Multi-dose duodenal ablation through an endoscope

A method of ablating tissue, the method comprising:

• inserting an endoscope into a gastrointestinal tract of a patient;
• passing a catheter through a channel of the endoscope such that a distal end of the catheter exits through the distal tip of the endoscope, wherein the catheter comprises a sheath and a wire mesh structure positioned on the distal end and is configured to transition from a compressed configuration when inside the sheath to an expanded configuration when outside the sheath;
• directing a first amount of energy to a portion of the patient's gastrointestinal tract through the distal end of the catheter over a first period of time, wherein the portion of the patient's gastrointestinal tract defines a first treatment zone and does not encompass the patient's ampulla of Vater;
• directing a second amount of energy to said first treatment zone through the distal end of the catheter over a second period of time, wherein the first amount of energy and the second amount of energy are different;
• after directing the second amount of energy to said first treatment zone, moving the sheath to compress the wire mesh structure;
• moving the catheter to a different portion of the patient's gastrointestinal tract to define a second treatment zone, wherein the second treatment zone does not encompass the patient's ampulla of Vater;
• directing a third amount of energy to the second treatment zone through the distal end of the catheter;
• and
• directing a fourth amount of energy to said second treatment zone through the distal end of the catheter, wherein the third amount of energy and the fourth amount of energy are different.

A method of ablating tissue, the method comprising:

• inserting an endoscope into a gastrointestinal tract of a patient wherein, in an initial position of the endoscope, a distal tip of the endoscope is positioned at least 15 cm distal to the patient's ampulla of Vater;
• passing a catheter through a channel of the endoscope such that a distal end of the catheter exits through the distal tip of the endoscope;
• directing a first amount of energy to a portion of the patient's gastrointestinal tract through the distal end of the catheter over a first period of time, wherein the portion of the patient's gastrointestinal tract defines a first treatment zone and does not encompass the patient's ampulla of Vater;
• directing a second amount of energy to said first treatment zone through the distal end of the catheter over a second period of time, wherein the first amount of energy and the second amount of energy are different;
• after directing the second amount of energy to said first treatment zone, moving the catheter to a different portion of the patient's gastrointestinal tract to define a second treatment zone, wherein the second treatment zone does not encompass the patient's ampulla of Vater;
• directing a third amount of energy to the second treatment zone through the distal end of the catheter;
• and
• directing a fourth amount of energy to said second treatment zone through the distal end of the catheter, wherein the third amount of energy and the fourth amount of energy are different.

A method of ablating tissue, the method comprising:

• inserting an endoscope into a gastrointestinal tract of a patient;
• passing a catheter through a channel of the endoscope such that a distal end of the catheter exits through the distal tip of the endoscope;
• directing a first amount of energy to a portion of the patient's gastrointestinal tract through the distal end of the catheter over a first period of time, wherein the portion of the patient's gastrointestinal tract defines a first treatment zone and does not encompass the patient's ampulla of Vater;
• directing a second amount of energy to said first treatment zone through the distal end of the catheter over a second period of time, wherein the first amount of energy and the second amount of energy are different;
• after directing the second amount of energy to said first treatment zone, moving the catheter to a different portion of the patient's gastrointestinal tract to define a second treatment zone, wherein the second treatment zone does not encompass the patient's ampulla of Vater;
• directing a third amount of energy to the second treatment zone through the distal end of the catheter wherein the first amount of energy and the third amount of energy are adapted to cause ablation of less than 25% of the patient's mucosa in the first treatment zone and in the second treatment zone, respectively;
• and
• directing a fourth amount of energy to said second treatment zone through the distal end of the catheter, wherein the third amount of energy and the fourth amount of energy are different.

A method of ablating tissue, the method comprising:

• inserting an endoscope into a gastrointestinal tract of a patient;
• passing a catheter through a channel of the endoscope such that a distal end of the catheter exits through the distal tip of the endoscope;
• directing a first amount of energy to a portion of the patient's gastrointestinal tract through the distal end of the catheter over a first period of time, wherein the portion of the patient's gastrointestinal tract defines a first treatment zone and does not encompass the patient's ampulla of Vater;
• directing a second amount of energy to said first treatment zone through the distal end of the catheter over a second period of time, wherein the first amount of energy and the second amount of energy are different;
• after directing the second amount of energy to said first treatment zone, moving the catheter to a different portion of the patient's gastrointestinal tract to define a second treatment zone, wherein the second treatment zone does not encompass the patient's ampulla of Vater;
• directing a third amount of energy to the second treatment zone through the distal end of the catheter wherein the first amount of energy and the third amount of energy are adapted to cause ablation of not more than 15% of the patient's submucosa in the first treatment zone and in the second treatment zone, respectively;
• and
• directing a fourth amount of energy to said second treatment zone through the distal end of the catheter, wherein the third amount of energy and the fourth amount of energy are different.

A method of ablating tissue, the method comprising:

• inserting an endoscope into a gastrointestinal tract of a patient;
• passing a catheter through a channel of the endoscope such that a distal end of the catheter exits through the distal tip of the endoscope;
• directing a first amount of energy to a portion of the patient's gastrointestinal tract through the distal end of the catheter over a first period of time, wherein the portion of the patient's gastrointestinal tract defines a first treatment zone and does not encompass the patient's ampulla of Vater;
• directing a second amount of energy to said first treatment zone through the distal end of the catheter over a second period of time, wherein the first amount of energy and the second amount of energy are different, and wherein, in combination, the first amount of energy and the second amount of energy are adapted to cause contiguous circumferential ablation of more than 50% of the patient's mucosa in the first treatment zone;
• after directing the second amount of energy to said first treatment zone, moving the catheter to a different portion of the patient's gastrointestinal tract to define a second treatment zone, wherein the second treatment zone does not encompass the patient's ampulla of Vater;
• directing a third amount of energy to the second treatment zone through the distal end of the catheter;
• and
• directing a fourth amount of energy to said second treatment zone through the distal end of the catheter, wherein the third amount of energy and the fourth amount of energy are different.

A method of ablating tissue, the method comprising:

• inserting an endoscope into a gastrointestinal tract of a patient;
• passing a catheter through a channel of the endoscope such that a distal end of the catheter exits through the distal tip of the endoscope;
• directing a first amount of energy to a portion of the patient's gastrointestinal tract through the distal end of the catheter over a first period of time, wherein the portion of the patient's gastrointestinal tract defines a first treatment zone and does not encompass the patient's ampulla of Vater, and wherein the first treatment zone defines a volume in a range of 3 cubic centimeters to 450 cubic centimeters;
• directing a second amount of energy to said first treatment zone through the distal end of the catheter over a second period of time, wherein the first amount of energy and the second amount of energy are different;
• after directing the second amount of energy to said first treatment zone, moving the catheter to a different portion of the patient's gastrointestinal tract to define a second treatment zone, wherein the second treatment zone does not encompass the patient's ampulla of Vater;
• directing a third amount of energy to the second treatment zone through the distal end of the catheter;
• and
• directing a fourth amount of energy to said second treatment zone through the distal end of the catheter, wherein the third amount of energy and the fourth amount of energy are different.

A method of ablating tissue, the method comprising:

• inserting an endoscope into a gastrointestinal tract of a patient;
• passing a catheter through a channel of the endoscope such that a distal end of the catheter exits through the distal tip of the endoscope;
• directing a first amount of energy to a portion of the patient's gastrointestinal tract through the distal end of the catheter over a first period of time, wherein the portion of the patient's gastrointestinal tract defines a first treatment zone and does not encompass the patient's ampulla of Vater;
• directing a second amount of energy to said first treatment zone through the distal end of the catheter over a second period of time, wherein the first amount of energy and the second amount of energy are different;
• after directing the second amount of energy to said first treatment zone, moving the catheter to a different portion of the patient's gastrointestinal tract to define a second treatment zone, wherein the second treatment zone does not encompass the patient's ampulla of Vater;
• directing a third amount of energy to the second treatment zone through the distal end of the catheter;
• directing a fourth amount of energy to said second treatment zone through the distal end of the catheter, wherein the third amount of energy and the fourth amount of energy are different;
• and
• after directing the fourth amount of energy to the second treatment zone, repeatedly moving the catheter to different portions of the patient's gastrointestinal tract, forming different treatment zones, and applying amounts of energy until a contiguous circumferential ablation of 25% to 90% of the patient's mucosa over a length of 2 cm to 25 cm is achieved.