RU2344785C1 - Method of endoscopic insertion of videocapsule into stomach and duodenum and device for implementation of method - Google Patents

Abstract

FIELD: medicine; endoscopy.

SUBSTANCE: device for endoscopic insertion of videocapsule into stomach and duodenum includes nozzle in the form of elastic resilient polymer tube. Tube has two windows matching objective lens and sight source lens of fibrogastroduodenoscope. Internal and external tube diametres are proportionate to videocapsule and endoscope diametres respectively. Tube is put onto the work end of fibrogastroduodenoscope. Videocapsule is placed into the tube. After endoscope positioning control in duodenum a biopsy device into work channel of endoscope. Capsule is extracted. Claimed method and device allow visual control over videocapsule insertion into stomach or duodenum, visual control videocapsule guidance with indication of anatomical stomach and duodenum parts, conduct observations when patient in the partial or full loss of consciousness, obstruction or inability to swallow videocapsule by themselves.

EFFECT: increased operation time of videocapsule in narrow intestine.

2 cl, 9 dwg, 1 ex

Description

The proposed group of inventions relates to medicine, namely to endoscopy, and can be used to determine the prevalence of the pathological process and control the treatment in the early postoperative period.

Diagnosis of pathological changes in the mucous membrane of the small intestine is relevant in modern abdominal surgery. This is due to the imperfection of existing methods for studying the mucous membrane of the small intestine. The most well-known diagnostic methods that allow minimally invasive or non-invasive detection of pathology of the small intestine - intestinoscopy using fiber-optic enteroscopes, radiation methods (magnetic resonance imaging, computed tomography, selective angiography, barium diagnostics, etc.) do not always have a sufficient degree of informational content or conjugation technical difficulties in conducting or with the impossibility of a total examination of the small intestine. Over the past 5 years, namely since 2000, a new method of video endoscopic capsule diagnostics has been introduced into the arsenal of surgeons, gastroenterologists, endoscopists and proctologists to identify small bowel diseases. The method was developed by GIVEN Imaging (Halpern M., Jacob H. Atlas of Capsule Endoscopy. Given Imaging. 2002. - 131).

Inspection of the mucous membrane of the small intestine is carried out using a wireless, autonomously working video capsule. Moreover, in order to perform a study of the small intestine, the examined patient independently swallows the video capsule. This device is a 26x11 mm capsule equipped with a video camera, a light source, a battery pack and a radio frequency antenna that transmits the image to a recording device attached to the patient’s belt. Reading and analysis of the video is made after the video capsule passes through the intestines and at the end of its working time. The average operating time of a video capsule is no more than 7 hours (Swain P et al. Capsule Endoscopy in Obscure Intestinal Bleeding. Endoscopy 2005; 37: 655-659).

The main indications for conducting the capsule endoscopy study are cases of etiologically unclear gastrointestinal bleeding, inflammatory diseases of the small intestine, suspected tumor of the small intestine, diagnosis of erosive and ulcerative lesions of the mucous membrane due to the use of non-steroidal anti-inflammatory drugs or after chemotherapy, celiac disease and several other diseases. Capsule endoscopy is prescribed to patients when previously performed fibroesophagogastroduodenoscopy, fibrocolonoscopy, and radiation diagnostic methods have not been able to establish the cause of the disease (Rosch T. Capsule Endoscopy. Endoscopy 2003; 35: 816-822).

Often patients with a clinic of acute gastrointestinal bleeding come in serious condition, requiring emergency surgery - laparoscopy, laparotomy to stop bleeding. It is often impossible to assess the nature and prevalence of the pathological process of the small intestine mucosa objectively and in full at the time of surgery. The main stages of the operation (resection of the small intestine, etc.) are aimed at eliminating the source of bleeding. Such a group of patients in the early postoperative period requires video endoscopic capsule diagnosis. The purpose of capsular diagnostics is to determine the prevalence of the pathological process that caused bleeding, control the effectiveness of the operation, and determine the effectiveness of drug therapy.

However, video endoscopic capsule diagnostics of the operated patient presents a number of difficulties:

1) operated patients on the abdominal organs are in serious condition with difficulty or inability to swallow a video endoscopic capsule;

2) children under 14 years old often cannot swallow a video capsule on their own;

3) in patients operated on by the abdominal organs, intestinal motor function is reduced, which increases the duration of the video capsule through the intestines and can lead to an incomplete examination of the small intestine mucosa.

In addition, video endoscopic capsule diagnostics in patients operated on on the abdominal cavity organs is associated with a risk of delayed video capsule. The reason for the delay in the video capsule may be postoperative intestinal paresis, anastomositis.

In order to improve the study by the method of video endoscopic capsular diagnosis of the small intestine mucosa in patients operated on by the abdominal organs and children with difficulty or inability to swallow the video capsule independently, we developed an endoscopic method and device for introducing the video capsule into the stomach and duodenum.

The prototype is a method for carrying out an endoscopic video capsule using a fibrogastroscope (Mohl Wet al. Insertion of a Video Capsule through an Overtube. Endoscopy 2005; 37: 605). This paper gives an example of a video capsule using a fibrogastroscope for a 74-year-old patient with a clinic of intestinal bleeding. The reason for this approach in this patient was a long history of violation of the act of swallowing any tablet medicines. The publication states that the goal was only to help carry the video capsule into the stomach.

The technical result when using the invention is a visually controlled video capsule with the definition of the anatomical sections of the stomach and duodenum, an increase in the useful (in the small intestine) time of the video capsule, the possibility for patients with temporarily impaired or absent consciousness (patients who are in drug sedation, under general anesthesia ), in a situation with difficulty or complete inability of the patient to the act of self-ingestion.

The method is as follows: put on the working part of the fibrogastroduodenoscope the device developed by us - a silicone tube commensurate with its inner diameter to the outer diameter of the distal part of the used fibrogastroduodenoscope and to the outer diameter (11 mm) of the video capsule. Immediately after activation of the video capsule (removal from the storage container), it is placed in a silicone tube. Then a fibrogastroduodenoscopy is introduced into the cavity of the stomach and it is carried out into the lumen of the duodenum. After visual verification of the presence of the fibrogastroduodenoscopy in the duodenum with the help of an endoscopic biopsytor inserted into the working channel of the fibrogastroduodenoscopy, the video capsule is pushed out (disconnected from the silicone tube) into the lumen of the duodenum, which allows us to start further research using the capsular endoscopy method. The duration of the capsule is 3 minutes.

Application of the method developed by us allows us to achieve the following goals:

1) it is safe, under the control of vision, to introduce the video capsule into the stomach or duodenum of the operated patients or children with a violation or inability to swallow the video capsule independently;

2) holding the video capsule into the lumen of the duodenum in patients operated on in the abdominal cavity allows increasing the useful time of the video capsule in the lumen of the small intestine due to the absence of the capsule being and standing in the stomach. With self-ingestion, the time spent for the video capsule in the stomach averages 48 minutes (Rosch T. Capsule Endoscopy. Endoscopy 2003; 35: 816-822), and in patients operated on the stomach it can reach up to 7 hours due to gastroparesis (Golder S et al. Failure of Capsule Transportation. Endoscopy 2005; 37: 397 ± 398). This is especially important, since the total operating time of the video capsule does not exceed 7 hours and the prolonged presence of the video capsule in the stomach reduces the useful time of its operation in the small intestine.

Figure 1 shows the proposed device for endoscopic introduction of a video capsule into the lumen of the stomach and duodenum, figure 2 is the same with a working light source, figure 3 is a visualization of the lumen of the duodenum through the window of the device for the lens of a fibrogastroduodenoscope, in Fig. 4 is a view of the working part of a fibrogastroduodenoscope with an attached device and an endoscopic video capsule; FIG. 5 is an introduction of a biopsytor into a working channel of a fibrogastroduodenoscope; FIG. 6 is a pushing (disconnecting) of a video capsule. and using a biopsy pump from the device, in Fig.7 - the video capsule is disconnected from the device, in Fig.8 is a drawing of the device, Fig.9 is the same, cross section.

In the available scientific, medical and patent literature, a description of a device for introducing a video capsule using a fibrogastroduodenoscope into the cavity of the stomach or duodenum has not been identified.

The technical result when using the invention is a visually controlled video capsule with the definition of the anatomical sections of the stomach and duodenum, an increase in the useful (in the small intestine) time of the video capsule, the possibility for patients with temporarily impaired or absent consciousness (patients who are in drug sedation, under general anesthesia ), in a situation with difficulty or complete inability of the patient to the act of self-ingestion.

A device for the endoscopic introduction of a video capsule into the stomach and duodenum is a nozzle in the form of a tube of elastic elastic polymer material (for example, a silicone tube) 30 mm long, end 1 of which serves to connect the video capsule, and end 2 - to connect to the fibrogastroduodenoscope, with an internal with a diameter of 10 mm (for good connection with a video capsule with a diameter of 11 mm) and an outer diameter of 14 mm. In the tube there are windows 3, 4 with dimensions 2 × 2 mm, corresponding respectively with the lens of the lens and the lens of the light source of the fibrogastroduodenoscope, to maintain the possibility of endoscopic examination of the cavity of the stomach and duodenum (Fig. 1).

The proposed method and device used in clinical practice in 3 patients. There were no complications during use. In all cases, it was possible to fully examine the mucous membrane of the small intestine and determine the type of its pathological change.

Example. Child S., 12 years old, was admitted to the children's surgical department of the Ufa Emergency Hospital with a clinic of acute intestinal bleeding. An emergency fibrogastroduodenoscopy and fibrocolonoscopy were performed, on which the source of bleeding was not installed. Considering the clinic of ongoing bleeding, the child underwent diagnostic laparoscopy, laparotomy, and a small intestine revision. However, the operations performed did not allow to localize the source of intestinal bleeding. In the postoperative period, on the seventh day, the child was assigned a video endoscopic capsule diagnosis. Given the fact that the child could not independently swallow the video capsule, it was introduced into the cavity of the stomach and duodenum according to the proposed method using a fibrogastroduodenoscope and device. The duration of the capsule was 3 minutes. The use of this method of introducing a video capsule allowed to increase the useful life and examine all sections of the small intestine. The diagnosis was established - small intestine angio dysplasia.

Thus, the method and device developed by us allows us to conduct a study of the small intestine mucosa by video endoscopic capsule diagnostics for a complex group of examined patients, namely, operated patients on the abdominal organs in the early postoperative period and people with inability or difficulties to swallow the video capsule on their own, and also achieve increase the useful (in the small intestine) time of the video capsule.

Claims (2)

1. A method for endoscopically introducing a video capsule into the stomach and duodenum using an endoscope, characterized in that a nozzle in the form of a tube of elastic flexible polymeric material is placed on the working end of the fibrogastroduodenoscopy, which has two windows matching the lens of the lens and the lens of the light source of the fibrogastroduodenoscope, and the inner and outer diameters of the tube are proportional to the diameters of the video capsule and the endoscope, place the video capsule in the tube, after checking the endoscope is in twelve rstnoy intestine in its working path and push administered biopsitor videocapsule. 2. A device for the endoscopic introduction of a video capsule into the stomach and duodenum, characterized in that it contains a nozzle in the form of a tube of elastic flexible polymeric material, on which two windows are made, coinciding with the objective lens and the lens of the light source of the fibrogastroduodenoscope, and the inner and outer diameters the tubes are commensurate with the diameters of the video capsule and endoscope, respectively.

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