WO2001050951A1 - Apparatus and method for continuous measurement of portal blood pressure - Google Patents
Apparatus and method for continuous measurement of portal blood pressure Download PDFInfo
- Publication number
- WO2001050951A1 WO2001050951A1 PCT/US2001/000595 US0100595W WO0150951A1 WO 2001050951 A1 WO2001050951 A1 WO 2001050951A1 US 0100595 W US0100595 W US 0100595W WO 0150951 A1 WO0150951 A1 WO 0150951A1
- Authority
- WO
- WIPO (PCT)
- Prior art keywords
- esophageal
- gastric
- balloon
- inflatable balloon
- tube
- Prior art date
Links
Classifications
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B5/00—Measuring for diagnostic purposes; Identification of persons
- A61B5/02—Detecting, measuring or recording pulse, heart rate, blood pressure or blood flow; Combined pulse/heart-rate/blood pressure determination; Evaluating a cardiovascular condition not otherwise provided for, e.g. using combinations of techniques provided for in this group with electrocardiography or electroauscultation; Heart catheters for measuring blood pressure
- A61B5/021—Measuring pressure in heart or blood vessels
- A61B5/022—Measuring pressure in heart or blood vessels by applying pressure to close blood vessels, e.g. against the skin; Ophthalmodynamometers
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B5/00—Measuring for diagnostic purposes; Identification of persons
- A61B5/02—Detecting, measuring or recording pulse, heart rate, blood pressure or blood flow; Combined pulse/heart-rate/blood pressure determination; Evaluating a cardiovascular condition not otherwise provided for, e.g. using combinations of techniques provided for in this group with electrocardiography or electroauscultation; Heart catheters for measuring blood pressure
- A61B5/021—Measuring pressure in heart or blood vessels
- A61B5/0215—Measuring pressure in heart or blood vessels by means inserted into the body
- A61B5/02152—Measuring pressure in heart or blood vessels by means inserted into the body specially adapted for venous pressure
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B5/00—Measuring for diagnostic purposes; Identification of persons
- A61B5/02—Detecting, measuring or recording pulse, heart rate, blood pressure or blood flow; Combined pulse/heart-rate/blood pressure determination; Evaluating a cardiovascular condition not otherwise provided for, e.g. using combinations of techniques provided for in this group with electrocardiography or electroauscultation; Heart catheters for measuring blood pressure
- A61B5/021—Measuring pressure in heart or blood vessels
- A61B5/022—Measuring pressure in heart or blood vessels by applying pressure to close blood vessels, e.g. against the skin; Ophthalmodynamometers
- A61B5/02233—Occluders specially adapted therefor
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
- A61M25/00—Catheters; Hollow probes
- A61M25/01—Introducing, guiding, advancing, emplacing or holding catheters
- A61M25/02—Holding devices, e.g. on the body
- A61M25/04—Holding devices, e.g. on the body in the body, e.g. expansible
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B5/00—Measuring for diagnostic purposes; Identification of persons
- A61B5/03—Detecting, measuring or recording fluid pressure within the body other than blood pressure, e.g. cerebral pressure; Measuring pressure in body tissues or organs
- A61B5/036—Detecting, measuring or recording fluid pressure within the body other than blood pressure, e.g. cerebral pressure; Measuring pressure in body tissues or organs by means introduced into body tracts
- A61B5/037—Measuring oesophageal pressure
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
- A61M2210/00—Anatomical parts of the body
- A61M2210/10—Trunk
- A61M2210/1042—Alimentary tract
- A61M2210/105—Oesophagus
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
- A61M2210/00—Anatomical parts of the body
- A61M2210/10—Trunk
- A61M2210/1042—Alimentary tract
- A61M2210/1053—Stomach
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
- A61M25/00—Catheters; Hollow probes
- A61M25/10—Balloon catheters
- A61M25/1011—Multiple balloon catheters
Definitions
- This invention pertains to a method and a device for the continuous measurement of portal blood pressure.
- method and device use an inflatable balloon inserted into the stomach and esophagus with a sensor to monitor the
- That invention provides a tamponade device and a
- an esophageal inflatable balloon mounted over the tube, a first inflation lumen opening into the esophageal inflatable balloon for directing pressurized fluid to inflate the esophageal inflatable balloon, a gastric inflatable balloon mounted over the tube between the esophageal inflatable balloon and the distal open end, a second inflation lumen opening into the gastric inflatable balloon for directing pressurized fluid to inflate the gastric balloon, and a non-visual sensor mounted on the esophageal balloon or a small endoscope or video camera that is inserted through the tube, to detect the changes resulting from tamponade.
- the invention also comprises a method of measuring the portal pressure by backloading the device on an endoscope by passing the endoscope through the open ends of the tube, passing the endoscope down the esophagus advancing the device along the endoscope and down the esophagus to a location within the diaphragmatic hiatus, positioning the gastric balloon inside the stomach and inflating the gastric balloon, pulling the balloon against the proximal stomach and the diaphragmatic hiatus with a traction means to seat the gastric balloon against the gastric cardia, inflating the esophageal inflatable
- diaphragmatic hiatus occludes, so that the esophageal varices collapse or blood flow ceases or is reduced to a
- the tamponade device may be deployed over an oral -gastric tube to obviate the need for endoscopic
- the device preferably also includes a bridle
- the bridle is manipulated to position the
- an aspiration tube is positioned within the stomach and a fluid supply tube is positioned adjacent to the esophageal balloon for coupling to the mucosal surface when an ultrasonic sensor is used.
- deaerated fluid is gradually infused adjacent to the esophageal balloon while aspirating the stomach.
- the stomach is aspirated and the fluid is infused adjacent to the esophageal balloon while deflating the esophageal inflatable balloon and gastric inflatable balloon until the esophageal varices " distend or blood flow increases as determined by the sensor.
- the pressure within the balloons is then measured with a monometer or a second sensor.
- the varices such as an ultrasound probe
- endoscope or video camera can serve to identify varix
- This endoscope could be used in conjunction with the present invention to visualize whether the varices are expanded and visible or collapsed and tamponade pressure adjusted to obtain a pressure measurement. Similar periodic measurements would similarly be made using the sensors described.
- the preferred method for measuring portal pressure would have a tamponade balloon such as that described in United States Patent No. 5,308,326, the disclosure of which is herein incorporated by reference, an expandable compression disc or other similar device located in the stomach and held in place by a similar device in the esophagus .
- a patent lumen connecting the esophagus and stomach to equalize pressure is important, since without such a lumen, swallowing and esophageal peristalsis periodically increases esophageal pressure to oppose variceal pressure and influences pressure and flow in esophageal varices .
- the tamponade device must be provided with a bridle for introduction and communication with the balloon or compression discs as well as the sensor. This would be similar to the esophagogastric balloon tamponade device bridle described in US Patent No. 5,308,326, that is hereby incorporated by reference.
- an additional source of fluid to couple the transducer to the esophageal wall is required. This is provided by a fine tube within or outside the bridle carrying a trickle of deaerated water or other fluid.
- FIG. 1 is a perspective view of one embodiment of a device used to practice this invention, for illustrative purposes, the full lengths of the wires 19 and of the lumens 16 and 18 are not shown; and
- FIGS. 2 to 8 are step-by-step sectional views of the device illustrated in FIG. 1 being placed in a patient, according to one embodiment of this invention.
- FIG. 1 a preferred esophago-gastric balloon device 11 is shown.
- the device 11 includes an elongate member 12, preferably a tube, having a proximal end 13 and a distal end 14, where both ends are preferably open.
- An esophageal inflatable balloon 15 is mounted over the elongate member 12, and an inflation lumen 16 is provided for directing pressurized fluid in and out the esophageal
- a gastric inflatable balloon 17 is mounted over the elongate member 12 and is adapted to seat against the gastric cardia when inflated in the
- a separate inflation lumen 18 is provided to inflate and deflate the gastric inflatable balloon 17.
- the esophageal inflatable balloon 15 is mounted over the elongate member 12. As to the method of mounting the
- esophageal inflatable balloon over the tube it may be mounted by silk ties, bonding or vulcanizing, or any
- the gastric inflatable balloon 17 is mounted over
- the gastric inflatable balloon 17 has an inflated diameter which is
- the gastric inflatable balloon 17 seats against and compresses the gastric cardia when the device 11 is pulled by the wires 19, or pulled by the proximal end of the elongate member 12 in a direction up the esophagus.
- the gastric inflatable balloon 17 can be mounted using silk ties, bonding or vulcanizing, or any other suitable airtight method known in the art.
- a non-visual sensor 20 is mounted to one of balloons 15 and 17 for measuring the pressure.
- Sensor 20 can be any one of a variety of sensors, such as a sensor that identifies a change in diameter of the varices, such as an ultrasound probe; a change in the color of the esophageal wall when the blue vessels diminish in size, such as reflectance spectrometry as in oximetry; or a change in velocity of flow as indicated by temperature, electrical impedance or doppler ultrasound.
- Sensor 20 can be mounted in any of a variety of positions on the device, depending on the type of sensor to be used. The various positions of sensor 20 are shown in FIGS. 2-8.
- An inflation lumen is also provided to direct pressurized fluid to inflate the gastric inflatable balloon 17.
- This lumen could be the same one which 01/50951
- inflation lumen 18 passes through the esophageal inflatable balloon 15 and into the gastric inflatable
- a preferred device 11 also includes a plurality of wires 19 which are attached to the elongate member 12 and generally form a bridle.
- the preferred device 11 the
- wires 19 are of sufficient length that, when the device 11 is in place, the wires 19 extend up the esophagus and
- the bridle is
- the device 11 adapted and operable to allow the device 11 to be secured in place in the patient while having the proximal open
- the device is passed down the esophagus, to a location within the patient's stomach.
- the device is backloaded on the endoscope or oral-gastric tube by passing the endoscope or oral-gastric tube through the open ends of the device.
- the endoscope or tube is then passed ⁇ through the patient's mouth, down the esophagus, and into the stomach, usually a distance of about 50 cm past the patient's incisors.
- the device 11 is advanced by pushing with an overtube until the gastric inflatable balloon 17 is positioned within the stomach while leaving a portion of the bridle external to the
- the esophageal inflatable balloon 15 is then inflated to fix the device 11 into
- the esophageal and gastric inflatable balloons are inflated and fixed into position by compressing the diaphragm and surrounding tissue from opposing sides of the diaphragm. The esophageal and gastric inflatable balloons are then further inflated and deflated, as needed, to measure portal blood pressure.
- suitable hemostatic such as microfibrillar collagen hemostat
- coagulant such as Thrombin, USP
- cytoprotective such as sucralfate
- the first end of the guide tube is then placed through the nose and out the mouth of the patient, with the second end of the guide tube remaining external of the nose.
- the bridle wires 19 and the inflation lumens 16 and 18, which are extending out of the mouth are passed into said first end and out the second end of the guide tube.
- the guide tube is then withdrawn from the nose to leave bridle wires 19 and lumens 16 and 18 positioned through the patient's nose.
- the established nasal bridle position is generally shown in FIG. 7.
- the gastric inflatable balloon 17 and the esophageal inflatable balloon 15 are inflated, and the wires 19 and the inflation lumens 16 and 18 are extending out of the nose.
- the appropriate connectors can then be placed on the inflation lumens 16 and 18 and the bridle wires 19 can be connected to a traction device as necessary. Having the lumens 16 and 18 and the bridle wires 19 positioned through the patient's nose increases patient comfort and reduces trauma to the nose and pharynx.
- the sensor measures the portal pressure as follows: pressure in the esophageal and gastric inflatable balloon is slowly reduced until the varices distend and reappear. Pressure is then increased in the esophageal and gastric inflatable balloon while monitoring the inflation pressure.
- pressure inside the gastric inflatable balloon is high enough to occlude blood flow in the portal veins traversing the diaphragmatic hiatus, the varices above the esophageal inflatable balloon collapse.
- the balloon pressure required to occlude these portal collateral veins is about identical to the pressure in the main portal vein.
- the balloons may be deflated to allow the esophageal varices to distend and this pressure is also measured.
- the sensor identifies the change in diameter of the varices (using an ultrasound probe) , a change in the color of the esophageal varices when the blue vessels diminish in size (using a reflectance " spectrometry as in oximetry) , or a change in velocity of flow as indicated by temperature or by using electrical impedance or doppler ultrasound.
- Sensor 20 is preferably mounted on the esophageal balloon. However, sensor 20 could also be mounted on the endoscope, tamponade shaft or bridle.
Abstract
Description
Claims
Priority Applications (4)
Application Number | Priority Date | Filing Date | Title |
---|---|---|---|
AU2001229319A AU2001229319A1 (en) | 2000-01-14 | 2001-01-09 | Apparatus and method for continuous measurement of portal blood pressure |
DE60134456T DE60134456D1 (en) | 2000-01-14 | 2001-01-09 | DEVICE AND METHOD FOR CONTINUOUS MEASUREMENT OF PORTAL BLOOD PRESSURE |
JP2001551377A JP2004500180A (en) | 2000-01-14 | 2001-01-09 | Apparatus and method for continuously measuring portal vein pressure |
EP01942289A EP1246562B1 (en) | 2000-01-14 | 2001-01-09 | Apparatus and method for continuous measurement of portal blood pressure |
Applications Claiming Priority (2)
Application Number | Priority Date | Filing Date | Title |
---|---|---|---|
US09/484,406 US6315733B1 (en) | 2000-01-14 | 2000-01-14 | Apparatus and method for continuous measurement of portal blood pressure |
US09/484,406 | 2000-01-14 |
Publications (1)
Publication Number | Publication Date |
---|---|
WO2001050951A1 true WO2001050951A1 (en) | 2001-07-19 |
Family
ID=23924045
Family Applications (1)
Application Number | Title | Priority Date | Filing Date |
---|---|---|---|
PCT/US2001/000595 WO2001050951A1 (en) | 2000-01-14 | 2001-01-09 | Apparatus and method for continuous measurement of portal blood pressure |
Country Status (7)
Country | Link |
---|---|
US (1) | US6315733B1 (en) |
EP (1) | EP1246562B1 (en) |
JP (1) | JP2004500180A (en) |
AT (1) | ATE398415T1 (en) |
AU (1) | AU2001229319A1 (en) |
DE (1) | DE60134456D1 (en) |
WO (1) | WO2001050951A1 (en) |
Cited By (1)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
RU2456913C1 (en) * | 2010-12-27 | 2012-07-27 | Государственное образовательное учреждение высшего профессионального образования "Челябинская государственная медицинская академия" ГОУ ВПО "ЧелГМА Росздрава" | Method of measurement of blood pressure in esophagus veins |
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IL129032A (en) * | 1999-03-17 | 2006-12-31 | Moshe Dudai | Gastric band |
WO2002098296A1 (en) * | 2001-06-05 | 2002-12-12 | Apex Medical, Inc. | Pressure sensing endograft |
DE102004018628A1 (en) * | 2004-04-16 | 2005-11-03 | Carl Zeiss Meditec Ag | Device and method for detecting eye movements |
US20050245788A1 (en) * | 2004-04-28 | 2005-11-03 | Medtronic, Inc. | Esophageal delivery system and method with position indexing |
US8475476B2 (en) * | 2004-06-01 | 2013-07-02 | Cook Medical Technologies Llc | System and method for accessing a body cavity |
JP3834820B2 (en) * | 2004-11-04 | 2006-10-18 | フジノン株式会社 | Balloon control device for endoscope apparatus |
AU2011203071B2 (en) * | 2005-02-17 | 2012-04-05 | Q-Pidt Bv | Measuring member and device for determining the blood flow of the gastrointestinal tract, as well as for registrating the intestinal peristalsis |
NL1028320C2 (en) * | 2005-02-17 | 2006-08-21 | Drs Jan Beute | Measuring device and device for determining the blood flow of the gastrointestinal tract, as well as registering the intestinal peristalsis. |
WO2006138728A2 (en) * | 2005-06-17 | 2006-12-28 | The Research Foundation Of State University Of New York | Method of determining cardiac indicators |
AU2009221844B2 (en) | 2008-03-06 | 2014-04-03 | Cook Medical Technologies Llc | Medical systems for accessing an internal bodily opening |
JP5528432B2 (en) | 2008-05-15 | 2014-06-25 | クック メディカル テクノロジーズ エルエルシー | System, apparatus and method for accessing a body opening |
TW201012429A (en) * | 2008-09-19 | 2010-04-01 | Univ Nat Taiwan | Endoscope examination system |
CA2783009A1 (en) | 2008-12-27 | 2010-07-01 | John Hancock | High specific gravity intragastric device |
US8267857B2 (en) * | 2009-01-30 | 2012-09-18 | Cook Medical Technologies Llc | Expandable port for accessing a bodily opening |
US8834361B2 (en) | 2009-05-15 | 2014-09-16 | Cook Medical Technologies Llc | Systems, devices and methods for accessing a bodily opening |
GB2496074B (en) * | 2010-07-13 | 2016-07-20 | Sandhill Scient Inc | Apparatus and method for detecting and measuring condition of esophageal mucosa and indications of gastroesophageal reflux disease |
CN103976722B (en) * | 2014-05-26 | 2016-07-06 | 中南大学湘雅三医院 | A kind of esophageal variceal vein non-invasivetesting method |
US20180325524A1 (en) * | 2014-11-10 | 2018-11-15 | University Of Florida Research Foundation, Inc. | Cycling balloon tamponade technology for managing esophageal varices |
EP3569280B1 (en) * | 2018-05-14 | 2020-04-29 | Peter Osypka Stiftung | Balloon dilation assembly with av node /his bundle sensing-stimulation system |
US11291382B2 (en) | 2018-06-01 | 2022-04-05 | Diversatek Healthcare, Inc. | System and method for detecting and measuring the condition of intraluminal esophageal mucosa |
CN108852448A (en) * | 2018-06-12 | 2018-11-23 | 无锡圣诺亚科技有限公司 | The stomach tube device of suspension traction compressing |
CN112244808B (en) * | 2020-11-10 | 2024-02-20 | 中国人民解放军陆军特色医学中心 | Stomach tube for measuring chest cavity pressure |
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US5181517A (en) * | 1989-09-18 | 1993-01-26 | The State University Of New York | Method and apparatus for the measurement of atrial pressure |
US5398692A (en) * | 1989-09-18 | 1995-03-21 | The Research Foundation Of State University Of New York | Combination esophageal catheter for the measurement of atrial pressure |
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2000
- 2000-01-14 US US09/484,406 patent/US6315733B1/en not_active Expired - Fee Related
-
2001
- 2001-01-09 JP JP2001551377A patent/JP2004500180A/en active Pending
- 2001-01-09 EP EP01942289A patent/EP1246562B1/en not_active Expired - Lifetime
- 2001-01-09 WO PCT/US2001/000595 patent/WO2001050951A1/en active Application Filing
- 2001-01-09 DE DE60134456T patent/DE60134456D1/en not_active Expired - Fee Related
- 2001-01-09 AU AU2001229319A patent/AU2001229319A1/en not_active Abandoned
- 2001-01-09 AT AT01942289T patent/ATE398415T1/en not_active IP Right Cessation
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US3055371A (en) * | 1958-12-23 | 1962-09-25 | Kulick George | Device for regulation and control of esophago-gastric balloons |
US4214593A (en) * | 1978-09-18 | 1980-07-29 | Mallinckrodt, Inc. | Esophageal pressure monitoring device |
US5048532A (en) * | 1989-09-18 | 1991-09-17 | State University Of New York | Method and apparatus for measuring blood pressure |
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Cited By (1)
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RU2456913C1 (en) * | 2010-12-27 | 2012-07-27 | Государственное образовательное учреждение высшего профессионального образования "Челябинская государственная медицинская академия" ГОУ ВПО "ЧелГМА Росздрава" | Method of measurement of blood pressure in esophagus veins |
Also Published As
Publication number | Publication date |
---|---|
AU2001229319A1 (en) | 2001-07-24 |
JP2004500180A (en) | 2004-01-08 |
DE60134456D1 (en) | 2008-07-31 |
US6315733B1 (en) | 2001-11-13 |
EP1246562A4 (en) | 2003-07-09 |
ATE398415T1 (en) | 2008-07-15 |
EP1246562B1 (en) | 2008-06-18 |
EP1246562A1 (en) | 2002-10-09 |
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