however, has the advantage that the fluid pressure within the balloon is more easily monitored.

Abstract

Bleeding from a duodenal ulcer (12) is arrested by a tamponade technique in which a balloon (20) is introduced uninflated into the duodenum (11) on the distal end (15) of an endoscope (13). The endoscope (13) is used to position the uninflated balloon (20), the balloon (20) is inflated using an inflation line (21) and tension in the line (21) holds the balloon (20) pressed against the ulcer (12). The endoscope (13) is withdrawn and gastro-intestinal continuity is maintained through the bore of the sleeve (19) on which the balloon (20) is carried.

Description

APPARATUS FOR ARREST OF BLEEDING AT A DUODENAL ULCER
There is still a high rate of mortality in patients suffering from bleed ing duodenal ulcers . Drug therapy has so far proved ineffective. The usual treatment is by blood transfusion and surgery, but surgical mortality is relatively high. A proposal for endoscopic laser treatment of duodenal ulcers has been made, but its effectiveness has not yet been demonstrated beyond dispute. The present invention is aimed at mitigating these problems.
According to the present invention, there is provided apparatus for arresting the bleeding of a duodenal ulcer by the application of physical pressure to the ulcer from within the duodenum, the apparatus comprising an inflatable balloon, means to mount the balloon on the distal end of an endoscope whereby the balloon may be conveyed in a deflated condition to the duodenum by the endoscope during visual inspection of the ulcer, an inflation and traction line communicating with the interior of the balloon and for connection externally of the patient to a source of inflation fluid and to a gripping device to maintain the line in tension.
It is contemplated that use of the device could avoid the need for surgery but, even if surgery is necessary, proper use of the device in the period before surgery should considerably reduce the quantity of blood which it is necessary to transfuse into the patient, or avoid the need for blood transfusion altogether. Surgery is more likely to be successful when performed on patients who have not needed large blood transfusions than on patients treated as at present, for which transfusions of many pints of blood are often essential.
The attached drawing illustrates, by way of example, a preferred embodiment of the invention.
Figure 1 is a schematic vertical section through the stomach 10 and duodenum 11 of a patient. On the wall of the duodenum 11 is an ulcer 12. The ulcer 12 is being inspected by an endoscope 13 which extends from the mouth of the patient (not shown) through the stomach 10 and pyloric sphincter 14 to the duodenum 11. (It is normal practice to perform an endoscopic inspection on duodenal ulcers as a preliminary to surgery.) For clarity, the device according to the invention is not shown in Figure 1.
Figure 2 shows the distal end 15 of the endoscope 13, with the usual optical elements 16, which need not be described herein. Gripping the cylindrical surface of the endoscope tube 13 is a rubber band 17 which serves, in a manner described below, as a back-stop collar to the balloon of the present invention.
The balloon device 18 is in the form of a sleeve which slides over the distal end 15 of the endoscope tube 13, to be arrested and held in position at the distal end 15 by the collar 17. The sleeve 18 is made up of a relatively stiff rubber tube 19 which is flexible but, at the same time, not easily collapsible. This combination of properties is achieved by embedding within the tube a helical wire reinforcement coil. The tube 19 carries an annular latex or silicone rubber balloon 20. The tube 19 and collar 17 together constitute means for mounting the balloon 20 on the endoscope 13. Communicating with the interior of the balloon 20 is a tough rubber inflation and traction line 21 which is of small diameter and thin wall thickness and runs (not shown) the full length of the endoscope tube 13 so that it can be manipulated outside the mouth of the patient. The balloon 20 is shown in Figure 2 in its deflated condition, and with exaggerated transverse dimensions. In practice, the balloon device 18 and collar 17 add little to the cross sectional area of the endoscope, so that penetration through the sphincter 14 is not a problem.
In use of the device, the collar 17, and then the balloon device 18, is slid onto the distal end 15 of the tube 13. The endoscope is then introduced into the duodenum, in conventional manner, with the inflation and traction line 21 available for manipulation at the mouth of the patient. The ulcer 12 is inspected, in the conventional way.
At this point, the endoscope tube 13 is manipulated further, in order to bring the balloon device 18 into what is considered to be the optimum position for inflation, for the application of physical pressure to the ulcer 12. When the balloon is in the desired position, inflation fluid is delivered to it along the inflation line 21 and, when the balloon 18 is inflated, the endoscope is withdrawn. The inflation and traction line 21 is gripped at or close to the mouth of the Patient, so that it is in sufficient tension to prevent the balloon 18 from moving downwardly away from the site of the ulcer 12.
One convenient way of doing this is shown in Figure 3. A hollow sphere 30 of resilient material about 7cm in diameter has a diametral slit 31 extending half way across the sphere. The sphere is of thin, tough and resilient rubber, so it grips the inflation line securely in the slit and seals tht line. The sphere as a whole is, however, soft and deformatle enough to lie pressed to the mouth of the patient with the ball surface against the patient's cheek, to keep the inflation line in tension.
upward movement of the balloon is prevented by the action of the sphincter 14. Gastro-intestinal continuity is provided through the cylindrical bore at the centre of the balloon device 15, where the endoscope tube 13 was previously.
The pressure which the balloon 16 applies to the ulcer 13 may be sufficient to arrest bleeding and avoid the need for surgery. Even if surgery is necessary, the pressure on the ulcer in the period prior to surgery will arrest or substantially reduce bleeding during this period, so that the patient is kept in better condition to survive surgery.
For removal of the balloon device 18, the inflation gas is allowed to exit along the line 21, so that the balloon may deflate fully and be drawn upwardly tnrough the sphincter 14 and stomach 10. Other embodiments are contemplated. In particular, the cylindrical bore which maintains gastrointestinal continuity may not be absolutely essential but it is desirable since obstruction of the duodenum is likely to produce hyper-secretion.
The technique of applying physical pressure to stop bleeding may be considered as a tamponade. The inflation and traction line is likely to have a length of around 70 to 80 cms. Because of their relatively small cross-sectional dimension, paediatric endoscopes may find special application for use with the present invention.
The fluid used for inflation may be liquid or gas. Liquid affords easier measurement of the size of the inflated balloon, because it is incompressible. Gas, however, has the advantage that the fluid pressure within the balloon is more easily monitored.

Claims

Claims :
1. Apparatus for arresting the bleeding of a duodenal ulcer (12) by the application of physical pressure to the ulcer from within the duodenum, the apparatus comprising an inflatable balloon (20), means (17,19) to mount the balloon on the distal end (15) of an endoscope (13) whereby the balloon may be conveyed in a deflated condition to the duodenum by the endoscope during visual inspection of the ulcer, and an inflation and traction line (21) communicating with the interior of the balloon and for connection externally of the patient to a source of inflation fluid and to a gripping device (30,31) to maintain the line in tension.
2. Apparatus as claimed in claim 1 wherein the mounting means comprises a back-step cellar (17) for fitting to the outside surface of the distal end (15) of the endoscope (13), and a sleeve (19) which carries the balllon (20) and slides over the said outside surface until its sliding movement is arrested by contact with the collar.
3. Apparatus as claimed in claim 2 wherein the cellar is a rubber band.
4. Apparatus as claimed in claim 2 or 3 wherein the sleeve comprises a flexible rubber tube
5. Apparatus as claimed in claim 4 wherein the rubber tube has embedded within it a helical wire reinforcement coil which prevents callapse of the tube.
6. Apparatus as claimed in any one of the preceding claims wherein the balloon (20) is annular, having a bore (19) into which the distal end (15) of the endoscope extends and which allows gastro- intestinal continuity after wi thdrawal of the endoscope.
7. Apparatus as claimed in any one of the preceding claims wherein the inflation and traction line (12) has a length of from 70 to 80 cms.
8. Apparatus as claimed in any one of the preceding claims with dimensions which permit it to be mounted on a paediatric endoscope (13).
9. A method of arresting the bleeding of a duodenal ulcer comprising the steps of: a) providing on the distal end of an endoscope a deflated balloon having an inflation and traction line; b) using the endoscope, positioning the balloon in the duodenum and inflating it using the inflation line; c) placing the inflation line in traction tc cause the ballloon to apply physical pressure to the ulcer; and
(d) gripping the inflation and traction line at the mouth of the patient to maintain the line in tension.
PCT/GB1987/000522 1986-01-16 1987-07-21 Apparatus for arrest of bleeding at a duodenal ulcer WO1989000407A1 (en)

Priority Applications (2)

Application Number Priority Date Filing Date Title
GB8601015A GB2185400B (en) 1986-01-16 1986-01-16 Apparatus for arrest of bleeding at a duodenal ulcer
PCT/GB1987/000522 WO1989000407A1 (en) 1987-07-21 1987-07-21 Apparatus for arrest of bleeding at a duodenal ulcer

Applications Claiming Priority (1)

Application Number Priority Date Filing Date Title
PCT/GB1987/000522 WO1989000407A1 (en) 1987-07-21 1987-07-21 Apparatus for arrest of bleeding at a duodenal ulcer

Publications (1)

Publication Number Publication Date
WO1989000407A1 true WO1989000407A1 (en) 1989-01-26

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Cited By (11)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
FR2651669A1 (en) * 1989-09-13 1991-03-15 Croisy Renaud OBSERVATION AND / OR INTERVENTION CATHETER IN A HUMAN BODY CONDUIT BROUGHT BY AN OPAQUE LIQUID.
WO1993007800A1 (en) * 1991-10-17 1993-04-29 Gyno Medical Holdings Pty. Ltd. A speculum
US5709657A (en) * 1989-06-28 1998-01-20 Zimmon Science Corporation Methods for placement of balloon tamponade devices
US5743852A (en) * 1996-04-15 1998-04-28 Johnson; William T. M. Speculums
US6203520B1 (en) 1995-11-16 2001-03-20 Zimmon Science Corporation Apparatus and method for the treatment of the gastrointestinal tract
NL1030500C2 (en) 2005-11-23 2007-05-24 Univ Delft Tech Device for preventing bleeding in a patient.
US7931693B2 (en) 2004-02-26 2011-04-26 Endosphere, Inc. Method and apparatus for reducing obesity
US8147561B2 (en) 2004-02-26 2012-04-03 Endosphere, Inc. Methods and devices to curb appetite and/or reduce food intake
US8585771B2 (en) 2004-02-26 2013-11-19 Endosphere, Inc. Methods and devices to curb appetite and/or to reduce food intake
US9060835B2 (en) 2006-05-26 2015-06-23 Endosphere, Inc. Conformationally-stabilized intraluminal device for medical applications
US9072861B2 (en) 2004-11-30 2015-07-07 Endosphere, Inc. Methods and devices for delivering or delaying lipids within a duodenum

Citations (3)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US4367747A (en) * 1980-10-01 1983-01-11 Lothar Witzel Pneumatic dilatator for introdution into the esophagus
WO1986003129A1 (en) * 1984-11-23 1986-06-05 Tassilo Bonzel Dilatation catheter
GB2185400A (en) * 1986-01-16 1987-07-22 Thomas Vincent Taylor Apparatus for arrest of bleeding at a duodenal ulcer

Patent Citations (3)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US4367747A (en) * 1980-10-01 1983-01-11 Lothar Witzel Pneumatic dilatator for introdution into the esophagus
WO1986003129A1 (en) * 1984-11-23 1986-06-05 Tassilo Bonzel Dilatation catheter
GB2185400A (en) * 1986-01-16 1987-07-22 Thomas Vincent Taylor Apparatus for arrest of bleeding at a duodenal ulcer

Cited By (15)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US5709657A (en) * 1989-06-28 1998-01-20 Zimmon Science Corporation Methods for placement of balloon tamponade devices
FR2651669A1 (en) * 1989-09-13 1991-03-15 Croisy Renaud OBSERVATION AND / OR INTERVENTION CATHETER IN A HUMAN BODY CONDUIT BROUGHT BY AN OPAQUE LIQUID.
EP0418147A1 (en) * 1989-09-13 1991-03-20 Renaud Croisy Diagnostic and/or surgical catheter for use in a vessel in the human body through which an opaque liquid is flowing
WO1993007800A1 (en) * 1991-10-17 1993-04-29 Gyno Medical Holdings Pty. Ltd. A speculum
US6203520B1 (en) 1995-11-16 2001-03-20 Zimmon Science Corporation Apparatus and method for the treatment of the gastrointestinal tract
US5743852A (en) * 1996-04-15 1998-04-28 Johnson; William T. M. Speculums
US8585771B2 (en) 2004-02-26 2013-11-19 Endosphere, Inc. Methods and devices to curb appetite and/or to reduce food intake
US7931693B2 (en) 2004-02-26 2011-04-26 Endosphere, Inc. Method and apparatus for reducing obesity
US8147561B2 (en) 2004-02-26 2012-04-03 Endosphere, Inc. Methods and devices to curb appetite and/or reduce food intake
US8603186B2 (en) 2004-02-26 2013-12-10 Endosphere, Inc. Methods and devices to curb appetite and/or reduce food intake
US8623095B2 (en) 2004-02-26 2014-01-07 Endosphere, Inc. Method and apparatus for reducing obesity
US9352126B2 (en) 2004-02-26 2016-05-31 Endosphere, Inc. Methods and devices to curb appetite and/or reduce food intake
US9072861B2 (en) 2004-11-30 2015-07-07 Endosphere, Inc. Methods and devices for delivering or delaying lipids within a duodenum
NL1030500C2 (en) 2005-11-23 2007-05-24 Univ Delft Tech Device for preventing bleeding in a patient.
US9060835B2 (en) 2006-05-26 2015-06-23 Endosphere, Inc. Conformationally-stabilized intraluminal device for medical applications

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