SYSTEMS AND METHODS FOR VISCERAL NEUROMODULATION
Methods, devices and systems are described for gel-based modulation of neural tissue, including prevention of nerve regeneration and neuroma formation. The gel can be delivered to selected target locations including the myenteric plexus.
1 . A method of modulating nerves of a myenteric plexus of a patient, comprising:
accessing a myenteric plexus of the patient; and
modulating nerves within the myenteric plexus by delivering a gel comprising a therapeutic agent to contact at least a portion of the myenteric plexus.
2 . The method of claim 1 , wherein the therapeutic agent comprises a neurolytic.
3 . The method of claim 1 , wherein the gel comprises polyethylene glycol.
4 . The method of claim 1 , wherein the polyethylene glycol comprises a multi-arm polyethylene glycol.
5 . The method of claim 1 , wherein accessing involves a transtracheal approach.
6 . The method of claim 1 , wherein accessing involves a transesophageal approach.
7 . The method of claim 1 , wherein accessing involves a transvascular approach.
8 . The method of claim 1 , wherein accessing involves a transcutaneous approach.
9 . The method of claim 1 , wherein accessing involves inserting a needle between the external longitudinal muscle and the circular muscle of the esophagus.
10 . The method of claim 9 , comprising creating a space between the external longitudinal muscle and the circular muscle of the esophagus.
11 . The method of claim 10 , wherein creating a space comprises expanding an expandable member.
12 . The method of claim 10 , wherein creating a space comprises hydrodissection.
13 . The method of claim 1 , further comprising ablating at least a portion of the myenteric plexus.
14 . The method of claim 1 , wherein ablating comprises RF, microwave, ultrasound, thermal, or cryoablation.
15 . The method of claim 1 , wherein the gel comprises at least one microstimulator.
16 . The method of claim 1 , wherein the method is sufficient to create a therapeutic effect on a cardiopulmonary condition of a patient.
17 . The method of claim 16 , wherein the therapeutic effect comprises reducing the signs or symptoms of asthma.
18 . The method of claim 16 , wherein the therapeutic effect comprises reducing the signs or symptoms of hypertension.
19 . The method of claim 16 , wherein the therapeutic effect comprises reducing the signs or symptoms of congestive heart failure.
20 . The method of claim 16 , wherein the therapeutic effect comprises reducing the signs or symptoms of atrial fibrillation.
21 . The method of claim 16 , wherein the therapeutic effect comprises reducing the signs or symptoms of coronary artery disease.
22 . The method of claim 16 , wherein the therapeutic effect comprises reducing the signs or symptoms of ventricular tachycardia or ventricular fibrillation.
23 . The method of claim 16 , wherein the therapeutic effect comprises reducing the signs or symptoms of angina pectoris.
24 . The method of claim 16 , wherein the therapeutic effect comprises reducing the signs or symptoms of pulmonary arterial hypertension.
25 . The method of claim 1 , wherein the gel comprises a neuromodulatory agent.
26 . The method of claim 1 , wherein the gel comprises a neuroablative agent.
27 . The method of claim 1 wherein the agent is combined with an anesthetic.
28 . The method of claim 1 , wherein the hydrogel comprises ethanol.
29 . The method of claim 28 , wherein the ethanol comprises greater than 50% loading in the hydrogel.
30 . The method of claim 1 , wherein the gel has a porosity of less than about 50 μm.
31 . The method of claim 1 , wherein the gel has a porosity of less than about 20 μm.
32 . The method of claim 1 , wherein the gel comprises a biodegradable or bioerodable polymer susceptible to hydrolysis, enzymatic, or oxidative degradation.
33 . The method of claim 1 , wherein the gel is in situ forming.
34 . The method of claim 1 , wherein the gel comprises a multi-arm PEG-NHS ester.
35 . The method of claim 1 , wherein the gel comprises a hydrolytically degradable urethane bond.
36 . The method of claim 1 , wherein the gel comprises PEG-ester.
37 . The method of claim 1 , wherein the gel comprises saline.
38 . Use of a hydrogel for neuromodulation, comprising delivery of the hydrogel to the myenteric plexus sufficient to modulate one or more nerves of the myenteric plexus.