EP2037863B1 - Gastrostomy tube, production methods thereof and insertion tool - Google Patents

Abstract

The invention relates to a gastrostomy tube, to the production methods thereof and to an insertion tool. The distal end (2) of the tube (1) is provided with a bulb (10) formed by parallel strips (6) which are provided in an area of the wall of the tube at a distance from the tip (2) at the distal end, said strips being separated by slits (4) in the wall, but being joined at each end (6a, 6b) to the tube wall. The strips curve outwards to form the bulb with the tip of the tube retracted inside the bulb, such that said tip must be pushed back out of the bulb in order to for the strips to be stretched, thereby eliminating the bulb and enabling the tube to be pulled through the stoma. The invention is suitable for use in gastrostomy.

Description

The invention relates to a gastrostomy tube according to claim 1 which has at its distal end a deformable bulb between a so-called stable configuration where the bulb is too wide to pass through a passage ("stoma") formed through the skin and the gastric wall and a so-called retaining configuration, caused by the action of appropriate solicitation, where the bulb is sufficiently reduced to pass in said passage, the bulb elastically resuming its stable configuration when the solicitation is removed, as well as a gastrostomy tube placement instrument.

The publication EP 0742708 discloses an embodiment in which the distal end of the tube is open and has been expanded and curved to form a hollow retaining bulb around the end of the tube, this end remaining protruding forward of the bulb.

The publication WO 95/18640 (= US 5,356,391 ) discloses an embodiment in which the distal end of the tube is open and has been expanded and bent to form a retaining bulb at the end of the tube, this end remaining projecting in front of the bulb.

In both cases, the material of the bulb is chosen so that the bulb is elastically deformable from one configuration to another under the effect of an action exerted on the bulb from the outside of the skin.

In fact, in the aforementioned examples, this deformation can be caused by a pull on the tube.

It may happen that this traction is exerted by the patient inappropriately.

The present invention aims to avoid such an accident.

It is achieved according to the invention with a gastrostomy tube which has at its distal end a bulb adapted to retain the tube in the gastric cavity and adapted to be elastically reduced on demand to allow the introduction or extraction of the tube by the stoma, characterized in that the bulb is constituted by wall lamellae formed in an area of the wall of the tube remote from the end of the distal end, these lamellae being separated by slots in the wall of the tube but remaining attached to this wall at each end of the lamella, in that the lamellae have been curved outwards to form the bulb, and in that the end of the distal end of the tube is recessed in the bulb, so that it is necessary to push this end out of the bulb so that the slats are stretched and return to their original positions, which eliminates the bulb and allows to introduce or remove the tube by the stoma.

It has been proposed in US 5,112,310 a tube of similar appearance, which has the disadvantage of leaving the distal end of the apparent tube outside the bulb.

To push the end of the tube according to the invention is used a mandrel that is introduced on demand in the tube.

It has been proposed US 5,248,302 ) to use a mandrel to push the head of a retaining piece attached to the end of a gastrostomy tube to lengthen the piece to allow it to pass into the stoma, but the shape of the piece of restraint did not prohibit the same result being achieved by the effect of a pull exerted by the tube.

• la figure 1 est un schéma longitudinal d'un exemple de réalisation d'un tube de gastrostomie conforme à l'invention, au cours d'une phase préparatoire à la formation d'un bulbe à une extrémité du tube ;
• la figure 1 bis est une coupe axiale du tube de la figure 1 ;
• la figure 2 est un schéma analogue au cours de la formation du bulbe ;
• la figure 2 bis est une coupe horizontale du bulbe ;
• la figure 3 est une vue de bout du bulbe formé ;
• la figure 4 représente des schémas du bulbe en coupe verticale au cours de différentes phases d'une traction exercée sur le tube ;
• la figure 5 représente des schémas du tube au cours d'une opération d'introduction du tube dans le stoma ;
• la figure 6 représente des schémas du tube au cours d'une opération d'extraction du tube hors du stoma ;
• les figures 7a et 7b sont des vues de face et profil d'un instrument de pose d'un tube de gastrostomie selon l'invention, l'instrument ne présentant pas de manchon ;
• les figures 8a et 8b sont une vue partielle de profil de l'extrémité distale de l'instrument de pose d'un tube de gastrostomie des figures 7a et 7b montrant le montage du manchon ; et
• les figures 9a à 9f sont des vues tridimentionnelles des différentes étapes d'utilisation de l'instrument de pose d'un tube de gastrostomie des figures 7a à 8b avec un tube de gastrostomie selon l'invention.

An embodiment of a gastrostomy tube according to the invention will be described below, with reference to the figures of the attached drawing in which:

• the figure 1 is a longitudinal diagram of an exemplary embodiment of a gastrostomy tube according to the invention, during a preparatory phase for the formation of a bulb at one end of the tube;
• the figure 1 bis is an axial section of the tube of the figure 1 ;
• the figure 2 is a similar pattern during the formation of the bulb;
• the figure 2 bis is a horizontal section of the bulb;
• the figure 3 is an end view of the bulb formed;
• the figure 4 represents diagrams of the bulb in vertical section during different phases of a pull on the tube;
• the figure 5 represents schemas of the tube during an operation of introduction of the tube into the stoma;
• the figure 6 represents schemas of the tube during an extraction operation of the tube out of the stoma;
• the Figures 7a and 7b are front views and profile of an instrument for fitting a gastrostomy tube according to the invention, the instrument having no sleeve;
• the Figures 8a and 8b are a partial profile view of the distal end of the instrument for fitting a gastrostomy tube Figures 7a and 7b showing the fitting of the sleeve; and
• the Figures 9a to 9f are three-dimensional views of the different stages of use of the instrument for placing a gastrostomy tube Figures 7a to 8b with a gastrostomy tube according to the invention.

The gastrostomy tube shown in the figures is a rectilinear cylindrical tube (1) which has at its distal end a closed end (2). In this example, the end is completely closed but, in variants, it could include orifices provided that they do not compromise the possibility of pushing the end by means of a mandrel introduced by the other end (3). (open) of the tube.

According to the invention, slots (4), ( figure 1 ), have been made in a zone (5) of the wall of the tube, at a distance, but preferably not far from the closed end (2), so as to determine in the wall of the tube wall lamellae, each lamella (6) being determined by two successive slits and remaining adjacent to the tube at each end (6a, 6b) of the slat.

The slots (4) can be directed parallel to the axis of the tube, which is the simplest case, or be oblique with respect to this axis.

The slots can be made by cutting or molding.

The closed end (2) of the tube is then pushed axially towards the open end (3) of the tube, which forces the slats (6) to bend outwardly of the tube forming a bulb (10) to inside which is the closed end (2) which has been pushed back ( figures 2 and 3 ).

During this crash, the tip of the tube turned on itself so that the slats that constitute the bulb have undergone some twisting.

To freeze the bulb in its shape, the end of the tube is heated.

The ready-to-use tube therefore has the bulb at its closed end. To introduce the tube by a stoma (9) into the gastric cavity (7), it is stretched by means of a mandrel (8) introduced into the tube to push the closed end (2) and return the lamellae in the wall of the tube ( Figure 5A ).

The mandrel is then removed ( Figure 5B ) and the bulb elastically resumes its initial configuration ( Figure 5C ).

We will notice on the Figure 5C that each slat (6) before being connected to the tube near the closed end (2) has an inflection (10) which constitutes a pre-bend opposite the elongation so that a force exerted on the tube ( figure 4 ) would cause the bulb to contract without being sufficiently reduced to allow extraction of the tube by the stoma.

For this extraction to be possible, a mandrel must be reintroduced into the tube to push the closed end and lengthen the tube until the bulb is removed ( figure 6 ).

On the Figures 4 to 5 , the tube has been shown in a simplified manner, especially with regard to its open end (3) which will remain outside the skin in a manner known per se.

The number of lamellae (6) which are like the petals of the bulb is chosen on demand and it is for example four.
The invention is not limited to the embodiment which has been described.

Preferably, a polyurethane tube or the like is used.

Polyurethane is a thermoplastic material that is injected into a mold or extruded at temperatures of 170 to 200 ° C. It can also be formed hot in an oven at 150 ° C.

In the stomach and at room temperature, it keeps its shape and is elastic. When it is deformed, it resumes its form at the end of the effort.

The polyurethane material is best suited for this use, because of its resistance to gastric juices, bacteria (candida albicans), its biocompatibility, its elasticity.

With reference to Figures 7a to 8b , we will describe an instrument for fitting (100) a gastrostomy tube according to the invention.

The laying instrument (100) comprises a body (110) and a mandrel (8).

The mandrel (8) has a shaft (122) extending along a longitudinal axis X of the delivery instrument (100), a distal end (123) and a proximal end bent at about 90 ° including a sleeve (121). .

The body (110) is of cylindrical shape which can be of revolution about the longitudinal axis X. It comprises at a proximal end a handle (115). Further, at a distal end (130), the body (110) has a thread (133) extending along a length in the direction of the longitudinal axis X, and two flats (134) which are diametrically opposed to each other according to the longitudinal axis X. In addition, the distal end (130) of the body (110) comprises a groove (131) circumferential and oriented substantially perpendicular to the axis X, which is adapted to receive a circlip (132). The thread (133) extends approximately distally from the groove (131) to a proximally abutment (135) forming a stop. Between the handle (115) and the thread (133), the body (110) has a slot (112) substantially perpendicular to the longitudinal axis X and extending about 90 ° along a circumference of the body (110), and a series of slots (111) inclined relative to the longitudinal axis X and substantially parallel to each other. This series of slots (111), like the slot (112), extend over substantially 90 ° along a circumference of the body (110). In addition, the body (110) has a longitudinal slot (113) substantially parallel to the longitudinal axis X, along a generatrix of the body (110) which connects the ends located on the same side of the slots (112) and (111). On the other hand, the body (110) has an X-axis longitudinal hole extending from the distal end (130) to at least the slot (112).

When mounting the delivery instrument (100), the distal end (123) of the mandrel shank (122) is inserted into the longitudinal X-axis hole through the slot (113). of the body (110). The shank (122) is threaded into this X-axis longitudinal hole until the angled proximal end of the mandrel (8) can be inserted into the slot (112) of the body (110). A nut (141) is screwed onto the distal end (130) to engage the threads (133) of the body (110). Then, the circlip (132) is mounted in the groove (131) of the distal end (130) of the body (110). This circlip (132) serves as a stop to the nut (141), when the latter is screwed or unscrewed towards the distal end of the body (110). A sleeve (142) is fitted onto the nut (141) to provide an assembly (140). In an alternative embodiment, the sleeve (142) is screwed onto the nut (141) or welded or glued. The sleeve (142) has at a distal end (144) two bayonets (145) diametrically opposite one another along the longitudinal axis X of the laying instrument (100).

With reference to Figures 9a to 9f , we will describe the use of the laying instrument (100).

Prior to the use of the delivery instrument (100), the gastrostomy tube (1) according to the invention is equipped with a base (20) having mounting means (23) on the gastrostomy tube (1). ) located on a lower face of the base (20). On an upper face of the base (20), the latter has an opening (21) on the periphery of which are located, diametrically opposed to the longitudinal axis X, notches (24), here at the number of two. Finally, the base (20) has a plug (22) adapted to come into the orifice (21) to close the gastrostomy tube sealingly. Further information concerning the base (20) and its mounting on the gastrostomy tube (1) are contained in the French patent application no. FR 0606140 , to which it is possible to refer.

Firstly, the assembly (140) formed of the sleeve (142) and the nut (141) is screwed onto the body (110) of the laying instrument (100) towards a distal end until the nut (141) comes into abutment against the circlip (132). The proximal end bent of the mandrel (8) is placed in the slot (112) of the body (110) of the delivery instrument (100), the distal end (123) of the mandrel (8) protruding from the distal end of the sleeve (142). ). Then, the distal end (123) of the mandrel (8) is introduced into the gastrostomy tube (1) through the orifice (21) of the base (20) along the longitudinal axis X in the direction of the F1 arrow. A movement along the arrow F1 is performed until the distal end (144) of the sleeve (142) is introduced into the orifice (21) of the base (20), the bayonets (145) passing through the notches (24). The sleeve (140) is then locked in the base (20) during a rotational movement T1 about the axis X in order to make the base (20) and the laying instrument (100) integral with a bayonet assembly, as illustrated in figure 9b .

Then, in a rotational movement T2, the bent proximal end of the mandrel (8) is extracted from the slot (112) to the longitudinal slot (113). Therefore, the mandrel (8) can slide in a movement F2 while the bent proximal end moves within the longitudinal slot (113). The movement F2 is carried out lightly until the distal end (123) of the mandrel (8) comes into contact with the closed end (2) of the gastrostomy tube (1), the bulb (10) of the tube gastrostomy (1) is then formed at rest. Once the distal end (123) of the mandrel (8) bears in contact with the closed end (2), the bent proximal end of the mandrel (8) is then inserted into one of the slots (111) which are then facing, in a rotational movement T3. Therefore, the body (110) is rotated along T4 which has the effect of screwing the body (110) into the assembly (140) by engagement of the nut (142) of the assembly (140) on the thread (133) of the distal end (130) of the body (110) of the delivery instrument (100) . This screwing movement takes place over a predetermined and limited distance (d). Once the distance (d) has been traveled, the nut (142) of the assembly (140) then abuts at a proximal end of the thread (133) on the flange (135), as illustrated in FIG. figure 9f . During this screwing movement, the distal end (123) of the mandrel (8) pushes the closed end (2) of the gastrostomy tube (1) out of the bulb (10) until the latter disappears. the blades forming the bulb (10) being completely stretched, the distance (d) traveled. As a result, the gastrostomy tube (1) can be either removed from the patient or introduced into the patient through the stoma.

The laying instrument (100) which has just been described and its use avoids having to push the mandrel manually and directly to stretch the lamellae forming the bulb and thus avoid the risk of perforating the wall opposite of the stomach if the mandrel passes through or escapes from the closed end of the gastrostomy tube. In addition, thanks to the series of slots (111), the laying instrument (100) is adjustable according to the length of the gastrostomy tube with which it is intended to cooperate and this laying instrument then allows a thrust stroke always identical, necessary for stretching the lamellae forming the bulb. The controlled realization of this race assures the user that the gastrostomy tube is ready to be placed or removed. This is especially important when removing the gastrostomy tube because the user do not see the state of deformation of the bulb in the stomach before removal. Therefore, the laying instrument (100) according to the invention allows manipulation with optimum safety of a gastrostomy tube according to the invention.

The invention is not limited either to the embodiment which has been described or to the material which has been recommended.

Claims (11)

1. Gastrostomy tube (1) which at its distal end has a bulb (10) designed to retain the tube in the gastric cavity (7) and suitable for elastic reduction on demand to allow the introduction or extraction of the tube through the stoma, the bulb (10) consisting of strips (6) in an area of the tube wall located at a distance from the end (2) of the distal end, such strips being separated by slits (4) in the wall but remaining adjacent to the wall of the tube at either end (6a, 6b) of the strip, the strips having being curved outwardly to form the bulb (10), characterized in that end (2) of the tube is withdrawn into the bulb so that it is necessary to push the end of the tube out of the bulb for the strips to be extended, thus eliminating the bulb and allowing the tube to be inserted or withdrawn via the stoma.
2. A tube according to claim 1 wherein strips (6) forming the bulb are twisted.
3. A tube according to claim 1 or 2 wherein each strip (6), before being connected to the tube near end (2) of the distal end has an inflection (10) forming a preliminary curve opposing the extension so that any force applied to the tube (figure 4) causes the bulb to contract without being able to be reduced sufficiently to allow the extraction of the tube through the stoma.
4. A tube according to one of claims 1 to 3 whose slits (4) in the tube wall are parallel to the tube wall.
5. A tube according to one of claims 1 to 4 whose said end (2) is closed.
6. A tube according to one of claims 1 to 5 the material of which is polyurethane or similar.
7. A process for manufacturing a tube according to one of claims 1 to 6, comprising operations consisting in splitting a closed tube at one end to form in the wall of the tube said wall strips, crushing the closed end of the tube to push the strips outward and form the bulb and heating the tube to stabilise the bulb.
8. A process of manufacturing a tube according to one of claims 1 to 6 wherein the tube is moulded by the injection of polyurethane plastic or similar material into a mould forming the tube, its closed end and said slits, then crushing the end of the tube to form the bulb and heating the tube to stabilise the bulb.
9. Insertion tool (100) for a gastrostomy tube (1) according to one of claims 1 to 6 incorporating a mandrel (8) of which a distal end (123) is designed to come to bear against end (2) of gastrostomy tube (1) characterized wherein it includes means (111, 133 and 140) for gradually driving the mandrel (8) over a limited predetermined distance (d) so that, during implementation, distal end (123) pushes end (2) of tube (1) out of bulb (10) so that strips (6) are drawn out.
10. Insertion tool according to claim 9 characterized in that the driving means include a nut (142) meshing with threads (133) and capable of screwing in/out solely along distance (d).
11. Insertion tool according to one of claims 9 to 10 characterized in that, the mandrel having a bent proximal end, the driving means comprise a series of slits (111) capable of receiving the bent proximal end.

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