MXPA06005503A - Improved track for medical devices - Google Patents

Abstract

A medical apparatus and method useful for positioning one or more members within the gastro-intestinal tract is disclosed. The medical apparatus can include a track supported on a sheath sized to receive an endoscope, and a carrier slidable with respe ct to the track. A feeding tube accessory adapted to slidably engage the carrier is disclosed.

Description

IMPROVED SLIDING GUIDE FOR MEDICAL DEVICES CROSS REFERENCE TO RELATED REQUESTS This application claims the priority of the following patent applications, which are incorporated herein by reference: Serial Numbers of E.U.A. 10 / 440,957 (published as US 2004/0230095); 10 / 440,660 (published as US 2004/0230096) and US 10 / 440,956 (published as US 2004/0230097); each filed on May 16, 2003. This application claims the priority of, and incorporates as reference the Patent Application of E.U.A. "Medical Instrument that Has a Guide Wire and an Aggregate Catheter", (Proxy File END-5335USNP5), filed on May 12, 2005 on behalf of Long et al., Which has the Serial Number FIELD OF THE INVENTION The present invention relates generally to medical devices, and more particularly to devices and methods useful in endoscopic procedures.

BACKGROUND OF THE INVENTION Minimally invasive procedures are desirable because such procedures can reduce pain and improve relatively fast recovery times compared to conventional open medical procedures. Many minimally invasive procedures are performed with an endoscope (including, but not limited to, laparoscopes). Such procedures allow a physician to position, manipulate and observe medical instruments and accessories within the patient through a small access opening in the patient's body. Laparoscopy is a term used to describe such an "endo-surgical" procedure, using an endoscope (often a rigid laparoscope). In this type of procedure, accessory devices are often inserted into a patient through trocars placed through the body wall. Even less invasive treatments include those performed through the insertion of an endoscope through a natural body orifice to a treatment site. Examples of this procedure include, but are not limited to, cystoscopy, hysteroscopy, esophagogastroduodenoscopy, and colonoscopy. Many of these procedures employ the use of a flexible endoscope during the procedure. Flexible endoscopes often have a section articulated flexible, steerable, near the distal end, which can be controlled by the user using the controls at the proximal end. Some flexible endoscopes are relatively small (1 mm to 3 mm in diameter), and may not have an integral accessory channel (also called a biopsy channel or work channel). Other flexible endoscopes, including gastroscopes and colonoscopes, have integral working channels that have a diameter of approximately 2.0 to 3.5 mm, for the purpose of introducing and removing medical devices and other accessory devices to perform diagnosis or therapy within the patient. As a result, accessory devices used by a physician, may be limited in size by the diameter of the accessory channel of the instrument to be used. In addition, the doctor can be limited to a single accessory device when using the standard endoscope that has a working channel. Certain specialized endoscopes are available, such as endoscopes with large working channels that have a working channel of 5 mm in diameter, which can be used to pass relatively large fittings, or to provide the ability to suction large blood clots. Other specialized endoscopes include those that have two working channels. One of the disadvantages of such endoscopes with large / multiple diameter working channels may be that such devices can be relatively expensive. In addition, such endoscopes with large / multiple diameter working channels may have a diameter external that makes the endoscope relatively rigid, or otherwise difficult to intubate. Several references describe methods or systems related to an endoscope, such as for example: Patent of E.U.A. 5,025,778, by Silverstein; Patent of E.U.A. 4,947,827, by Opie; US 2002/107530 published on August 8, 2002 in the name of Sauer; Patent of E.U.A. 6,352,503, from Matsui. A disadvantage of known systems is the potential of the distal end of a device used externally of an endoscope to move, which may cause the accessory to lack precision or the ability to be maintained within a desired field of vision of the ability. of image formation of the endoscope. WO 00/48506, published August 24, 2000, in the name of Herrmann, describes a deformable endoscope with at least one supplementary device. The unit comprising the endoscope and the supplementary device has a non-round cross section. Such a non-circular endoscope can be disadvantageous from the point of view of cost, complexity or ease of cleaning / sterilization. For example, a standard endoscope with a smooth, substantially circular cross section may be relatively easy to sterilize and clean. WO 00/48506, published on August 24, 2000, in the name of Kortenbach, describes methods and devices for supplying a medical instrument on the outside of an endoscope to allow the use of instruments too large to fit through the opening of the instrument. endoscope Kortenbach describes a collar for use with an endoscope, elastic straps, a flexible wrap having a reclosable tie line, flexible polymer extrusions and a soft tangential wrap defining an opening having an irregular cross section (collapsible) ). Kortenbach also describes a sliding guide with an inverted T configuration. Endoscopes can also be used with feeding tubes. For example, it is known to advance a feeding tube through an internal channel of an endoscope. It is also known to advance a feeding tube together with an endoscope, holding the distal end of the feeding tube with a pair of forceps extending from a distal end of the endoscope, and "dragging" the feeding tube along the outside of the endoscope while advancing the endoscope to a desired location. Researchers have reported that a conventional traction method of placing a PEG can be supplemented with an outer tube to reduce the risk of peristomal infection. "Efficacy of an Overtube for Reducing the Risk of Peristomal Infection after PEG Placement: a Prospective, Randomized Comparison Study" Iruru Maetani, MD, et al., Gastrointestinal Endoscopy, Volume 61, No. 4, 2005, incorporated herein by reference , describes the use of an outer tube during the placement of a PEG.

Scientists and engineers are still looking for improved devices and methods to introduce medical devices into the gastrointestinal tract, including improved devices and methods for placing feeding tubes in patients.

BRIEF DESCRIPTION OF THE INVENTION The present invention provides methods and devices useful with various medical procedures, including non-exclusively, methods and devices useful with endoscopes, methods and devices employed through natural body orifices, and methods and devices related to the placement of feeding tubes. For example, in one embodiment, the present invention can be used to quickly and consistently place an accessory, such as a feeding tube, in a desired location, such as in the stomach or jejunum, and so that the device remains in the desired position during removal of the endoscope. In certain embodiments, the present invention can be employed to reduce the number of intubations required for certain procedures, such as the number of intubations required to place a feeding tube. In certain embodiments, the present invention may also be employed to reduce the number of steps required in certain medical procedures, such as reducing the steps of oral to nasal transfer in the installation of a feeding tube, reduce the number of times the tools or devices are changed or deployed in the body, reduce the number of hands required to perform a procedure, and / or reduce the number of times the medical professional must change the position of the hand during a process. In one embodiment, the invention provides a sheath sized to receive an endoscope; and a sliding guide placed along the length of the envelope. At least one portion of the sliding guide is formed to have greater flexibility than the other portion. The sliding guide may include a relatively more flexible portion of the sliding guide disposed distally of a relatively less flexible portion of the slide. In one embodiment, the sliding guide comprises at least three regions, wherein each region has a different flexibility from an adjacent region. In certain embodiments, the invention may be employed with respect to procedures involving tubes for Percutaneous Endoscopic Gastrostomy (PEG) and / or a Jejunal Enteral Tube through Percutaneous Endoscopic Gastrostomy Procedures (JET PEG).

BRIEF DESCRIPTION OF THE FIGURES Figure 1 is a schematic illustration of a sheath and an endoscopic guidewire.

Figure 1A is a schematic illustration of an endoscope inserted in a grip having an articulated clip in an open configuration. Figure 1 B is a schematic illustration similar to that of Figure 1A, showing the articulated fastener in a closed position and the feeding tube and the carrier being advanced in a sliding guide. Figure 2 is a schematic illustration of the distal end of the casing of Figure 1, showing a carrier that is advanced in the slide. Figure 2A is a schematic isometric illustration showing the proximal end of the cap. Figure 3 illustrates different sections of a sliding guide placed in a wrapper. Figure 4 is an illustration of a top view of a portion of a slide. Figure 5 is a cross-sectional illustration of a sliding guide supported on a shell (it is understood that the shell may be formed of a thin film that will not maintain the circular configuration shown in Figure 5 in the absence of an inner member, such as an endoscope, being placed inside the envelope). Figure 6 is a schematic illustration of a carrier of the feeding tube according to an embodiment of the present invention.

Figure 7 is a schematic illustration of a distal portion of a sheath and a slide guide showing a carrier being advanced to a distal position in the slideway, and with an indicator tab extending through a slot in a cap to be observed by an endoscope. Figure 8 is a schematic illustration showing the distal end of an endoscope being advanced through a wrap, with the wrap, the slide and the carrier shown in cross section. Figure 9 is a schematic illustration of a distal portion of a sheath, slide and carrier, and illustrating the carrier and feed tube being advanced to a distal position in the slide. Figure 10 is a schematic illustration of a feeding tube having a feature for providing sliding engagement with a sliding guide. Figure 11 is a schematic illustration of the proximal portion of the feature shown in Figure 10. Figure 12 is a schematic illustration of an opening for use to hold the feeding tube in a desired position in the gastrointestinal tract after the feeding tube is placed and the sliding guide has been removed from the Gl tract.

Figure 13 is an illustration of a schematic side view of a distal portion of the feeding tube shown in Figure 10, illustrating a distal portion of a passage (dotted line), through which nutrients can be directed, in a manner that the distal portion of the passage does not have to flex or bend to communicate with a distal feeding opening, with the portion of the feeding tube extending distally from the distal feeding opening that is inclined with respect to the passage, and the figure illustrates weights (in dashed lines), which can be used at a distal end of the feeding tube. Figure 14 is a schematic illustration of a distal portion of a limb that can be used to hold the feeding tube in a desired position during removal of the endoscope and the Gl tract carrier from the patient. Figure 15 is a schematic illustration of the distal end of the member of Figure 14 and showing the contact surfaces positioned, sized and / or formed for contact by coupling the surfaces at the proximal end of a rail feature associated with a feeding tube. Figure 16 is a schematic illustration of the distal portion of the member of Figure 14 positioned with respect to the proximal end of the rail feature in the feed tube.

Figure 17 is an illustration of a schematic bottom view of adjacent portions of the rail feature in the feed tube and the member of Figure 14. Figure 18 illustrates the introduction of an endoscope into a medical device (medical device which may include a handle, sheath, cap and slide) in the Gl tract of a patient, so that the cap and the distal end of the slide guide are placed in the small intestine (such as in the jejunum)

Claims (24)

7 NOVELTY OF THE INVENTION CLAIMS

1. - A medical device, comprising: a casing sized to receive an endoscope; and a sliding guide positioned along the wrapping, wherein at least a portion of the slide is formed to have greater flexibility than another portion of the slide.

2. The apparatus according to claim 1, further characterized in that a relatively more flexible portion of the slide is positioned distally of a relatively less flexible portion of the slide.

3. The apparatus according to claim 1, further characterized in that the sliding guide comprises at least three regions, wherein each screed has a different flexibility from an adjacent region.

4. The apparatus according to claim 1, further characterized in that at least a portion of the slide is interrupted at intervals to reduce the rigidity by curvature.

5. The apparatus according to claim 4, further characterized in that the sliding guide has interruptions in a portion of the sliding guide, which are alternated with respect to interruptions in another portion of the sliding guide.

6. The apparatus according to claim 1, further characterized in that at least one portion of the sliding guide comprises a plurality of slits.

7 - The apparatus according to claim 1, further characterized in that at least a portion of the sliding guide comprises a plurality of alternating slits.

8. The apparatus according to claim 1, further characterized in that at least a portion of the slide comprises a plurality of slits that extend partially, but not completely, across the width of the slide.

9. The apparatus according to claim 1, further characterized in that at least some of the slits extend through a central line of the slide.

10. The apparatus according to claim 1, further characterized in that the sliding guide is formed in such a way that the axial loads directed along the sliding guide result in a flexion of the separated portions of the sliding guide. .

11. The apparatus according to claim 1, further characterized in that the sliding guide is extendable elastically in a direction generally parallel to the longitudinal axis of the envelope.

12. The apparatus according to claim 1, further characterized in that the sliding guide comprises a plurality of laterally extending portions for maintaining the slide in a desired orientation with respect to an endoscope placed within the envelope.

13. A medical device, comprising: a casing dimensioned to receive an endoscope, wherein the casing has substantially no torsional rigidity; and a sliding guide positioned along the casing, wherein the sliding guide is formed to maintain a radial orientation of the sliding guide with respect to an endoscope placed within the casing.

14. The apparatus according to claim 13, further characterized in that the flexibility of curvature of the sliding guide varies along the sliding guide.

15. The apparatus according to claim 12, further characterized in that the axial flexibility of the sliding guide varies along the sliding guide.

16. A medical device, comprising: a casing sized to receive an endoscope, the casing has substantially no torsional rigidity; a cap placed on a distal end of the envelope; and a sliding guide positioned along the wrapping.

17. The medical device according to claim 16, further characterized in that at least one portion of the slide is formed to have greater flexibility than another portion of the slide.

18. The medical device according to claim 16, further characterized in that at least a portion of the sliding guide is configured not to provide a direct axial load path.

19. The medical device according to claim 16, further characterized in that at least a portion of the sliding guide comprises a plurality of slits.

20. The medical device according to claim 16, further characterized in that at least a portion of the slide comprises a plurality of tabs that extend laterally to support the slide on the envelope.

21. A medical device comprising: a sliding guide adapted to be positioned along the outside of an endoscope, wherein at least a portion of the sliding guide is formed to have greater flexibility than another portion of the guide Sliding.

22. - The medical device according to claim 21, further characterized in that the sliding guide has a distal end associated with a cap.

23. The medical device according to claim 21, further characterized in that the sliding guide has a proximal end associated with a handle.

24. The medical device according to claim 21, further characterized in that at least a portion of the sliding guide is interrupted in separate locations. 25.- The medical device in accordance with the claim 21, further characterized in that at least one portion of the sliding guide has a plurality of spaced apart slits. 26.- The medical device in accordance with the claim 21, further characterized in that at least one portion of the slide has a plurality of spaced apart slits, and wherein at least some of the slits extend through the entire thickness of the slide. 27.- The medical device in accordance with the claim 22, further characterized in that at least one portion of the sliding guide has a plurality of spaced apart slits, and wherein at least some of the slits extend at least half across the width of the sliding guide. SUMMARY OF THE INVENTION A medical device and a method are described, useful for placing one or more members within the gastrointestinal tract; the medical apparatus may include a slide guide supported on a housing sized to receive an endoscope, and a carrier slidable with respect to the slideway; An accessory of a feeding tube adapted to desirably couple the carrier is described. JOHNSON