US20100256632A1 - Large area thermal ablation - Google Patents

Abstract

A large area thermal ablation apparatus for use with an endoscope includes a housing and at least one electrode. The housing is removably attachable to a distal terminating end of the endoscope. The housing includes an outer surface and a cross-sectional area that is at least as large as a cross-sectional area of the distal terminating end of the endoscope. The electrode is supported by the outer surface of the housing. The electrode is capable of delivering energy to a tissue region inside a body to ablate the tissue region.

Description

CROSS-REFERENCE TO RELATED CASE
• This application claims priority to and claims the benefit of U.S. provisional patent application Ser. No. 60/103,060 filed Oct. 5, 1998, which provisional application is incorporated herein by reference.
TECHNICAL FIELD
• The invention relates to thermal ablation and, more particularly, to thermal ablation apparatus for use with an endoscope.
BACKGROUND INFORMATION
• Thermal ablation of tissue can be performed to remove diseased tissue, such as precancerous or cancerous tissue. For example, thermal ablation has been used in the treatment of Barrett's esophagus, which is a precancerous condition. Thermal ablation can also be performed to remove old tissue and to provide a new surface to support growth of new tissue. Typically, thermal ablation is performed by passing an electrode through a working channel of an endoscope, placing the electrode near the tissue region to be treated and applying radio-frequency (RF) energy to the electrode. An advantage of this technique is that the procedure can be performed under direct visualization. A disadvantage of this technique is that the diameter of the electrode is necessarily limited by the small diameter of the working channel of the endoscope. As a result, the electrode can only treat a small area of the tissue at a time.
• In some precancerous conditions that may be treatable via thermal ablation, the area to be treated is relatively large with respect to the electrode, resulting in very long procedure times, irregular or incomplete ablation, and variations in the depth of the ablative effect. The inability to control sufficiently the depth of the ablation procedure can lead to charring or perforation of the tissue or a failure to reduce significantly the number of precancerous cells to sufficiently low level.
• Attempts have been made to provide large electrodes to overcome these limitations. For example, electrodes have been provided on expandable surfaces such as balloons. These apparatuses, however, have been limited to some extent by the diameter of the accessory channel of an endoscope.
SUMMARY OF THE INVENTION
• In general, the invention relates to thermal ablation of a large tissue area. Thermal ablation apparatuses, according to the invention, are designed for use with an endoscope.
• In one aspect, the invention features an apparatus for use with an endoscope which includes a housing and at least one electrode. The housing is removably attachable to a distal terminating end of the endoscope. The housing includes an outer surface and a cross-sectional area that is at least as large as a cross-sectional area of the distal terminating end of the endoscope. The electrode is supported by at least a portion of the outer surface of the housing. The electrode is capable of delivering energy to a tissue region inside a body to ablate the tissue region.
• Embodiments of this aspect of the invention can include the following features.
• In one embodiment, the housing comprises an insulator. For example, the housing can comprise a thermal insulator and/or an electrical insulator. At least a portion of the housing can be transparent. Examples of materials suitable for forming the housing include, but are not limited to, a ceramic material, a glass, and a polymeric material. The housing can be substantially ring-shaped. In another embodiment, the housing includes a distal end and a proximal end. The proximal end comprises an elastomeric material and is sized and shaped to slip over the distal terminating end of the endoscope.
• In one embodiment, at least one electrode includes a pattern. For example, the pattern can comprise a row of linear elements or a helical pattern. The electrode can be monopolar or bipolar. The housing can include at least one groove and the electrode can be positioned in the groove. The apparatus can further include an electrical conduit in electrical communication with at least one electrode. For example, the electrical conduit can be a wire, a pair of twisted wires, or a coaxial conductor.
• In another aspect, the invention features an apparatus for use with an endoscope which includes a sheath, a housing, and at least one electrode. The sheath includes a first channel for receiving the endoscope. The housing is attached to a distal end of the sheath. The housing includes an outer surface and a cross-sectional area at least as large as a cross-sectional area of a distal terminating end of the endoscope. The electrode is supported by at least a portion of the outer surface of the housing. The electrode is capable of delivering energy to a tissue region inside a body to ablate the tissue region.
• Embodiments of this aspect of the invention can include the following features.
• In one embodiment, the sheath further includes a second channel coextensive with the first channel. An electrical conduit is disposed in the second channel. The electrical conduit is in electrical communication with at least one electrode. In another embodiment, the sheath further includes a second channel coextensive with the first channel for receiving a fluid. The sheath can comprise polyethylene. The sheath can have a thickness in the range from about 0.015 inches to about 0.085 inches.
• In another aspect, the invention features a medical apparatus which includes an endoscope, a housing, and at least one electrode. The endoscope terminates at a distal end. The housing is removably attachable to the distal end of the endoscope. The housing includes an outer surface and a cross-sectional area at least as large as a cross-sectional area of the distal end of the endoscope. The electrode is supported by at least a portion of the outer surface of the housing. The housing is capable of delivering energy to a tissue region inside a body to ablate the tissue region.
• In another aspect, the invention features a medical apparatus which includes an endoscope, a sheath, and at least one electrode. The endoscope terminates at a distal end. The sheath comprises a channel for receiving the endoscope and a housing attached to a distal end of the sheath. The housing includes an outer surface and a cross-sectional area at least as large as a cross-sectional area of the distal end of the endoscope. The electrode is supported by at least a portion of the outer surface of the housing. The electrode is capable of delivering energy to a tissue region inside a body to ablate the tissue region.
• In another aspect, the invention features a method of treating tissue in a body which includes the following steps. A housing is removably attached to a distal terminating end of an endoscope. The housing is removably attachable to the distal terminating end of an endoscope. The housing includes an outer surface supporting at least one electrode on at least a portion of the outer surface and a cross-sectional area at least as large as a cross-sectional area of the distal terminating end of the endoscope. The endoscope and the housing are inserted inside the body near a tissue region to be treated. Energy is applied to at least one electrode to treat the tissue region.
• In one embodiment, at least one electrode is connected to a power source through an electrical conduit housed in a channel of the endoscope. In another embodiment, a housing comprising at least one aperture is attached to the distal terminating end of the endoscope and a fluid is provided to the tissue region through the aperture. The fluid can be a cooling fluid, a flushing fluid and/or a conductive fluid. In still another embodiment, the tissue region is illuminated and an optical property of the tissue region is detected.
• In another aspect, the invention features a method of treating tissue in a body including the following steps. A sheath comprising a channel for receiving an endoscope and a housing attached to a distal end of the sheath is provided. The housing includes an outer surface supporting at least one electrode on at least a portion of the outer surface and a cross-sectional area at least as large as a cross-sectional area of a distal terminating end of the endoscope. An endoscope is inserted inside the channel of the sheath, such that the housing is positioned near the distal terminating end of the endoscope. The sheath and the endoscope are inserted inside the body near a tissue region to be treated. Energy is applied to at least one electrode to treat the tissue region.
• In one embodiment, at least one electrode is connected to a power source through an electrical conduit housed in a second channel of the sheath. In another embodiment, energy is applied to the tissue region to ablate the tissue region.
• In another aspect, the invention features a method of manufacturing an ablation apparatus including the following steps. A housing is provided. A slurry comprising a conductive material and a solution is also provided. The slurry is applied to at least a portion of a surface of the housing. The solution is removed from the slurry applied on the surface of the housing to form an electrode comprising the conductive material on the surface of the housing.
• In one embodiment, a slurry including a conductive material is printed on the surface of the housing. In another embodiment, the slurry including a conductive material is applied to the housing by spraying, brushing or dipping the housing into the slurry.
• In another embodiment, the slurry is heated to remove the solution and to melt or reflow the conductive material.
• In yet another embodiment, a housing comprising at least one groove is provided. The solution in the slurry applied to the surface of the housing is removed to form the electrode in the groove of the housing.
• The foregoing and other objects, aspects, features, and advantages of the invention will become more apparent from the following description and from the claims.
BRIEF DESCRIPTION OF THE DRAWINGS
• In the drawings, like reference characters generally refer to the same parts throughout the different views. Also, the drawings are not necessarily to scale; emphasis instead generally being placed upon illustrating the principles of the invention.
• FIG. 1ais a side view of a thermal ablation apparatus for use with an endoscope according to one embodiment of the invention.
• FIG. 1bis an end view of the thermal ablation apparatus ofFIG. 1.
• FIG. 2 is a partial cross-sectional view of the thermal ablation apparatus ofFIG. 1 mounted at the distal terminating end of an endoscope.
• FIG. 3 is a partial cross-sectional view of a thermal ablation apparatus having a coextensive outer sheath arrangement disposed over a typical endoscope, according to one embodiment of the invention.
• FIG. 4 is a cross-sectional view of a thermal ablation apparatus according to another embodiment of the invention.
• FIG. 5 is a perspective view of a power source and an electrical conduit arrangement for mating with a thermal ablation apparatus according to one embodiment of the invention.
• FIG. 6ais a side view of a housing of a thermal ablation apparatus according to one embodiment of the invention.
• FIG. 6billustrates a step in a method of manufacturing a thermal ablation apparatus according to one embodiment of the invention.
• FIG. 6cillustrates another step in a method of manufacturing a thermal ablation apparatus according to one embodiment of the invention.
• FIG. 6dillustrates another step in a method of manufacturing a thermal ablation apparatus according to one embodiment of the invention.
• FIG. 7 is a schematic cross-sectional view of a thermal ablation apparatus including a light assembly and a light modulator disposed in a housing according to another embodiment of invention.
• FIG. 8 is a detailed view of the light modulator assembly of the thermal ablation apparatus ofFIG. 7.
DESCRIPTION
• Referring toFIGS. 1aand1b, athermal ablation apparatus10 includes ahousing1 andmultiple electrodes9 supported by thehousing1. Thehousing1 has adistal end3 and aproximal end5. Thedistal end3 of thehousing1 supports theelectrodes9. Theproximal end5 of thehousing1 is designed to attach removably to a distal terminatingend28 of anendoscope21, as shown inFIG. 2. Thehousing1 is “removably attachable” to the distal terminatingend28 of theendoscope21 in that thehousing1 can be attached and detached from the distal terminatingend28 of anendoscope21 any number of times without affecting or changing the functionality of theendoscope21 itself. Thehousing1 is not formed integrally with the distal terminatingend28 of theendoscope21, but instead is placeable on and removable from the distal terminatingend28 of theendoscope21 as a separate piece. In one embodiment, thehousing1 has a generally cylindrical shape. In another embodiment, thehousing1 is a cap-like structure.
• Thedistal end3 of thehousing1 can be constructed of a non-conductive material. Ahousing1 made of a non-conductive material provides electrical isolation betweenmultiple electrodes9 supported by thehousing1. Thedistal end3 of thehousing1 can also be constructed of a thermally insulating material. Ahousing1 made of a thermally insulating material protects theendoscope21 from heat generated by theelectrodes9 during an ablation procedure. In some embodiments, the source of the thermal energy can be very close to areas of theendoscope21 that can be damaged by the thermal energy. Therefore, in these situations, ahousing1 made of thermally insulating material can be essential to ensuring the usefulness of theendoscope21.
• Thehousing1 can further be made of an optically transparent material, for example, glass tubing. Ahousing1 made of an optically transparent material allows an operator to observe the ablation procedure through spaces between theelectrodes9. Examples of materials suitable for forming thehousing1 include, but are not limited to, ceramic material, glass, and plastic material. In one embodiment, thehousing1 can be made of a ceramic material that can be molded or machined into a suitable shape and subsequently fired to form thehousing1. Advantages of ahousing1 comprising a ceramic material include low heat transfer, low cost and good adhesion properties. In another embodiment, thehousing1 can made of glass that is generally shaped or molded by heat. Advantages of ahousing1 comprising glass is that glass allows an operator the opportunity to observe the ablation procedure. In yet another embodiment, thehousing1 can be made of polymers such as polyimide or polysulfone, or a high temperature, epoxy resin such as phenol-formaldehyde resin. The advantage of using these materials is that they can be made to be optically transparent.
• Theproximal end5 of thehousing1 can be constructed of an elastomeric material. The elastomeric material can be stretched to slip over the distal terminatingend28 of theendoscope21 and provide a relatively secure mounting that can still allow flexure between thehousing1 relative to theendoscope21. Examples of suitable elastomeric materials for constructing theproximal end5 of thehousing1 include, but are not limited to silicone and rubber.
• An outer diameter of theproximal end5 can be similar to an outer diameter of thedistal end3 so that theentire housing1 has a generally uniform diameter. Thedistal end3 and theproximal end5 of thehousing1 can be connected via alap joint7. Thelap joint7 provides an overlapping surface for placing an epoxy. The epoxy provides a firm attachment of theproximal end5 to thedistal end3 of thehousing1. Alternatively, a filament can be tightly tied around the lap joint7 to provide a firm attachment of theproximal end5 to thedistal end3 of thehousing1.
• Referring toFIG. 2, thedistal end3 of thehousing1 can be relatively short in length to minimize obstruction of the view provided by a typically wide-angle view of theendoscope21. In one embodiment, thehousing1 does not protrude significantly beyond the distal terminatingend28 of theendoscope21. The distance between thedistal end3 of thehousing1 and the distal terminatingend28 of theendoscope21 can be easily adjusted due to a generally cylindrical and coaxial configuration of thehousing1. Thehousing1 can be slid into various axial positions along the length of the distal end of theendoscope21, and further be repositioned as needed. Various types of stops, marks, location dots or the like can be placed along theendoscope21 or thethermal ablation apparatus10 to aid alignment of thethermal ablation apparatus10 and theendoscope21. Radial positioning of thethermal ablation apparatus10 relative to theendoscope21 can also be accomplished by rotating thehousing1 relative to theendoscope21 with the aid of location marks, stops or other reference points or indicia located on thehousing1 or other portion of thethermal ablation apparatus10 in such a way as to be easily visible and evident to an operator.
• In another embodiment, an articulatedhousing1 provides operating flexibility and reduces the need forendoscope21 manipulation. Articulation of thehousing1 relative to theendoscope21 can be achieved through the use of a secondary force. Examples of secondary forces include, but are not limited to, water and air pressure. The secondary force can also be a guidewire.
• In the embodiment ofFIGS. 1aand1b, an outer surface of thedistal end3 of thehousing1 supportsmultiple electrodes9 that are spaced apart and electrically connected to each other. Theelectrodes9 are constructed of a conductive material. Examples of suitable conductive materials for forming theelectrodes9 include, but are not limited to, copper foil, gold plating, and sintered or renown metal and wires. In one embodiment, theelectrodes9 are formed in a pattern for varying the application of energy to a tissue region. For example, theelectrodes9 can form a helical pattern or a dotted linear pattern. In another embodiment, the patterns comprise a bipolar arrangement of interspersed electrodes. The electrode patterns can be placed around the circumference of thehousing1 or at adistal end3 of thehousing1. Alternatively, theelectrodes9 can be disposed over a more limited area, angle or position on thehousing1. The shape and thickness of theelectrodes9 can also vary as desired.
• Thethermal ablation apparatus10 further includes anelectrical conduit11 connected to theelectrodes9 at a distal end. Referring toFIG. 1b, theelectrodes9 are placed radially from the circumference of thehousing1. Theelectrodes9 are connected to theelectrical conduit11 viaapertures13. This arrangement allows all theelectrodes9 to be connected to a power source by anelectrical conduit11 that can be passed through the workingchannel24 of anendoscope21. Theelectrical conduit11 has aconnector15 at a proximal end. Theelectrical conduit11 can be a pair of wires. The pair of wires can be in the form of a twisted pair such as pigtail wires, as shown inFIG. 1, or a coaxial conductor. Alternatively, theelectrical conduit11 can be a single wire. The wires can be insulated. Theconnector15 can be a single pin connector or a multi-pin connector. As shown inFIG. 2, theelectrical conduit11 of thethermal ablation apparatus10 is coupled to a secondelectrical conduit23 which extends from a power source. Theelectrical conduit11 and the secondelectrical conduit23 are mated through theconnectors15,25. Theelectrical conduits11,23 are positioned inside a workingchannel24 of theendoscope21. Afluid sealing ring47 can be provided at a junction where the twoconnectors15 and25 mate. Thefluid sealing ring47 prevents any fluid from infiltrating theelectrical conduits11,23 should the workingchannel24 accommodate both theelectrical conduits11,23 and a fluid.
• Referring toFIG. 3, athermal ablation apparatus30 includes acoextensive sheath35 having afirst channel39 for receiving anendoscope21′, ahousing1′ attached to a distal end of thesheath35, andmultiple electrodes9′ supported by the outer surface of thehousing1′. Theendoscope21′ is inserted inside thefirst channel39 of thesheath35, such that the distal terminatingend28′ of theendoscope21′ is positioned next to thehousing1′.
• In one embodiment, thesheath35 is long enough to extend along the entire length of theendoscope21′. Alternatively, the length of thesheath35 can be shorter than the length of theendoscope21′ such that the proximal end of theendoscope21′ is exposed outside thesheath35. Thesheath35 can be made of a flexible material that permits some flexure between thesheath35 and thehousing1′, but still maintain a sufficiently fixed relationship between the two. For example, thesheath35 can be constructed of polyethylene. Asheath35 made of polyethylene with a wall thickness of about 0.015″ to about 0.085″ provides reasonable strength and flexibility. In addition, thesheath35 can be made to conform to the size and shape of theendoscope21′, thus eliminating the need for thehousing1′ to have a separate elastomeric proximal end which fits over the distal terminatingend28′ of theendoscope21′. Alternatively, the proximal end of thehousing1′ can be designed to fit over the distal terminatingend28′ of theendoscope21′.
• In the embodiment ofFIG. 3, thesheath35 has a coextensivesecond channel33. Thesecond channel33 can extend from the distal end of thesheath35 near thehousing1′ through the entire length of thesheath35 and terminate in a small opening near the proximal end of thesheath35. Thesecond channel33 can be used to accommodate anelectrical conduit31 connecting theelectrodes9′ to a power source. Thesecond channel33 can also be used to deliver a fluid to a tissue region or to remove a bodily fluid from a tissue region. Examples of fluids that can be delivered to the tissue include, but are not limited to, cooling, cleaning, flushing, and conducting fluids. Thesecond channel33 may be formed onto thesheath35 by coextrusion processes.
• Thethermal ablation apparatus30 includes astop ring37. Thestop ring37 controls the position of thehousing1′ relative to theendoscope21′. Changing the position of thestop ring37 relative to thehousing1′ changes the position of thehousing1′ relative to the distal terminatingend28′ of theendoscope21′. Thus, the further away thestop ring37 is from the distal end of thehousing1′, the further away the distal end of thehousing1′ is from the distal terminatingend28′ of theendoscope21′. Therefore, thestop ring37 can prevent thehousing1′ from slipping too far over the distal end of theendoscope21′. Thestop ring37 can be generally circular in shape. Since thestop ring37 allows the position of thehousing1′ to be altered relative to the distal terminatingend28′ of theendoscope21′, thethermal ablation apparatus30 can be used with a large number of types and various sizes of endoscopes. Different types of endoscopes usable with thethermal ablation apparatus30 include those used for surgical procedures and for exploratory procedures in areas of the body such as the oral and gastrointestinal tract. The endoscopes can also be flexible or rigid.
• FIG. 4 shows another embodiment of a thermal ablation apparatus of the present invention. Thethermal ablation apparatus40 includes ahousing1″ having an array ofapertures43 andmultiple electrodes9″ provided at thedistal end41 of thehousing1″.
• This embodiment is useful for thermal ablation procedures performed with a fluid. Examples of fluids used in a thermal ablation procedure include, but are not limited to, cooling, cleaning, flushing and conducting fluids. These fluids can enhance the thermal ablation procedure by cooling and/or cleaning the treatment region by flushing or irrigating with a fluid. Application of a conductive fluid can improve the electrical contact between theelectrode9″ and the tissue during the thermal ablation procedure. Saline is an example of a fluid that can be used as a flushing as well as a conducting fluid. Theapertures43 permit the flow of the fluid to the tissue region. Theapertures43 can also permit a bodily fluid to be removed from the tissue region. In one embodiment, thedistal end41 of thehousing1″ can be made foraminous by providing pores orapertures43 to thedistal end41 of thehousing1″. For example, a porous ceramic can form thehousing1″. Alternatively, plastic or a relatively transparent material such as glass can be made foraminous by drilling microapertures in the material.
• Theelectrodes9″ supported by the outer surface of thehousing1″ are interdigitated with alternatingelectrodes42,44. Theelectrodes42 are connected to each other and to awire52. Theelectrodes44 are connected to each other and to awire54. Theelectrodes42 can be positively charged and theelectrodes44 can be negatively charged. A positively chargedelectrode42 is positioned adjacent a negatively chargedelectrode44 with an insulator region separating the twoelectrodes42,44. The distance between theelectrodes42,44 determines the depth of penetration of the ablative energy into a tissue region, since current flows from a negative chargedelectrode44 to an adjacent positively chargedelectrode42 through a tissue region near the twoelectrodes42,44. The further apart theadjacent electrodes42,44 are, the greater the distance the current has to flow through the tissue, thus causing a deeper penetration of the ablative energy into the tissue.
• In the embodiment ofFIG. 4, theelectrodes42,44 are placed near theapertures43, and a conductive fluid can be delivered to a tissue region through theapertures43. Placing theelectrodes42,44 near theapertures43 allows theelectrodes42,44 to be in close contact with the conducting fluid, permitting an even and controlled application of RF energy to the tissue region. Thethermal ablation apparatus40 includes anelectrical conduit11″ connected toelectrodes9″ at a distal end. Theelectrical conduit11″ has anelectrical connector15″ at a proximal end. Theelectrical connector15″ has a sealingring47′. The sealingring47′ prevents fluids such as saline from entering and possibly interfering with the connections between theelectrical connector15″ to another electrical connector. The sealingring47′ can be made of rubber.
• Referring toFIG. 5, anelectrical conduit23′ is used for connecting a thermal ablation apparatus (exemplary embodiments of which are shown inFIGS. 1,3, and4) to apower source57. Theelectrical conduit23′ terminates with a pair ofplugs55 at a proximal end and aconnector25 at a distal end. Theplugs55 can be banana plugs. Theelectrical conduit23′ also includes astopper59 positioned along theelectrical conduit23′. Thestopper59 adjusts the length ofelectrical conduit23′ placed in the workingchannel24 of anendoscope21, as shown inFIG. 2. Thestopper59 can be made of rubber.
• Thepower source57 can be a RF energy source. Thepower source57 includesjacks59 to accept theplugs55, arheostat61 to control the duration of the RF energy applied to the thermal ablation apparatus and afloor foot pedal63 for activating the application of RF energy to the thermal ablation apparatus as desired by the operator.
• Prior to performing a thermal ablation procedure, anelectrical conduit23′ is passed through the workingchannel24 of anendoscope21, as shown inFIG. 2, so that the distal end of theconduit23′ protrudes from the distal end of the workingchannel24 of theendoscope21. Theelectrical conduit23′ is allowed to protrude out of the distal terminatingend28 of theendoscope21 to a length sufficient to allow a person's fingers to mate theconnectors15,25′. In one embodiment, astopper59 provided along theelectrical conduit23′ is adjusted prior to passing theelectrical conduit23′ through the workingchannel24 to control the amount ofelectrical conduit23′ that is allowed to protrude out the distal end of theendoscope21. Theconnectors15 and25 are mated, and theelectrical conduits11,23′ are slid back into the workingchannel24 of theendoscope21. Thehousing1 is fit over the distal terminatingend28 of theendoscope21. Theplugs55 at the proximal end of theelectrical conduit23′ are plugged into thejacks59 of thepower source57, if it has not already been done. Under endoscopic guidance, theendoscope21 and thehousing1 are inserted into a body and positioned near a tissue region to be treated. The thermal ablation apparatus is positioned near the tissue region and RF energy of a selected duration and amplitude is applied to theelectrodes9 to ablate the tissue. In one embodiment, thehousing1 is at least partially transparent and the ablation procedure is monitored through the transparent spaces between theelectrodes9.
• FIGS. 6a-6dillustrate a method of fabricating an electrode of a thermal ablation apparatus. Ahousing61 havinggrooves63 is provided as shown inFIG. 6a. Thehousing61 can be made of a ceramic, polymeric, or glass material. Thegrooves63 can be machined in thehousing61. Alternatively, a base material for thehousing61 can be molded to form thehousing61 with thegrooves63. Thegrooves63 define a desired electrode pattern. In the embodiment ofFIGS. 6a-6d, thegrooves63 form a helical pattern.
• Aslurry65 comprising a conductive material is applied to the outer surface of thehousing61 as shown inFIG. 6b. Theslurry65 can be applied through any appropriate means such as spraying, dipping, and brushing. Theslurry65 can comprise a water-based weak glue, such as a solution of glycerin and water, mixed with powdered metal. For example, theslurry65 can include powder made from gold, silver, antimony, or tin. Theslurry65 can also be silver bearing epoxy. In one embodiment, the conductive material included in theslurry65 has a melting temperature which is lower than a melting temperature of a base material for thehousing61. In another embodiment, the conductive material has low toxicity. Theslurry65 applied to thehousing61 is dried to remove any fluid, gas or other volatile substance contained in theslurry65. Theslurry65 can be dried at room temperature or at an elevated temperature.
• Thehousing61 and the driedslurry65 are heated. Heating burns off any remaining volatile substance in theslurry65 and melts the conductive material. The molten conductive material flows into thegrooves63 and covers at least a portion of the outer surface of thehousing61. An appropriate duration and temperature of the heating step depends on several factors including the composition of theslurry65. In one embodiment, heat is applied slowly to reduce the generation of gas bubbles that can cause pinholes or lifting of the conductive material from thehousing61. Subsequent to the heating step, thehousing61 comprising the conductive material is cooled. After cooling, the conductive material is fused to thehousing61. In one embodiment, thehousing61 is cooled slowly or tempered to prevent the conductive material from cracking, peeling, shattering or otherwise breaking away from thehousing61.
• Once thehousing61 has cooled, the fused conductive material provided on the protruding surfaces62 of thehousing61 is removed. The conducting material can be removed by machining. For example, ahardened cutting tool69 can be moved across the protruding surfaces62 of thehousing61, as thehousing61 is simultaneously turned to remove the conductive material, as is commonly done in lathe operations. Alternatively, a grinding operation, such as centerless grinding, can be employed to remove the conductive material on the protrudingsurface62 of thehousing61.
• In other embodiments, theslurry65 is printed or dispensed over thegrooves63 of thehousing61, eliminating the need for the subsequent machining step. Alternatively, theslurry65 can be printed or dispensed over a smooth surface of thehousing61, thereby creating conductive regions that are raised above the general surface of thehousing61. An advantage of raising the conductive material above the surface of thehousing61 is improved electrode to tissue contact. A further advantage of using the printing or dispensing method is that it can be a less expensive method of fabrication. For example, the printing of a conductive ink or epoxy, such as silver epoxy, can produce a low cost, albeit somewhat less durable, pattern of conductive material on ceramic, glass, and substrates that cannot withstand the application of very high temperatures such as plastics. In still other embodiments, electroplating conductive materials upon various substrates can be employed in the construction of the thermal ablation apparatus, as long as the electroplated layer is of sufficient conductivity to carry the current and make contact with the subject tissue. The electroplated electrodes on thehousing61 can be further modified by chemical etchings.
• The use of electrodes to apply RF energy in ablation procedures is just one useful mode of operation. The housing of the thermal ablation apparatus can also be equipped with spectroscopic, light filtering and light emitting devices for performing tissue spectroscopy.
• Referring toFIG. 7, athermal ablation apparatus70 includes ahousing72 which can be removably attached to the distal terminating end of an endoscope. Thehousing72 includes alight source102 and alight modulator104 disposed in thehousing72, as substantially described in co-pending commonly-owned U.S. patent application Ser. No. 08/939,706 filed on Sep. 9, 1997, the entire contents of which are incorporated herein by reference. Thehousing72 further includes at least oneelectrode74 supported by the outer surface of thehousing72. Thelight source102 illuminates tissue within the body. Thelight source102 can include, without limitation, a light emitting diode, a laser, a pulsed light source, a source of ultraviolet energy, or a flashlamp. Thelight modulator104 modifies the light emitted by thelight source102. Thelight modulator104 can include a filter providing a range of wavelengths to the optical channel of the endoscope. The filter can include, without limitation, an acousto-optic tunable filter, an interference filter, a grating, a prism, a holographic filter, a birefringent filter, or other component that provides a spectral passband. Thelight modulator104 can also include a shutter. The shutter, for example, can comprise a liquid crystal device. This embodiment allows the tissue to be characterized by tissue spectroscopy prior to thermal ablation.
• FIG. 8 shows a detailedlight modulator assembly75 disposed within thehousing72 as shown inFIG. 7. Aliquid crystal shutter81 and an adjacent acousto-optic tunable filter (AOTF)83 are mounted on a surface of thethermal ablation apparatus70 with an adhesive. Ametal mounting block99 provides a mounting surface for the individual components of theshutter81 and theAOTF83. The AOTF control leads101 and shutter control leads103 extend through recess channels (not shown). Theliquid crystal shutter81 includes aliquid crystal85 located between twoelectrodes87. Theelectrodes87 can be metalization layers on glass covers89. When an electric field is applied between theelectrodes87, light passing through theliquid crystal85 becomes polarized. Apolarizing filter91 is aligned for cross-polarization with theliquid crystal85 in its active state. Therefore, when an electrical signal is applied to theelectrodes87, optical energy is prevented from passing to the optical channel of the endoscope. An electrical signal can be applied for the duration of the optical pulse from a flashtube in order to momentarily shutter the optical channel.
• An electrical signal applied to both sides of theelectrodes93 of theAOTF83 changes the refractive index of theAOTF crystal95 and polarizes the transmitted optical energy. Attenuation or selection of specific wavelengths is achieved when theAOTF crystal95 is used in conjunction withpolarizing filters97. Voltage applied to theelectrodes93 controls the selected wavelength, allowing transmission of specific colors while rejecting other colors.
• Thermal ablation apparatuses and procedures of the present invention can be imported to other procedures that can benefit from the application of thermal energy, such as afforded by RF and electrode contact. Procedures such as coagulation and tamponade used to stop bleeding of esophageal varices, ulcerations, and resected margins can also benefit from providing an apparatus which can treat a large tissue region at a time. Other procedures that currently use catheter devices that are small and may not apply enough force over a sufficiently large area can also benefit from the present invention.
• The thermal ablation apparatus of the present invention provides several advantages. The proximity of the thermal ablation apparatus to the distal end of the endoscope afforded by the present invention allows for closer and more precise control of the thermal ablative procedure as compared to other procedures performed with conventional methods. The present invention also allows the endoscope to be manipulated by a user to apply firm, even and well controlled pressure, tamponade and directional inputs to the ablation apparatus at the tissue interface. In addition to RF energy, light, heat, and cold (e.g. via cryogenic fluids) can be delivered inside a body by providing appropriate compounds inside a housing which is removably attached to a distal end of an endoscope. A further advantage is that it provides the user the ability to perform procedures quickly, easily and less expensively with a wide variety of endoscopes.
• Variations, modifications, and other implementations of what is described herein will occur to those of ordinary skill in the art without departing from the spirit and the scope of the invention as claimed. Accordingly, the invention is to be defined not by the preceding illustrative description but instead by the spirit and scope of the following claims.

Claims (21)

1-60. (canceled)

61. An apparatus for use with an endoscope comprising:

an articulating housing removably attachable to a distal terminating end of the endoscope, the housing comprising an outer surface and a cross-sectional area at least as large as a cross-sectional area of the distal terminating end of the endoscope, the articulating housing configured to articulate relative to the endoscope when secured thereto; and

at least one electrode supported by at least a portion of the outer surface of the housing and capable of delivering energy to a tissue region inside a body to ablate the tissue region.

62. The apparatus of claim1, wherein a plurality of electrodes are supported by at least a portion of the outer surface of the housing and capable of delivering energy to a tissue region inside a body to ablate the tissue region.

63. The apparatus ofclaim 62, wherein the plurality of electrodes are formed in a pattern.

64. The apparatus ofclaim 63, wherein the pattern comprises a row of linear elements.

65. The apparatus ofclaim 63, wherein the pattern comprises a helical pattern.

66. The apparatus ofclaim 62, wherein the plurality of electrodes comprise a bipolar arrangement of interspersed electrodes.

67. The apparatus ofclaim 61, wherein the housing comprises an insulator.

68. The apparatus ofclaim 61, wherein the housing comprises at least one of a ceramic material, a glass, and a polymeric material.

69. The apparatus ofclaim 67, wherein the insulator comprises a thermal insulator.

70. The apparatus ofclaim 67, wherein the insulator comprises and electrical insulator.

71. The apparatus ofclaim 61, wherein at least a portion of the housing is transparent.

72. The apparatus ofclaim 61, wherein the housing comprises at least one groove and a plurality of electrodes are positioned in the groove.

73. The apparatus ofclaim 61, wherein the housing is substantially ring-shaped.

74. The apparatus ofclaim 61, wherein the housing further comprises a stop ring.

75. The apparatus ofclaim 61, further comprising an electrical conduit extending proximally from the housing, the electrical conduit having a connector in electrical communication with a proximal end thereof.

76. An apparatus for use with an endoscope comprising:

an elastomeric housing removably attachable to a distal terminating end of the endoscope, the housing comprising an outer surface and a cross-sectional area at least as large as a cross-sectional area of the distal terminating end of the endoscope, the elastomeric housing configured for axial sliding movement along a length of the endoscope in response to repositioning of the same; and

at least one electrode supported by at least a portion of the outer surface of the housing and capable of delivering energy to a tissue region inside a body to ablate the tissue region.

77. The apparatus ofclaim 76, wherein the elastomer comprises silicone.

78. The apparatus ofclaim 76, wherein the elastomer comprises rubber.

79. The apparatus ofclaim 76 wherein the elastomer is optically transparent.

80. An apparatus for use with an endoscope comprising:

a housing removably attachable to a distal terminating end of the endoscope, the housing comprising an outer surface and a cross-sectional area at least as large as a cross-sectional area of the distal terminating end of the endoscope, the housing having a plurality of apertures dimensioned for fluid passage formed in a distal portion of the housing; and

a plurality of electrodes supported by at least a portion of the outer surface of the housing and capable of delivering energy to a tissue region inside a body to ablate the tissue region.

Images