GB1581068A - Permanent oesophagel intubation - Google Patents

Description

(54) PERMANENT OESGPHAGEAL IN TUBATION (71) I, NICHOLAS LEONIDAS LEKACOS, of Greek Nationality, of Nireos 10, Pal.

Phaliron, Athens, Greece, do hereby declare the invention, for which I pray that a patent may be granted to me, and the method by which it is to be performed, to be particularly described in and by the following statement: - This invention relates to permanent oesophageal intubation, which has been accepted as a satisfactory method of palliative treatment in cases of malignant oesophageal obstruction. An important step in this method is to anchor the oesophageal tube in a stable position. This is usually achieved by transfixion sutures merely through the tube and gastric wall; through the tube, gastric wall and diaphragmatic crura; or through the tube, gastric wall and abdominal wall.

All the above techniques have disadvantages and may cause serious complications.

Unsuccessful surgical fixation or rejection of the fixation sutures may cause the oesophageal tube to move in a retrograde way and in some cases airway obstruction may result.

Erosion of the gastric wall and severe bleeding may occur due to pressure of the tip of the oesophageal tube against the gastric wall or by the tearing effect of the transfixion sutures.

The present invention provides a device for securing in position an oesophageal tube, in the form of a funnel-like gastric tube having an upper narrower part adapted to receive and retain a lower end of the oesophageal tube and a lower wider part adapted to open into the stomach and abut with the stomach wall so as to prevent proximal rejection of the oesophageal tube.

The narrower part of the gastric tube may be formed with internal screw-threads to engage with corresponding external screw-threads formed on the lower end of the oesophageal tube. Instead of or in combination with the screw threads, securing together of the two tubes may be carried out by a glue, elastic adhesive tape, sutures, or other suitable means, or by a combination of such means.

By use of such a gastric tube, the oesophageal tube may be secured in position in the oesophagus without the necessity for transfixion sutures with their inherent disadvantages.

Another disadvantage of the known methods of permanent oesophageal intubation is the possibility of oesophagitis due to gastro-oesophageal reflux. To minimize this possibility a pyloroplasty is normally recommended as an additional procedure.

According to a further preferred feature of the invention, the gastric tube incorporates in its lower wide part a valve adapted to prevent gastric oesophageal reflux.

The valve may be gravity-operated, so that when the patient is erect the valve is open, and when the patient is recumbent, the valve is closed. For this purpose, the valve may be adapted to close, for example, when the oesophageal tube is inclined at 45" or more to the vertical.

The invention also provides a combination comprising an oesophageal tube and a gastric tube as described above. The oesophageal tube is preferably a tube of the kind known as a Celestin tube or Mousseau Barbin tube, and is formed with external screw threads at its lower end for engagement with the upper part of the gastric tube.

Celestin and Mousseau-Barbin tubes are described in detail in Shackleford's Surgery of the Alimentary Tract, published by Saunders, Philadelphia, 2nd ed., pp. 742749.

The invention will now be more particularly described by way of example only with reference to the accompanying drawings in which: - Figure 1 shows an oesophageal tube secured by a gastric tube in position in a patient; Figure 2 is a fragmentary view of the oesophageal and gastric tubes in separated condition; Figure 3 is a sectional view of the gastric tube showing one form of valve in open configuration; Figure 4 is a sectional view of the gastric tube showing another form of valve in open configuration; Figure 5 is an underneath view of the tube of Figure 4 with the valve closed; Figure 6 is a sectional view of the gastric tube showing a third form of valve in open configuration; Figure 7 is a sectional view of the gastric tube showing a fourth form of valve in open configuration; and Figure 8 is a sectional view of the gastric tube showing a fifth form of valve in open configuration.

The oesophageal tube 1 shown in Figures 1 and 2 differs only from the known Celestin tube in that the outer surface of its lower end has spiral grooves or threads 2 enabling it to be screwed into the upper part 3 of the gastric tube 4. The tube 1 may have a length of about 25cm and a diameter of 15mm. Its upper end 5 widens to an elliptical section with diameters of 18 and 22mm.

The gastric tube 4 is a shorter tube of 8 to 10cm in length. Its upper part 3 is grooved or screw threaded on its internal surface so that it can engage with the threaded end 2 of the oesophageal tube.

The lower part 6 of the gastric tube has a funnel-like expansion which encloses a valve apparatus. The connection of the two tubes is stabilized by the use of a glue and possibly by an elastic adhesive tape.

All items must be made of materials resistant to the action of gastric juice. If the above method of connection proves to be unsatisfactory an alternative method could be devised.

The valve apparatus is designed in such a way so as to allow the free entry of the bolus into the stomach and to prevent gastro-oesophageal reflux. The above process could be arranged to start at a tilt of approximately 45 degrees. The valve mechanism should be simple and operated by the force of gravity.

One form of valve is shown in Figure 3, and comprises a disc 7 supported on a spring 8 carried by a cage 9 attached to the gastric tube 4. When the device is sufficiently inclined, the spring 8 will press the disc 7 against the neck of the tube 4 and effect closure.

Another form of valve is shown in Figures 4 and 5, and comprises three equal sectors 10 each carrying at their inner apex a bias weight 11 serving to hold the sectors in an open configuration when the tube 4 is upright. When the tube is inclined, the sectors may be returned to a closed con figuration under the influence of their own resilience, or of additional means such as leaf springs.

The form of valve shown in Figure 6 comprises a cage 12 having a ferromagnetic ring 13 at its upper end adjacent the mouth of the tube. A ball 14 consisting of a ferromagnetic nucleus surrounded by a plastics material is held within the cage, so that it can move between the open position shown and an upper position where it is received in the ring 13 to close the neck of the tube 4. Either the ring 13 or the nucleus of the ball 14 is magnetised so that there is a magnetic attraction between the ring 13 and the ball 14. The weight of the ball and the magnetic attraction between it and the ring 13 are calculated so that when the tube is in the upright position as shown, the weight of the ball will cause it to drop to the lower position shown.When inclined at 45 , the magnetic attraction should become stronger than the component of the weight acting directly downwards, so that the ball will be pulled up by the magnetic force to close the neck of the tube. This type of valve has the advantage of being easily identified by means of X-rays, and if badly positioned, it can be readjusted to its proper position by exterior magnetic forces.

The valve shown in Figure 7 has a flap 15 articulated at 16 at the end of the tube so as to obstruct the tube when the tube is in a horizontal position, but to leave the passage open when the tube is in the upright position. In the upright position, the flap 15 is held open by gravity.

The valve shown in Figure 8 consists of a tube 17 of soft plastics cloth. The material should be resistant to liquids likely to be encountered in the gastric regions.

The tube 17 has a metal ring 18 at its bottom edge, and when the gastric tube 4 is upright, the ring 18 will cause the tube to be extended as shown. When the tube 4 is horizontal, the soft cloth will kink, to prevent regurgitation of liquids on a large scale.

The funnel-like expansion of the gastric tube with a diameter of 10-llcm and a length of 3Xcm, for example, has a dual purpose: to protect the valve and to prevent the proximal rejection of the two-tubes system. This is achieved because the external diameter of the funnel-like expansion exceeds sufficietly the diameter of the cardia (greatest external diameter 6-7cm). To prevent trauma, the funnel-like expansion is made in such a way that its wall is resiliently deformable, especially at its lower open end part.

The technique of positioning the tube is as follows: For the oesophageal intubation the known "pull through" technique is used.

After the oesophageal tube has been passed down in the right position, its gastric tip is cut to exceed the cardia by only a few centimetres (approximately 3~4cam). This tip is then steadily held by the assistant by means of a swab wet with ether, and the surgeon screws onto it the gastric tube after having placed a quantity of glue into the internal surface of the gastric tube. Finally the connec tion of the tubes is further reinforced by the elastic adhesive tape. The operation is finished by the closure of the gas trotomy and routine closure of the abdominal wall.

In contrast to known techniques, it is not necessary using the present invention to anchor the tube by fixation sutures, thus avoiding the complications of tissue tearing and pulling, resulting from these sutures.

The proximal rejection of the tube is also prevented by the funnel-like expansion of the gastric tube.

The valve in the gastric tube obviates the requirement for a pyloroplasty and for the usual instructions to the patient to sleep in a recumbent position, since the valve prevents gastro-oesophageal reflux. With the simple and safe valve the patient can stay in bed in a horizontal position and can receive food in bed while he does not lose the ability of eructation. Thus the patient drinking carbonated beverages can wash out the tubes and the valve from any food debris.

WHAT I CLAIM IS: 1. A gastric tube having a funnel-like shape with an upper narrower part adapted to receive and retain a lower end of an oesophageal tube and a lower wider part adapted to open into the stomach and abut with the stomach wall so as to prevent proximal rejection of the oesophageal tube.

2. A gastric tube as claimed in Claim 1, including a valve in its lower wider part adapted to prevent gastric oesophageal reflux.

3. A gastric tube as claimed in Claim 2, wherein the valve is gravity operated so that when the patient is erect the valve is open and when the patient is recumbent the valve is closed.

4. A gastric tube as claimed in Claim 2 or Claim 3, wherein the valve is adapted to close when the tube is inclined at 450 or mode to the vertical.

5. A combination of an oesophageal tube and a gastric tube, the gastric tube having an upper narrower part for receiving and retaining a lower end of the oesophageal tube, and a lower wider part adapted to open into the stomach and abut with the stomach wall so as to prevent proximal rejection of the oesophageal tube.

6. A combination as claimed in Claim 5, wherein the narrower part of the gastric tube is formed with internal screw threads to engage with corresponding external screw-threads formed on the lower end of the oesophageal tube.

7. A combination as claimed in Claim 5 or Claim 6, wherein the oesophageal tube is a tube of the kind known as a Celestin tube or Mousseau-Barbin tube.

8. A combination as claimed in any one of Claims 5 to 7, wherein the gastric tube incorporates in its lower wider part a valve adapted to prevent gastric oesophageal reflux.

9. A combination as claimed in Claim 8, wherein the valve is gravity operated so that when the patient is erect the valve is open and when the patient is recumbent the valve is closed.

10. A combination as claimed in Claim 8 or Claim 9, wherein the valve is adapted to close when the oesophageal tube is inclined at 45" or more to the vertical.

11. A gastric tube substantially as herein described with reference to the accompanying drawings.

12. A combination of an oesophageal tube and a gastric tube substantially as herein described with reference to Figures 1 and 2 of the accompanying drawings.

**WARNING** end of DESC field may overlap start of CLMS **.

Claims (12)

**WARNING** start of CLMS field may overlap end of DESC **. only a few centimetres (approximately 3~4cam). This tip is then steadily held by the assistant by means of a swab wet with ether, and the surgeon screws onto it the gastric tube after having placed a quantity of glue into the internal surface of the gastric tube. Finally the connec tion of the tubes is further reinforced by the elastic adhesive tape. The operation is finished by the closure of the gas trotomy and routine closure of the abdominal wall. In contrast to known techniques, it is not necessary using the present invention to anchor the tube by fixation sutures, thus avoiding the complications of tissue tearing and pulling, resulting from these sutures. The proximal rejection of the tube is also prevented by the funnel-like expansion of the gastric tube. The valve in the gastric tube obviates the requirement for a pyloroplasty and for the usual instructions to the patient to sleep in a recumbent position, since the valve prevents gastro-oesophageal reflux. With the simple and safe valve the patient can stay in bed in a horizontal position and can receive food in bed while he does not lose the ability of eructation. Thus the patient drinking carbonated beverages can wash out the tubes and the valve from any food debris. WHAT I CLAIM IS:

1. A gastric tube having a funnel-like shape with an upper narrower part adapted to receive and retain a lower end of an oesophageal tube and a lower wider part adapted to open into the stomach and abut with the stomach wall so as to prevent proximal rejection of the oesophageal tube.

2. A gastric tube as claimed in Claim 1, including a valve in its lower wider part adapted to prevent gastric oesophageal reflux.

3. A gastric tube as claimed in Claim 2, wherein the valve is gravity operated so that when the patient is erect the valve is open and when the patient is recumbent the valve is closed.

4. A gastric tube as claimed in Claim 2 or Claim 3, wherein the valve is adapted to close when the tube is inclined at 450 or mode to the vertical.

5. A combination of an oesophageal tube and a gastric tube, the gastric tube having an upper narrower part for receiving and retaining a lower end of the oesophageal tube, and a lower wider part adapted to open into the stomach and abut with the stomach wall so as to prevent proximal rejection of the oesophageal tube.

6. A combination as claimed in Claim 5, wherein the narrower part of the gastric tube is formed with internal screw threads to engage with corresponding external screw-threads formed on the lower end of the oesophageal tube.

7. A combination as claimed in Claim 5 or Claim 6, wherein the oesophageal tube is a tube of the kind known as a Celestin tube or Mousseau-Barbin tube.

8. A combination as claimed in any one of Claims 5 to 7, wherein the gastric tube incorporates in its lower wider part a valve adapted to prevent gastric oesophageal reflux.

9. A combination as claimed in Claim 8, wherein the valve is gravity operated so that when the patient is erect the valve is open and when the patient is recumbent the valve is closed.

10. A combination as claimed in Claim 8 or Claim 9, wherein the valve is adapted to close when the oesophageal tube is inclined at 45" or more to the vertical.

11. A gastric tube substantially as herein described with reference to the accompanying drawings.

12. A combination of an oesophageal tube and a gastric tube substantially as herein described with reference to Figures 1 and 2 of the accompanying drawings.