GB2185400A

GB2185400A - Apparatus for arrest of bleeding at a duodenal ulcer

Info

Publication number: GB2185400A
Application number: GB08601015A
Authority: GB
Inventors: Thomas Vincent Taylor
Original assignee: Individual
Current assignee: Individual
Priority date: 1986-01-16
Filing date: 1986-01-16
Publication date: 1987-07-22
Also published as: GB8601015D0; GB2185400B

Abstract

Bleeding from a duodenal ulcer is arrested by a tamponade technique in which a balloon 20 is introduced uninflated into the duodenum 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. The endoscope 13 is withdrawn and gastro- intestinal continuity can be maintained through the bore of the sleeve 19 on which the balloon 20 can be carried. <IMAGE>

Description

SPECIFICATION Apparatus for arrest of bleeding at a duodenal ulcer There is still a high rate of mortality in patients suffering from bleeding 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.

Fig. 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 Fig. 1.

Fig. 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 Fig. 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. 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 18, where the endoscope tube 13 was previously.

The pressure which the balloon 18 applies to the ulcer 12 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 through the sphincter 14 and stomach 10.

Other embodiments are contemplated. In particular, the cylindrical bore which maintains gastro-intestinal 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

1. 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, and 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.

2. Apparatus as claimed in claim 1 wherein the mounting means comprises a back-stop collar for fitting to the outside surface of the distal end of the endoscope, and a sleeve which carries the balloon and slides over the said outside surface uptil its sliding movement is arrested by contact with the collar.

3. Apparatus as claimed in claim 2 wherein the collar 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 is annular, having a bore into which the distal end of the endoscope extends and which allows gastro-intestinal continuity after withdrawal of the endoscope.

7. Apparatus as claimed in any one of the preceding claims wherein the inflation and traction line 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.