RU2805342C1 - Method for fixing intestinal loops when performing therapeutic interventions in large and small intestine - Google Patents

Abstract

FIELD: medicine; endoscopy; gastroenterology.

SUBSTANCE: silicone tube is used with a silicone balloon at the distal end of the tube, with a tube length of 1450 mm, an internal diameter of 11 mm, an external diameter of 13.2 mm and an inflated balloon diameter of 40 mm. The tube is placed on the endoscope, which is guided to the area where the treatment is performed. The balloon is inflated, tightening the intestinal loops. After the therapeutic intervention, the endoscope is removed, and the tube with the inflated balloon is left in place. The endoscope is reinserted into the treatment area through the lumen of the tube, using it as a guide.

EFFECT: method simplifies the re-insertion of the endoscope to the area where the treatment is performed, reduces the morbidity and time of surgical intervention.

1 cl, 9 dwg, 2 ex

Description

The invention relates to medicine, namely to endoscopic surgery, and can be used to fix loops of the large and small intestine when performing medical interventions in these parts of the digestive tube.

Colonoscopy has long been the “gold standard” in diagnosing various diseases of the colon. Therapeutic interventions performed through a colonoscope have proven to be highly effective in the minimally invasive treatment of patients, including those with epithelial formations of the colon. Thanks to the development of endoscopic technology and instruments, as well as the skills of endoscopists, the size and macroscopic type of formation are no longer factors that completely limit the possibility of removal through a colonoscope. According to various authors, the effectiveness of endoscopic removal of both benign and malignant formations of the colon by various methods reaches about 75.5% (“The effectiveness of methods of “cold” removal of small (less than 10 mm) benign epithelial formations of the colon during diagnostic colonoscopy in an outpatient setting "Ageikina N.V.).

However, complications of therapeutic endoscopic interventions in the colon are formidable and in 15% of cases cause emergency surgical interventions, and in 3% of cases, fatal (“Cavity surgery for large colon polyps. Arguments for and against.” Andrey Goritsky November 26, 2019). The most common type of complications that develop after endoscopic removal of epithelial formations in the colon are bleeding (Endoscopic surgery of gastrointestinal tumors, Alexey P., etc.), which are often massive. It is obvious that carrying out measures to prevent the development of bleeding is most effective directly during the intervention. When performing them, the time factor is important (for example, clipping a wound). However, there are a number of factors that impede the prompt implementation of measures to prevent or intraoperatively stop bleeding. First of all, these include fixation and/or looping of the left half of the colon. An elongated sigmoid colon, freely moving in the abdominal cavity, or, on the contrary, involved in the adhesive process, complicates colonoscopy, as well as therapeutic interventions (“Technique for performing colonoscopy for dolichosigma” R.A. Bashirov, 2018, journal “Endoscopic Surgery”). Also, the difficulty is in extracting the remote formation for subsequent histological examination (HI): if bleeding has occurred and is being combated, the severed polyp can simply be “lost” in blood clots, but it is on the basis of the HI of the remote formation that further tactics for managing the patient are determined. The anatomical features of the colon may cause the impossibility of re-reaching the area of interest when removing a remote epithelial formation after bleeding. There are frequent cases of total polyposis of the colon and small intestine (Peutz-Jeghers syndrome). The introduction of enteroscopy into clinical practice has made it possible to carry out diagnostic and therapeutic endoscopic interventions in the deep parts of the small intestine. Enteroscopy is a study that requires not only consumables, but also serious time expenditure (“Capsule and balloon-assisted enteroscopy in the diagnosis and treatment of diseases of the small intestine” manual. E.V. Ivanova, E.D. Fedorov, Moscow, 2014 g. - p. 48). Therapeutic enteroscopy is the most effective and least traumatic way to sanitize the lumen of the small intestine. When removing epithelial formations of the small intestine, the risk of bleeding poses a great threat due to the difficulty of accessing the source of bleeding.

The above factors were the reason for the development of the proposed method.

This method is used to fix the collected intestinal loops during medical interventions and to simplify the placement of the endoscope to the area where the medical intervention is performed.

An analogue of this method can be considered the invention “Tube casing of a medical endoscopic device and a medical endoscopic device containing it” TUBE CASING FOR MEDICAL ENDOSCOPIC DEVICE AND MEDICAL ENDOSCOPIC DEVICE CONTAINING IT, author Exxon Patrick. Its essence is as follows. Thanks to the presence of protruding elements on the outer part of the casing, it is possible to improve the visualization of the mucous membrane during removal of the endoscope, and it is also possible to facilitate the insertion of the endoscope in case of complex bowel (elongated intestinal loops, the presence of adhesions). The difference between this invention is the impossibility of fixing intestinal loops and, as a result, returning the endoscope to the area where the treatment is performed. Another analogue of the method we propose is to carry out standard balloon-assisted enteroscopy, in which the intestinal loops are constantly tightened by deflating/inflating the balloon at the distal end of the splinting tube in order to pass the endoscope into the deep parts of the small intestine. However, in the method we propose, the goal is to fix a specific area of the intestine with the possibility of quick and, if necessary, repeated access to it during the therapeutic intervention.

The purpose of this invention is to develop a method that makes it possible to fix loops of the large or small intestine for re-insertion of the endoscope when carrying out medical interventions in these parts of the digestive tube.

The essence of this method is as follows:

The patient undergoes standard preparation for endoscopic examination of the intestine.

To implement the proposed method, a standard set of equipment used for balloon-assisted enteroscopy is used, and includes a silicone tube with a silicone balloon at the distal edge of the splinting tube, the diameter of the balloon in the inflated state is 40 mm, the total length of the device is 1450 mm, the internal diameter is 11 mm, and external diameter 13.2 mm. Other endoscopic instruments used for therapeutic interventions in the large and small intestine.

A splinting tube (Fig. 1, element 1) is attached to an endoscope (Fig. 1, element 2), which is carried out to the area where the treatment is performed, for example, to a polyp of the small intestine (Fig. 2, element 3). The balloon at the distal end of the tube (Fig. 3 element 4) is inflated to allow tightening of intestinal loops. After the therapeutic intervention, if it is necessary to remove the endoscope (Fig. 4 element 2) (for example, to remove a removed polyp, Fig. 5 element 3, Fig. 6 element 3), the splinting tube with the inflated balloon remains in place (Fig. 7 element 1) . A splinting tube that fixes a loop of intestine makes it possible to repeatedly return the endoscope to the area where a medical intervention is performed, for example, for clipping (Fig. 8 element 5) a wound (Fig. 9 element 6).

Example 1:

Patient K., 59 years old, was admitted to the Regional Clinical Hospital No. 2 in Krasnodar on August 22, 2022 with a diagnosis of colon polyp, class 1B. group. From the medical history: on June 14, 2022, an attempt was made to perform a colonoscopy. At the level of the upper third of the sigmoid colon, a polyp was detected on a short thick stalk D of the head up to 25 mm. Due to elongation of the sigmoid colon, the study could not be performed. Conclusion: Signs of dolichosigma (?). Incomplete inspection.

According to irrigography data dated June 15, 2022, the sigmoid colon is elongated and looped. At the level of the upper third of the sigmoid colon there is a contrast defect up to 2.5 cm in diameter, probably a polyp. Conclusion: Dolichosigmoid, type 2 colon structure (elongation of the sigmoid colon). Polyp (?) of the upper third of the sigmoid colon.

After appropriate preparation, on August 24, 2022, a colonoscopy was performed with a splinting tube attached to the endoscope. After a total examination of the colon, a polypectomy was performed, and the polyp was removed for histological examination. During the extraction of the polyp, the tube remained as a guide in the intestinal lumen, which made it possible to quickly move the endoscope to the area of the treatment to clip the wound. The patient was discharged home on the fourth day in satisfactory condition.

Example 2.

Patient A. born 1993 was admitted to the ES "GBUZ KKB No. 2" in Krasnodar with a diagnosis of Peutz-Jeghers symptom.

From the anamnesis: he has been ill since 2015, endoscopic polypectomies of the colon have been performed several times. According to the video capsule study, polyps were found at the level of the distal third of the jejunum. After appropriate preparation, the patient underwent balloon-assisted enteroscopy via oral access in the operating room. At a distance of about 100 cm from the ligament of Treitz, a polyp is visualized at the narrowed base of the head, D up to 25 mm. Before endoscopic polypectomy, the intestinal loops are fixed with a balloon inflated at the distal end. Polypectomy was performed.

The removed polyp was removed for histological examination. During the extraction of the polyp, the splinting tube remained as a guide in the intestinal lumen, which made it possible to quickly move the endoscope to the area of the treatment to clip the wound. On the fourth day the patient was discharged in satisfactory condition.

Claims (1)

A method for fixing loops of the large and small intestine when performing therapeutic endoscopic interventions, including performing balloon-assisted enteroscopy, characterized in that a silicone tube with a silicone balloon at the distal end of the tube is used, with a tube length of 1450 mm, an internal diameter of 11 mm, an external diameter of 13 .2 mm and the diameter of the balloon in the inflated state is 40 mm; put the tube on the endoscope, which is passed to the area where the treatment is performed, while the balloon is inflated, tightening the intestinal loops; after the therapeutic intervention, the endoscope is removed, and the tube with the inflated balloon is left in place; the endoscope is reinserted into the area of the therapeutic intervention through the lumen of the tube, using it as a guide.