Methods and systems for determining physiologic characteristics for treatment of the esophagus
A system for measuring physiologic characteristics for treating abnormal mucosa in the esophagus comprises a sizing device having an inflatable balloon on a distal end of a catheter that is inflated with an expansion medium to expand the balloon to engage the wall of the esophagus so that the internal cross-section can be calculated or measured. The sizing device may also include an infusion source for delivering the expansion medium and means for measuring the amount and pressure of the expansion medium inside the catheter. The system also comprises one or more energy delivery devices for injuring or ablating the esophageal tissue.
1. A method for treating the esophagus at a treatment location comprising a diseased mucosal lining, the method comprising:
introducing an expandable sizing member at the treatment location within the esophagus;
substantially unfolding surface contours of a wall of the esophagus at the treatment location by expanding the sizing member;
measuring a substantially unfolded esophageal luminal dimension at the treatment location while the sizing member retains the contours of the wall of the esophagus in a substantially unfolded condition;
removing the sizing member from the patient;
selecting an electrode structure with a pre-selected deployed state which corresponds to the measured esophageal luminal dimension;
after removal of the sizing member and while maintaining the sizing member outside of the patient, introducing and deploying the selected electrode structure to the pre-selected deployed state to engage the substantially unfolded esophageal wall at the treatment location; and
delivering energy to an electrode of the electrode structure for treatment of a portion of the diseased mucosal lining of the esophageal tissue at the treatment location.
2. The method for treating the esophagus according to claim 1 , wherein expanding the sizing member comprises inflating a sizing balloon by introducing an expansion medium.
3. The method for treating the esophagus according to claim 2 , wherein the expansion medium is a compressible fluid.
4. The method for treating the esophagus according to claim 2 , wherein the expansion medium is an incompressible fluid.
5. The method for treating the esophagus according to claim 1 , wherein measuring comprises determining the amount of an expansion medium introduced to the sizing balloon while it is inflated.
6. The method for treating the esophagus according to claim 5 , wherein determining the amount of expansion medium comprises measuring the mass of the expansion medium introduced to the sizing balloon.
7. The method for treating the esophagus according to claim 5 , wherein determining the amount of expansion medium comprises measuring the volume of the expansion medium introduced to the sizing balloon.
8. The method for treating the esophagus according to claim 5 , wherein determining the amount of expansion medium comprises measuring an internal pressure exerted from the expansion medium using a pressure sensor coupled to the sizing balloon.
9. The method for treating the esophagus according to claim 8 , wherein calculating further comprises determining the esophageal luminal dimension based on the measured amount of expansion medium introduced to the balloon at a given pressure.
10. The method for treating the esophagus according to claim 1 , wherein the selecting step comprises choosing one electrode structure from an inventory of devices having different electrode deployment sizes.
11. The method for treating the esophagus according to claim 1 , wherein deploying the selected electrode structure comprises inflating a balloon configured to expand the electrode structure.
12. The method for treating the esophagus according to claim 11 , wherein deploying the electrode structure comprises inflating the balloon with an expansion medium.
13. The method for treating the esophagus according to claim 12 , wherein deploying the selected electrode structure further comprises controlling inflation of the balloon to a pressure no greater than 7 psig by sensing pressure using a pressure sensor.
14. The method for treating the esophagus according to claim 13 , wherein the balloon is inflated to a pressure between 4 psig and 7 psig.
15. The method for treating the esophagus according to claim 1 , wherein the selected electrode structure comprises an array of electrodes.
16. The method for treating the esophagus according to claim 15 , wherein delivering energy comprises applying radiofrequency energy to tissue of the esophagus through the array of electrodes, wherein the array of electrodes comprises a multiplicity of parallel bipolar electrode pairs having a width in the range from 0.1 mm to 3 mm, and are spaced-apart by a distance in the range from 0.1 mm to 3 mm.
17. A method for treating the tissue of an esophagus at a treatment location proximal to the lower esophageal sphincter, the method comprising:
introducing an expandable sizing member at the treatment location within the esophagus and proximal to the lower esophageal sphincter;
substantially unfolding surface contours of a wall of the esophagus at the treatment location by expanding the sizing member;
measuring a substantially unfolded esophageal luminal diameter at the treatment location;
positioning an electrode deployment device at the treatment location within the esophagus and proximal to the lower esophageal sphincter, wherein the electrode deployment device has an electrode structure coupled to an expansion member;
deploying the expansion member to a size based on information obtained during the measuring step so as to engage the electrode structure against a wall of the esophagus; and
delivering sufficient energy to the electrode structure for treatment of a diseased esophageal tissue based on the unfolded esophageal luminal diameter at the treatment location.
18. The method for treating the esophagus according to claim 17 , wherein expanding the sizing member comprises inflating a sizing balloon by introducing an expansion medium.
19. The method for treating the esophagus according to claim 18 , wherein the expansion medium is a compressible fluid.
20. The method for treating the esophagus according to claim 18 , wherein the expansion medium is an incompressible fluid.
21. The method for treating the esophagus according to claim 17 , wherein measuring comprises determining the amount of the expansion medium introduced to a sizing balloon while it is inflated.
22. The method for treating the esophagus according to claim 21 , wherein determining the amount of expansion medium comprises measuring the mass of the expansion medium introduced to the sizing balloon.
23. The method for treating the esophagus according to claim 21 , wherein determining the amount of expansion medium comprises measuring the volume of the expansion medium introduced to the sizing balloon.
24. The method for treating the esophagus according to claim 21 , wherein determining the amount of expansion medium comprises measuring an internal pressure exerted from the expansion medium using a pressure sensor coupled to the sizing balloon.
25. The method for treating the esophagus according to claim 24 , wherein calculating further comprises determining the esophageal wall diameter based on the measured amount of expansion medium inside the balloon at a given pressure.
26. The method for treating the esophagus according to claim 17 , wherein deploying the expansion member of the electrode deployment device comprises inflating the expansion member, wherein the expansion member comprises a balloon configured to expand to a range of diameters between 12 mm and 50 mm.
27. The method for treating the esophagus according to claim 26 , wherein deploying the expansion member comprises inflating the balloon with an expansion medium.
28. The method for treating the esophagus according to claim 27 , wherein inflating the expansion member comprises inflating the balloon to a pressure no greater than 10 psig.
29. The method for treating the esophagus according to claim 28 , wherein the balloon is inflated to a pressure between 4 psig and 7 psig.
30. The method for treating the esophagus according to claim 17 , wherein delivering energy comprises applying radiofrequency energy to tissue of the body lumen through electrodes of the electrode structure, wherein the electrodes comprise a multiplicity of parallel bipolar electrode pairs having a width in the range from 0.1 mm to 3 mm, and are spaced-apart by a distance in the range from 0.1 mm to 3 mm.
31. The method for treating the esophagus according to claim 17 , the delivery step further comprising: delivering an energy density in the range from 1 joules/cm 2 to 50 joules/cm 2 to the diseased esophageal tissue.
32. The method for treating the esophagus according to claim 17 , wherein the delivery step is completed in less than 0.5 seconds.