US20010037127A1

Movatterモバイル変換

Info

Publication number: US20010037127A1
Application number: US09/792,234
Authority: US
Inventors: Andres De Hoyos Garza
Original assignee: Individual
Current assignee: Individual
Priority date: 2000-02-24
Filing date: 2001-02-23
Publication date: 2001-11-01
Also published as: MXPA00001922A; US6454785B2

Abstract

The present invention relates to a percutaneous intragastric balloon catheter for the treatment of obesity. The invention occupies a portion of the gastric cavity causing a feeling of satiety and decreasing the consumption of food by an obese patient. This invention consists in a percutaneous intragastric balloon that is placed in a non-surgically form. The percutaneous intragastric balloon catheter is collocated by percutaneous endoscopic gastrotomy (PEG). The invention comprises an affixed valve for regulating the amount of fluid introduced or evacuated from the percutaneous intragastric balloon.

Description

FIELD OF THE INVENTION

This invention relates to gastrostomy devices for use in the treatment of obesity. More particularly, the invention relates to percutaneous balloon catheters positioned in the stomach for medical treatment of morbid obesity in humans.[0001]

BACKGROUND OF THE INVENTION

Morbid obesity is a chronic medical illness defined as overweight of 50 to 100 percent above the ideal body weight. Obesity is a major medical problem affecting millions of people worldwide. In addition to the phychosocial stigmas associated with the condition or disease, many serious health ramifications may develop. Hypertension, hyperlipidemia, exacerbation of diabetes mellitus, heart disease, degenerative arthritis, and Pickwickian syndrome. Certain types of cancer, gallstones, varicose veins, thromboembolism and hernias are more common among overweight individuals. In addition, morbid obesity can lead to psychosocial difficulties such as depression, loss of self-esteem and decreased employability.[0002]

To date, numerous attempts have been made to cause weight loss in morbidly obese patients. None of them have been entirely successful. The weight loss methods can be broadly divided into behavioral modification, vigorous exercise, use of pharmaceuticals, medical diets, surgical procedures and devices.[0003]

The recommended methods for weight loss are medical diets and behavioral modification. However, many persons are unable to achieve significant or sustained results using these methods because they depend solely upon the willpower of the patients. Sometimes vigorous exercise is recommended to achieve an increase in energy output. However many obese individuals risk further damage to their health from such activity (for example, heart attacks).[0004]

Another solution involves pharmaceuticals, their use may cause drawbacks such as the individual becoming addicted or ill-affected by side effects. Sometimes, these drugs become less potent over time due to the development of a high drug tolerance.[0005]

Surgical procedures for treatment of obesity include procedures that lead to weight loss by malabsorption such as jejunoileal or gastric bypass surgery, gastroplasty and gastric stapling and oral surgical procedures such as wiring shut the patient's jaws to reduce food intake. These procedures are usually quite effective in producing weight loss but some of them have been accompanied by serious complications and side effects, including operative mortality as high as three to six percent, postoperative wound infection, liver disfunction and failure, kidney stones, diarrhea and the need for further surgeries to treat intestinal obstruction or hernias, or to revise original surgery because of intolerable side effects.[0006]

In U.S. Pat. No. 4,133,315, Berman proposes placing a distensible device within the lumen of the stomach having a filling tube permanently extended up through the esophagus and out of the nasal cavity or out of the mouth. While this method basically assures retrieval of the balloon upon deflation, the extreme discomfort and major inconvenience for the patient with this method should be selfevident.[0007]

A surgical adjunct is described in U.S. Pat. No. 4,246,893. An inflatable balloon-like device is implanted surgically through an incision in the abdominal wall and the peritoneum into the upper abdomen and anterior to the stomach, reducing its capacity.[0008]

U.S. Pat. Nos. 4,416,267 and 4,899,747 of Garren et al., disclose an intragastric balloon which is discharged into the stomach through an orogastric introducer tube to provide satiety. However, spontaneous deflation of the balloon is possible and passage of the deflated device through the pylorus often results in small bowel obstruction which requires surgery. Also it is believed that the failure to show any significant increased weight loss may be caused by a high incidence of spontaneous balloon deflation. Furthermore this kind of adjunct presents the inconvenience of not regulating the volume of the balloon according to the results in weightloss or gastric discomfort of the patient.[0009]

A similar device for weight loss is set forth in U.S. Pat. Nos. 4,485,805; 4,739,758 and 4,723,547 wherein a free-floating intragastric balloon is placed in the stomach. The intragastric balloon may be withdrawn by endoscopy using a loop that is placed on the balloon. It is believed that mucosal erosion and gastric ulceration in some patients are caused by the cylindrical shape of the device and the balloon edges.[0010]

Catheters are commonly used as providing nourishment and for gastrostomy tubes for the purpose of lavaging a patient's stomach. Such gastrostomy devices have been the subject of U.S. Pat. Nos. 4,315,513 and 4,666,433. The use of an inflatable balloon as part of the tube for holding it in place while feeding or lavaging is set forth in U.S. Pat. Nos. 4,624,657 and 4,861,334.[0011]

A similar device is presented in U.S. Pat. No. 2,687,131; the inflatable balloon is placed adjacent the drainage eyes of the catheter.[0012]

U.S. Pat. No. 4,057,065 presents the use of two balloons within a catheter: the gastrointestinal tube has an inflatable balloon within the stomach to decompress it. A second inflatable balloon is provided at the distal end of the tube which is threatened through the pyloris, jejunum and ligament of Trietz and into the small intestine where it may be inflated.[0013]

Gan et al., in U.S. Pat. No. 5,084,061 propose a free-floating intragastric balloon with a self-sealing valve, using an endoscope for inflating or deflating the balloon.[0014]

Bangs (U.S. Pat. No. 5,234,454), describes a fixation device employing nylon garment T-fasteners to affix the anterior gastric wall to the abdominal wall for percutaneous gastrostomy. Nevertheless the intragastric balloon catheter is placed with surgery.[0015]

U.S. Pat. No. 5,259,399 relates to a bladder being positioned into and withdrawn from the stomach through a percutaneous endoscopic gastrostomy tube permanently placed. The method for collocating the tube is very complex and elaborate.[0016]

Chan et al. (U.S. Pat. No. 5,993,473), mention a device that requires a gastrocutaneous fistula established in the obese individual via a percutaneous endoscopic gastrostomy. The disadvantage is that the fistula track is allowed to mature over a long period of time, from 1 to 2 weeks.[0017]

Notwithstanding the above described art, there continues to be a need for a percutaneous intragastric balloon catheter which can be non-surgically placed in the lumen of the stomach with easy collocation consisting of just one step, of simple and low cost manufacture, with few collateral effects and that will provide satiety to a patient without significant risk of morbidity.[0018]

SUMMARY OF THE INVENTION

It is a first object of the invention to provide an improved percutaneous intragastric balloon catheter for the treatment of obesity.[0019]

It is a second object of the invention to provide an improved percutaneous intragastric balloon catheter which is easily introduced by Percutaneous Endoscopic Gastrostomy (PEG).[0020]

It is a third object of the invention to provide an improved percutaneous intragastric balloon catheter which has a low ulceration and erosion potencial.[0021]

It is a fourth object of the invention to provide an improved percutaneous intragastric balloon catheter which is prevented from moving and/or prevented from excessive movement while in the gastric cavity.[0022]

It is a fifth object of the invention to provide an improved percutaneous intragastric balloon catheter for the gastric cavity which is safe to use causing a feeling of satiety and that achieves less consumption of food by a patient.[0023]

It is a sixth object of the invention to provide an improved percutaneous intragastric balloon catheter having a low risk of small bowel obstruction or esophageal obstruction.[0024]

It is a seventh object of the invention to provide a percutaneous intragastric balloon catheter which comprises an affixed valve, which permits to regulate the volume (filling and emptying) of the percutaneous intragastric balloon since the placement procedure thorough the treatment.[0025]

In one aspect of the invention, a percutaneous intragastric balloon catheter is provided to cause weight loss in obese persons by occupying a portion of the stomach volume. The balloon catheter is positioned into the stomach through the “Pull” or “Push” technique, more especifically by Percutaneous Endoscopic Gastrostomy (PEG) and withdrawn by endoscopy, both are non-surgical procedures.[0026]

The balloon is filled to occupy a large portion of the stomach to cause a feeling of satiety and to decrease the consumption of food by an obese patient. The emptying of the balloon provides periods of reduced trauma to the stomach.[0027]

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 shows a longitudinal cross-sectional view of the percutaneous intragastric balloon catheter in its inflated position according to the present invention.[0029]

FIGS. 2 and 3 show the placement procedure for the percutaneous intragastric balloon catheter.[0030]

FIG. 4 shows a partial longitudinal cross-sectional view of the percutaneous intragastric balloon catheter within the gastric cavity of a person.[0031]

DESCRIPTION OF THE PREFERRED EMBODIMENTS

With reference to FIG. 1, the present invention, the percutaneous intragastric balloon catheter, is depicted by the[0032]

number

1. It comprises a non-rigid circular plastic fillant catheter6 having a distal end that includes a slot11, through which the fluid fills the percutaneous intragastric balloon10, shown in its inflated position. The aforementioned fluid may be a gas, liquid, gel or a mixture thereof. An internal anchor9 is placed near the distal end of the fillant catheter to prevent excessive movement of the percutaneous balloon10 while in the gastric cavity. As it can be appreciated in this figure, after internal anchor9 there is a portion8 of the fillant catheter. This portion8 trespasses the abdominal wall. The external anchor7 has the purpose of securing the percutaneous intragastric balloon10 to the outside flank of the abdominal wall. On the proximal end of the fillant catheter6 there is a valve5 for allowing the fillant fluid to be introduced and evacuated from the fillant catheter6. The purpose ofdetachable cover3 is to envelop the extreme end of the valve5, where the fillant device13 (FIG. 4) is connected, during the placement procedure (FIG. 2) and to facilitate the passage of the valve5 and fillant catheter6 through the tiny incision on the skin made by a needle, as described in FIG. 2. On the surface of the valve5 and underneath thedetachable cover3, a filament orthread2 is positioned as means for attaching the guidewire15 (FIG. 2) during the process of collocation.

FIGS. 2 and 3 show the placement procedure, and function of the components of the percutaneous intragastric balloon catheter, that include: inspecting with an endoscope[0033]16 the lumen of the stomach of the obese person. The endoscope16 is introduced through the mouth down the esophagus into the stomach, with a needle puncturing the abdominal wall12, through this puncture in the abdominal wall inserting the guidewire15 from the outside into the fundus of the stomach, and grasping with the endoscope16 the said guidewire15. Extracting one end of the guidewire15 by pulling the endoscope16 out of the mouth while the other end of the guidewire15 still remains outside of the abdomen12. The percutaneousintragastric balloon catheter1 is placed through the abdominal wall12 by attaching the filament orthread2 of the percutaneousintragastric balloon catheter1 to the guidewire15 extended out of the patient's mouth and pulling on the other end of the guidewire15 until the filament orthread2 of the percutaneousintragastric balloon catheter1 is pulled through the puncture opening in the abdominal wall12. The placed percutaneousintragastric balloon catheter1 is secured on the stomach wall with the internal anchor9, then the external anchor7 is collocated through the proximal end, after the procedure of Percutaneous Endoscopic Gastrostomy (PEG), further securing themedical device1 on the abdominal wall. As it can be seen in both figures, a plastic membrane14 is covering the percutaneousintragastric balloon catheter1. This membrane14 has the function of compacting the percutaneous intragastric balloon, also the membrane14 can be covered with a biocompatible lubricant to facilitate the passage through the mouth, esophagus and stomach. After the placement procedure, the membrane14 is removed (FIG. 3) using biopsy clamps17 attached to an endoscope16.

FIG. 4 shows the percutaneous[0034]

intragastric balloon catheter

1 as it is collocated within the gastric cavity of a person. In this figure, it can be appreciate that the percutaneous intragastric balloon10, in its inflated position, has a smooth surface to prevent gastric erosion. Anchors7 and9 are holding the percutaneousintragastric balloon catheter1 attached to the abdominal wall12 preventing accidental withdrawal of the percutaneous intragastric balloon associated with deflation and passage of the above mentioned balloon into the small bowel and esophagus. Valve5 is connected with the fillant device13 that provides an adequate amount of fluid for filling the percutaneous intragastric balloon10, as it can be observed in the schematic representation. Fillant device13 may be a pump or a hypodermic syringe that forces the fluid in and out of the percutaneous intragastric balloon10.

Based upon the foregoing disclosure, certain embodiments and details have been described for the purpose of illustrating the present invention, it will be apparent to those skilled in the art that variations and modifications may be made without departing from the scope of the invention.[0035]

Claims

What is claimed is:

1. A percutaneous intragastric balloon catheter for the treatment of obesity that occupies a segment of the stomach volume, said device comprising:

a percutaneous intragastric balloon shaped for occupying a portion of the gastric cavity;

a fillant catheter connected to said percutaneous intragastric balloon for repeated filling and emptying with a fluid and as means for supporting two anchors and a valve;

two anchors, external and internal, for providing suitable surfaces that prevent movement of the percutaneous intragastric balloon catheter while in the gastric cavity;

a valve for controlling the amount of fluid introduced or evacuated from the percutaneous intragastric balloon through the fillant catheter;

a detachable cover that envelopes the extreme end of the valve, which connects with the fillant device, during the placement procedure; and,

a fillant device that is loaded with the appropriate amount of fluid for filling the percutaneous intragastric balloon.

2. The percutaneous intragastric balloon catheter of

claim 1

, wherein said percutaneous intragastric balloon, in its non-inflated position, is covered with a plastic membrane during the placement procedure.

3. The percutaneous intragastric balloon catheter of

claim 1

, which is easily positioned into the stomach through the “Pull” or “Push” technique, a preferred embodiment is by Percutaneous Endoscopic Gastrostomy (PEG); and withdrawn by endoscopy.

4. The percutaneous intragastric balloon catheter of

claim 1

, wherein said percutaneous intragastric balloon has a smooth surface and is preferably constructed of a durable and biocompatible material, such as surgical grade latex rubber.

5. The percutaneous intragastric balloon catheter of

claim 1

, wherein said fillant catheter is non-rigid, circular and made of a plastic material.

6. The percutaneous intragastric balloon catheter of

claim 1

, wherein said fluid may be a gas, liquid, gel or a mixture thereof.

7. The percutaneous intragastric balloon catheter of

claim 1

, wherein a filament or thread is positioned on the surface of said valve and underneath said detachable cover as means for facilitating the placement procedure.

8. The percutaneous intragastric balloon catheter of

claim 1

, wherein said external anchor is collocated on the abdominal wall after the placement procedure.

9. The percutaneous intragastric balloon catheter of

claim 1

, wherein said fillant device may be a pump or a hypodermic syringe.