1988-06-01
1990-04-24
Cohen, Lee S.
Surgery
Truss
Pad
128784, A61N 105
Patent
active
049191470
DESCRIPTION:
BRIEF SUMMARY
The invention concerns an esophagus probe with a tubus that can be advanced in the esophagus of a patient and which is provided with a device for stopping an esophageal hemorrhage.
An esophagus probe of that type where the device for stopping the bleeding consists of an inflatable espohagus balloon is the so-called Sengstaken-Blakmore probe. In addition to the inflatable esophagus balloon, this probe comprises an inflatable gastric balloon by which the distal end of the probe is secured inside the stomach. To the proximal end of the probe, which protrudes out of the patient's nose, a weight is attached so as to insure a constant position of the probe.
By inflating the esophagus balloon in the gullet, the bleeding veins of the esophagus wall are compressed, thereby achieving a stoppage of the bleeding.
But the prior probe is associated with a number of risks and inconveniences to the patient. Above the esophagus balloon, secretion and blood may accumulate. Severe aspiration pneumonia may occur due to drainage into the lung. Another source of danger is constituted by the fact that in the event of a bursting of the gastric balloon, which serves as an abutment for the weight forces, the probe may be pulled out of the esophagus by the weight arranged on the proximal end. The result may be a blockage of the entrance to the windpipe by the esophagus balloon which is still inflated.
Another disadvantage of the prior probe is that the constant pressure of the two balloons on the mucous membranes of the stomach and the windpipe may cause damage to the mucous membrane and ulceration. The ulcers may again be a source of bleeding.
When the bleeding of the dilated veins in the esophagus, which for instance may have occurred due to a cirrhosis of the liver, has been stopped, the probe needs to be removed. This involves often considerable difficulties because the probe sticks to the esophagus wall due to coagulated blood and often must be mobilized by heavy pull. Renewed varices bleeding occurs in more than 60% of all cases immediately after removal of the probe.
Basing on this prior art, the invention seeks to provide an esophagus probe where the risks and inconveniences to the patient are avoided.
This problem is inventionally solved in that the device is an electrode pair which is arranged on the tubes and can be forced on the mucous membrane of the esophagus while connected with an apparatus which delivers an electrical stimulating current.
The invention bases on the insight that the esophagus wall consists in its bottom third of smooth muscles. Such muscles are capable of performing contractions, that is, contractions of long duration. These are generated in the case of the inventional probe by application of an electrical stimulus. The voltage required for that purpose depends on the type of electrodes and on the local resistance. The optimal shape and size of the electrodes and the optimum frequency of the alternating or rectangular pulse current with alternating polarity pulses to be applied can be determined easily by experiments.
The contraction of the muscles or an increased muscle tonus of the esophagus of long duration causes a clamping of the veins extending through the esophagus wall. The hydrostatic pressure of this vein ranges in cirrhosis patients between 20 and 40 mmHg. The esophagus wall can through electrical stimulation easily produce a pressure of 100 to 200 mmHg.
In the presence of an esophageal varices bleeding, the probe--consisting of elastic material--is inserted through the nose into the esophagus while the patient is in a lying or standing position. The correct localization of the probe part that is provided with the electrode pair can either be estimated through a centimeter scale which is provided on the probe or can be determined accurately by x-ray. In acute emergencies it is sufficient to advance the probe by a specific measure, for instance by 45 cm. Once the probe has reached the intended position in the esophagus, the electrodes of the electrode pair are pierced into the mucous membra
REFERENCES:
patent: 3858586 (1975-01-01), Lessen
patent: 3866615 (1975-02-01), Hewson
patent: 4776349 (1988-10-01), Nashef et al.
Reinhardt Josef
Rossle Martin
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