This disclosure relates generally to a medical device for tissue treatment. More particularly, at least some embodiments of the disclosure relate to devices for treating tissue with an adhesive or an agent, via a patch.
The gastrointestinal (GI) tract may require treatment for various reasons including perforations, bleeding defects, post-surgical leaks, or other wounds of the tract. However, limited treatment options exist for managing such wounds. Options include surgical re-operation, which is relatively invasive and may have high morbidity and mortality rates. Thus, endoscopic delivery of a treatment aid may be a less invasive and more effective option, promoting natural healing of tissue.
According to an example, a medical device may comprise a first tube, a second tube configured to sheath at least a portion of the first tube and configured to translate along a length of the first tube, an expandable device at a distal portion of the first tube, the expandable device having a collapsed state and an expanded state, a patch surrounding at least a portion of an outer surface of the expandable device, and a connector for holding the patch to the expandable device when the second tube covers the patch and the expandable device and for releasing the patch from the expandable device after the second tube uncovers the patch and the expandable device.
In another example, the first tube may include a lumen in fluid communication with the expandable device to supply a fluid to the expandable device. The connector may extend longitudinally along a portion of the expandable device. The connector may comprise a folded sheet forming a first half of the folded sheet and a second half of the folded sheet, wherein the first half of the folded sheet is attached to the expandable device, and the second half of the folded sheet is attached to the patch. The second half of the folded sheet may include a first surface adjacent to the first half of the folded sheet and a second surface adjacent to the patch, wherein the second surface is attached to the patch. The first half of the folded sheet may be attached to the expandable device via an adhesive, and the second half of the folded sheet may be attached to the patch via a soluble adhesive. The soluble adhesive may be configured to dissolve when the second tube uncovers the patch and the expandable device, and the patch may be exposed to a solvent, thereby releasing the patch from the connector and the expandable device.
In another example, the medical device may further comprise a wire, wherein a distal end of the wire is coupled to a distal portion of the first tube, the wire is sutured through the patch and the connector, and the wire extends proximally through a lumen of one of the first tube and the second tube. The wire may be sutured linearly through the patch and the connector, along a longitudinal length of the connector. The connector may include a plurality of openings configured to receive the sutured wire. A proximal end of the wire may be configured to be pulled so that the wire translates proximally, thereby removing the wire from the patch and the connector. The distal end of the wire may be removably secured to the distal portion of the first tube via a heat shrink or a crimp. The proximal end of the wire is coupled to an actuator configured to pull the wire proximally.
In another example, the connector may comprise a soluble adhesive directly between the patch and the expandable device, and the soluble adhesive is configured to dissolve when the second tube uncovers the patch and the expandable device and the soluble adhesive is exposed to a solvent, thereby releasing the patch from the expandable device. The patch may comprise chitosan and/or a chitosan modified material.
According to another example, a medical device may comprise a tube, an expandable device at a distal portion of the tube, the expandable device having a collapsed state and an expanded state, a patch surrounding at least a portion of an outer surface of the expandable device, the patch being removably attached to the expandable device via a connector.. The medical device may further comprise a wire suturing a portion of the connector to the patch, wherein the wire extends proximally along a length of the tube, and a proximal portion of the wire may be coupled to an actuator. The actuator may comprise a knob or a switch configured to pull the wire proximally, thereby removing the wire from the patch and the second half of the connector. The actuator may be positioned on a proximal portion of the tube.
According to an example, a method of treating a subject may comprise introducing a medical device into a gastrointestinal system of the subject, positioning a distal end of the medical device within a body lumen of the subject, wherein the distal end of the medical device includes an expandable device, a patch removably coupled to an outer surface of the expandable device, and a connector for holding the patch to the expandable device, retracting an outer sheath to expose the expandable device and the patch, supplying a fluid to the expandable device, such that the expandable device expands and the patch contacts a tissue surface of the bodily lumen, and releasing the patch from the expandable device.
The accompanying drawings, which are incorporated in and constitute a part of this specification, illustrate various exemplary embodiments and together with the description, serve to explain the principles of the disclosed embodiments.
Reference will now be made in detail to aspects of the disclosure, examples of which are illustrated in the accompanying drawings. Wherever possible, the same or similar reference numbers will be used through the drawings to refer to the same or like parts. The term “distal” refers to a location or portion of a medical device farthest away from a user of the device, e.g., when introducing a device into a subject (e.g., patient). By contrast, the term “proximal” refers to a location or portion closest to the user, e.g., when placing the device into the subject.
Both the foregoing general description and the following detailed description are exemplary and explanatory only and are not restrictive of the features, as claimed. As used herein, the terms “comprises,” “comprising,” “having,” “including,” or other variations thereof, are intended to cover a non-exclusive inclusion such that a process, method, article, or apparatus that comprises a list of elements does not include only those elements, but may include other elements not expressly listed or inherent to such a process, method, article, or apparatus. In this disclosure, relative terms, such as, for example, “about,” “substantially,” “generally,” and “approximately” are used to indicate a possible variation of ±10% in a stated value or characteristic.
Embodiments of this disclosure includes devices, systems, and methods for treating bodily wounds, e.g., endoluminal wounds, including the endoscopic delivery of a treatment aid. Examples of a treatment aid may include an adhesive or any suitable therapeutic agent, or a combination with an adhesive and a therapeutic agent. Said adhesive may be in the form of a patch, and said agent, in any suitable form, may be delivered via a patch. For example, the patch may be loaded with a therapeutic agent, and the patch may deliver the agent over time when in contact with tissue. Therefore, the patch may be configured to adhere to tissue and serve as a protective layer, and/or deliver agent to any bodily lumen, cavity, etc., for example, the GI tract.
The patch is not particularly limited. The patch may be a biodegradable and/or biocompatible patch of any suitable shape, e.g., a square, rectangle, etc., or any suitable dimension, e.g., 1 cm×1 cm, depending on the treatment site. Moreover, the patch may be of any suitable material, e.g., polysaccharides (chitosan, cellulose, starch, alginates, etc.) that may be further modified with synthetic biocompatible materials (PGA, PLA, PCA, PEG, etc.) In some embodiments, the patch may be multi-layered, with each layer having different properties and characteristics to delay degradation over time. For example, each layer of a patch configured for agent delivery may comprise of a different ratio of natural/synthetic polymers to yield a timed release of the agent for an extended period of time. Thus, layers may degrade and the patch may continue to provide therapy.
The patch may be delivered via a catheter, scope (endoscope, bronchoscope, colonoscope, etc.), tube, or sheath, inserted into the GI tract via a natural orifice. The orifice can be, for example, the nose, mouth, or anus, and the placement can be in any portion of the GI tract, including the esophagus, stomach, duodenum, large intestine, or small intestine.
Referring to
Outer sheath 120 may be any suitable, biocompatible catheter configured to sheath a portion of inner catheter 110, and in some instances, delivery feature 150 (further discussed below). Outer sheath 120 includes proximal end 122 including a handle 123. Handle 123 is not particularly limited, and may be any suitable handle that is fixed to the outer surface of proximal end 122 or a proximal portion of sheath 120. A user may grip handle 123 to retract outer sheath 120 proximally, relative to inner catheter 110, thereby exposing delivery feature 150 to an external environment, e.g., a bodily lumen. Outer sheath 120 also includes a distal end 124, which may abut nose 115 when outer sheath 120 is translated distally, relative to inner catheter 110.
Referring to
Balloon 152 may be an inflatable/deflatable feature of any suitable material, e.g., polymer, plastic, etc. The size and shape of balloon 152 is not particularly limited, and may be such that balloon 152, in an inflated state, contacts or abuts the targeted bodily lumen, e.g., the esophagus, colon, etc. For example, balloon 152 may be 1.5 cm to 2 cm in diameter when inflated, similar to the dimensions of a typical human esophagus. Balloon 152 maybe a compliant balloon (inflated by volume rather than pressure), non-compliant, or semi-compliant.
Balloon 152 may be fitted over a distal portion 114 of inner catheter 110, which may include at least one opening (not shown). Said at least one opening is in fluid communication with the inner channel of catheter 110, which in turn is in communication with the fluid source. Thus, said at least one opening may serve as an outlet by which balloon 152 may be inflated with fluid or deflated. The number of openings is not particularly limited. In a deflated state (shown in
In some examples, a proximal end of balloon 152 or another aspect of inner catheter 110 may further include a pressure relief valve (not shown). Said pressure relief valve may be pre-set with a cut off pressure value, e.g., 4 psi, thereby inhibiting over-inflation of balloon 152. This helps to ensure that the body lumen is not perforated during the procedure. Device 10 may also include an additional vent, valve, or other structure by which fluid from balloon 152 may be released, thereby deflating balloon 152.
Patch 160, as discussed above, is not particularly limited. Patch 160 may be configured to adhere to tissue when in contact, and may also deliver agent to a bodily lumen of the GI tract. Patch 160 may be coupled to balloon 152, via connector 154 further discussed below. In the pre-deployment state (
Connector 154 may be a sheet or an adhesive of any suitable material, e.g., paper, silicone, etc. Connector 154 may be folded into two halves—a first portion 1541 and a second portion 1542. First portion 1541 is adhered to an outer surface of balloon 152, via any suitable adhesive means, e.g., soluble, insoluble adhesives. For example, said adhesive means may be an insoluble adhesive so that first portion 1541 remains adhered to the outer surface of balloon 152. In another example, said adhesive means may be a soluble adhesive so that connector 154 may detach from balloon 152 after a duration of time. A surface of second portion 1542, that is adjacent to a surrounding patch 160 while connector 154 remains folded, may be attached to patch 160. Thus, connector 154 may serve as an intermediary connector between balloon 152 and patch 160. Second portion 1542 may be attached to patch 160 by any suitable dissolvable adhesive. For example, said adhesive may be a water-soluble adhesive, e.g., polyvinyl alcohol, etc. Thus, after inflation of balloon 152 and expansion of patch 160, patch 160 may be released from connector 154, via the dissolution of the adhesive between second portion 1542 and patch 160 (shown in
Referring to
Referring to
Wire 210 is not particularly limited, and may be any suitable wire-like feature, including suture material. Wire 210 may be of a length extending from a distal portion of device 10′ to a point that is proximal to proximal end 122 of outer sheath 120. For example, a distal end of wire 210 may be secured under a heat shrink tube 117, or any other suitable mechanism, e.g., a crimp, which may be distal to feature 150′ and fixed to catheter 110. Heat shrink tube 117 is not particularly limited. A portion of wire 210 proximal to its distal end may be sewn through patch 160 and second portion 1542′, coupling second portion 1542′ to patch 160. The remaining proximal portion of wire 210 may extend throughout the lumen of sheath 120, and past proximal end 122 of sheath 120. A proximal end of wire 210 may be secured or attached to a knob or switch 305. Knob or switch 305 may be positioned on any portion of device 10′, e.g., handle 113, proximal to sheath 120, or may be separate from device 10′. Knob or switch 305 may be configured to wind or pull wire 210 proximally, so that the distal end of wire 210 may be released from heat shrink 117 tube and removed from patch 160 and second portion 1542′, thereby releasing patch 160 from connector 154′. Alternatively, wire 210 may hang out of proximal end 122 of sheath 120 for a user to manually pull, without any intervening mechanical features. In other examples, delivery feature 150′ may include a plurality of wires 210, sewn through patch 160 and second portion 1542′. The additional wires may further secure patch 160 onto second portion 1542′.
Medical device 10′ may be used in a similar manner as medical device 10, except a user may pull wire 210 proximally to deploy patch 160 from connector 154′ and balloon 152. Wire 210 may be pulled by any suitable means. In some examples, a user many actuate knob or switch 305 which winds wire 210 proximally, so that wire 210 may be removed from connector 154′. In other examples, a user may manually pull on wire 210 to do the same.
It is noted suturing is not limited to coupling patch 160 onto connector 154′. In other examples, additional aspects of the medical device 10′ may be sutured together as well. For example, delivery feature 150′, in a pre-deployment state, may be packaged or contained in a wrapper of any suitable, biocompatible material. Said wrapper may be sutured onto an outer surface of patch 160, via a second wire. Thus, in addition to wire 210, a second wire may extend proximally along the length of device 10′. In such an example, device 10′ may be without outer sheath 120, as delivery feature 150′ may be contained within the sutured wrapper. To expose delivery feature 150′, the second wire may be pulled proximally to remove the second wire, and release said wrapper from patch 160.
Referring to
It is noted connectors 154, 154′ and adhesive 156, discussed above, extend along only a portion of balloon 152. However, delivery features 150, 150′ 150″ are not limited to a single connector 154, 154′ or a single spot of adhesive 156. In some examples, said features may have a plurality of their respective connectors 154, 154′ or adhesive 156 at different radial and longitudinal positions throughout balloon 152, for greater adherence with patch 160 to balloon 152.
Stent 270 is not particularly limited, and may be any suitable, bio-absorbable stent. Stent 270 may be of any flexible and elastic-like material, e.g., PLLA, so that stent 270 may expand to its default shape after being adjusted or manipulated. Stent 270 may be of a shape memory material. The size and shape of stent 270 is not limited, and may depend on the dimensions of the bodily lumen, e.g., esophagus, colon, etc., to be treated. For example, stent 270 may be of a sufficient size to apply a necessary degree of pressure against the surrounding walls of a bodily lumen, without causing a perforation. This may also reduce the likelihood of undesired migration of stent 270. Furthermore, stent 270, in an expanded, default state, may be of a sufficient width to enable the proximal retraction of inner catheter 210 and nose 215 through a lumen of stent 270. As discussed above, patch 160 is not particularly limited, and may be wrapped or folded around stent 270 via any suitable manner. In some instances, patch 160 may be coupled to stent 270 in a manner that would allow for patch 160 to expand as stent 270 expands. It is noted that patch 160 may be of a sufficient size to fully cover stent 270 in its expanded, original state. This may also reduce risk of ripping patch 160 upon expansion of stent 270. However, in some examples, patch 160 may cover only a circumferential portion of stent 270 for treating less than a full circumference of a bodily lumen.
Delivery feature 250 includes a pre-deployment state (shown in
Medical device 20 may be used in a similar manner as medical device 10, except there is no inflation or deflation of an expandable device, e.g., a balloon. Rather, a user may translate outer sheath 220 proximally via any suitable manner, thereby exposing delivery feature 250 to the surrounding lumen. Subsequently thereafter, stent 270 will expand towards its original size and shape, and patch 160 will unfold and expand simultaneously. Once stent 270 (and surrounding patch 160) is deployed and stabilized within the targeted lumen, a user may then retract device 20 proximally until device 20 is removed from the subject.
It will be apparent to those skilled in the art that various modifications and variations can be made to the disclosed device without departing from the scope of the disclosure. Other embodiments of the disclosure will be apparent to those skilled in the art from consideration of the specification and practice of the invention disclosed herein. It is intended that the specification and examples be considered as exemplary only, with a true scope and spirit of the invention being indicated by the following claims.
This application claims the benefit of priority from U.S. Provisional Application No. 63/151,092, filed on Feb. 19, 2021, which is incorporated by reference herein in its entirety.
Number | Date | Country | |
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63151092 | Feb 2021 | US |