Electrical energy ablation systems, devices and methods for the treatment of tissue
A device for ablating target tissue of a patient with electrical energy is provided. An elongate shaft includes a proximal portion and a distal portion, and a radially expandable element is attached to the distal portion. An ablation element for delivering electrical energy to target tissue is mounted to the radially expandable element. The device can be constructed and arranged to ablate the duodenal mucosa of a patient while avoiding damage to the duodenal adventitial tissue. Systems and methods of treating target tissue are also provided.
1 . A system for treating duodenal mucosal tissue of a patient, the system comprising:
a treatment device comprising:
an elongate shaft having a proximal portion and a distal portion;
a radially expandable element attached to the distal portion of the elongate shaft and comprising a radially expandable sheet; and
an ablation element mounted to the radially expandable sheet, wherein the ablation element comprises an array of conductors; and
an energy delivery unit coupled to the array of conductors of the ablation element and configured to deliver radiofrequency electrical energy as a pulsed waveform and to pulse-width modulate the energy with an on-time no more than 20% of a cycle and to maintain the radiofrequency at or below about 1 MHz,
wherein the ablation element is configured to treat the duodenal mucosal tissue by generating an electric field with the array of conductors in response to the array of conductors receiving the radiofrequency electrical energy from the energy delivery unit, the electric field performing a non-desiccating ablation of the duodenal mucosal tissue that causes apoptosis in the treated duodenal mucosal tissue.
2 . The system of claim 1 , wherein the radially expandable sheet is configured to be furled to a compact condition and unfurled to an expanded, at least partially tubular structure, in an expanded condition and wherein, in the expanded condition, the radially expandable element defines a flexible, at least partially tubular structure with a resiliently biased convex cross-section.
3 . The system of claim 2 , wherein the treatment device further comprises a motion control mechanism configured to conduct the furling operation of the expandable element.
4 . The system of claim 3 , wherein the motion control mechanism comprises a drive assembly configured to rotate and/or linearly move the radially expandable element to conduct the furling operation.
5 . The system of claim 1 , wherein the energy delivery unit is configured to deliver radiofrequency energy in a current-driven mode.
6 . The system of claim 5 , wherein the electrical energy delivered by the ablation element includes monopolar and/or bipolar radiofrequency energy.
7 . The system of claim 4 , wherein the energy delivery unit is configured to modify one or more RF energy delivery parameters including at least one of voltage, current, frequency, pulse-width-modulation on-time or off-time, or a time-division-multiplexing parameter.
8 . The system of claim 1 , wherein the array of conductors comprises at least two conductors each comprising a height of at least 100 microns.
9 . The system of claim 8 , wherein the array of conductors comprises at least two conductors that are radially edge-to-edge spaced at a distance between 200 microns and 2.00 mm.
10 . The system of claim 1 , wherein the system is configured to confine the treatment performed by the ablation element to the duodenal mucosal tissue.
11 . The system of claim 1 , wherein the treatment device is configured to apply the electric field to at least a portion of the duodenal mucosal tissue for at least 5 seconds.
12 . The system of claim 1 , wherein the system is constructed and arranged to apply a negative pressure that is configured to bring the duodenal mucosal tissue in contact with the expandable element.
13 . The system of claim 1 , wherein the treatment of the duodenal mucosal tissue comprises a non-desiccating ablation of the duodenal mucosal tissue.
14 . The system of claim 1 , wherein the array of conductors is constructed and arranged to directly contact the duodenal mucosal tissue during the treatment of the duodenal mucosal tissue.
15 . The system of claim 1 , wherein the radially expandable element is constructed and arranged to expand to a diameter between about 15 mm and about 30 mm.
16 . The system of claim 1 , wherein the radially expandable sheet comprises a plurality of holes.
17 . The system of claim 1 , wherein the ablation element is configured to treat the duodenal mucosal tissue while avoiding ablating at least an outermost layer of small intestine submucosal tissue.
18 . The system of claim 1 , wherein the system further comprises a temperature sensor configured to provide a signal related to the temperature of the duodenal mucosal tissue during treatment of the duodenal mucosal tissue.
19 . The system of claim 18 , wherein the energy delivery unit is configured to modulate the electrical energy based on the signal related to the temperature of the duodenal mucosal tissue.
20 . A system for treating duodenal mucosal tissue of a patient, comprising:
an ablation device including an elongate shaft and a radially expandable element carrying an electrode array configured to contact the duodenal mucosal tissue;
an energy delivery unit operably coupled to the electrode array and configured to deliver radiofrequency electrical energy as a pulsed waveform; and
a controller configured to pulse-width modulate the energy with an on-time no more than 20% of a cycle and to maintain the radiofrequency at or below about 1 MHz, and the system is configured to perform a non-desiccating ablation that causes apoptosis in the treated duodenal mucosal tissue.
21 . The system of claim 20 , wherein, in an expanded condition, the radially expandable element defines a flexible, at least partially tubular structure with a resiliently biased convex cross-section.
22 . The system of claim 20 , wherein the array of conductors comprises at least two conductors each comprising a height of at least 100 microns.
23 . The system of claim 20 , wherein the electrical energy delivered by the ablation element includes monopolar and/or bipolar radiofrequency energy.
24 . The system of claim 20 , wherein the system is constructed and arranged to apply a negative pressure that is configured to bring the duodenal mucosal tissue in contact with the electrode array.