An injector is disclosed for treating esophageal varices and other disorders with injected medications. The injector includes a needle which has a tubular bore for injecting the medication into the varices. The needle has an exposed length which is sufficiently long to enter a vein wall but not sufficiently long to pass through the vein and esophagus walls. A tubular connector has an internal bore connected with the needle and has a flange for inhibiting the connector from following the needle through a puncture. The tubular connector has a shank portion which is connected with a flexible tube. The flexible tube, tubular connector, and needle are slidingly receivable in a biopsy channel of a flexible, fiberoptic endoscope. A syringe is connected to the other end of the flexible tube for selectively forcing medications through the tube, connector, and needle into the varices.

BACKGROUND OF THE INVENTION 
This application pertains to the art of non-operative esophageal treatment 
and more particularly to apparatus for the treatment of esophageal varices 
and other esophageal disorders by the injection of medications. The 
invention is particularly applicable to the treatment of esophageal 
varices in conjunction with the treatment of cirrhosis of the liver and 
will be described with particular reference thereto. It will be 
appreciated, however, that the invention has broader applications such as 
the treatment of esophageal disorders whose healing is promoted by a 
localized injection of medication. 
A common side effect to cirrhosis of the liver is the development of 
esophageal varices. These varices are varicose venous channels which 
develop in the esophagus because the blood flow from the intestine to the 
liver is impaired by the cirrhosis. When one of these varices ruptures, 
life threatening internal gastrointestinal bleeding occurs. Treatment of 
the varices in patients with cirrhosis of the liver is hindered by the 
generally weakened liver condition. Many of these patients doe not have an 
adequate liver reserve to withstand surgery or the physiological stresses 
of general anesthesia. 
In 1939, a procedure was described for treating the varices by injections. 
In this procedure, a needle was passed through a rigid endoscope and into 
a selected varix. Each selected varix was injected with an agent that 
caused scarring of the internal wall of the vein. This tended to eliminate 
or reduce the severity of future bleeding episodes. When this procedure 
was developed, endoscopes consisted of a long, rigid system of lenses 
housed in a long metal tube. The use of a rigid endoscope usually requires 
the use of a general anesthesia. This rigid endoscopic procedure was never 
adopted by the medical profession. Rather, operative approaches to the 
management of hemorrhages from esophageal varices have become the standard 
treatment. 
Today, flexible, fiberoptic endoscopes are in common usage. The fiberoptic 
endoscope is a flexible tubular instrument in which light is carried in 
and out of the patient by bundles of glass fibers. The proximal end of the 
instrument i.e., the end held by the physician, has a viewing lens and 
controls for manipulating its opposite or distal end. The controls 
selectively bend the distal end causing the distal tip to be angulated in 
any selected direction. This allows the instrument to follow the course of 
the gastrointestinal tract and examine its walls. The fiberoptic 
endoscopes, conventionally, have a tubular biopsy channel extending from 
the proximal end to the distal end. Various accessories are passed through 
the biopsy channel into the patient's gastrointestinal tract. 
It has been suggested that the 1939 injection procedure described above be 
adapted for use with flexible, fiberoptic endoscopes. Specifically, it has 
been suggested that a needle be secured to a length of flexible, plastic 
tubing by tying several ligatures. The flexible tubing and needle are 
diametrically sized to be received in the biopsy channel of conventional 
fiberoptic endoscopes. This procedure, however, has many drawbacks. One 
problem is that the rigid needle, about a centimeter in length, tends to 
impale the side walls of the biopsy channel. Because this construction is 
unsuitable for passing the needle from the proximal end to the distal end 
of the biopsy channel, the needle is commonly backloaded. That is, the 
tubing is threaded from the distal end backward through the biopsy channel 
to the proximal end. Another problem has been the needle becoming detached 
from the tubing during injections. If the needle is lengthened to enable 
it to be tied more securely to the tubing, the problems associated with 
moving the needle through the biopsy channel are compounded. Yet another 
problem has been the difficulty in controlling the depth of the insertion 
of the needle into the varix. The diameters of the tubing and the needle 
are so close that the tubing is readily inserted with the needle through 
the puncture into the varix. This tends to enlarge the puncture and cause 
excessive damage to the varix. 
The present invention overcomes the above-referenced problems and others, 
yet provides an injector for non-operative treatment of esophageal varices 
and other esophageal disorders. 
SUMMARY OF THE PRESENT INVENTION 
The present invention relates to an esophageal injector which includes an 
elongated, flexible tube, a tubular connector, and a needle. The tubular 
connector is connected with the elongated, flexible tube. It has an 
internal bore which is connected in fluid communication with an internal 
passage of the flexible tube. The needle, in turn, is affixed to the 
connector. It has an internal bore which is connected in fluid 
communication with the connector bore. The flexible tube, the connector, 
and the needle are dimensioned to be received in a biopsy channel of a 
flexible, fiberoptic endoscope and to pass longitudinally through the 
biopsy channel from a proximal end to a distal end. 
One advantage of the present invention is that it precisely controls the 
depth of insertion of the needle into a treated varix. The precise control 
eliminates the danger of inserting the needle through the varix and 
esophagus wall into surrounding organs. 
Another advantage of the present invention is that it eliminates the 
possibility of the needle becoming detached during an injection and 
remaining embedded in a varix or the esophagus wall. 
Still other advantages of the present invention will become apparent upon 
reading and understanding the detailed description of the preferred 
embodiment.

DESCRIPTION OF THE PREFERRED EMBODIMENT 
The FIGURE shows an injector for injecting medications into esophageal 
varices and other disorders. The injector includes a needle A for entering 
each varix to be treated and introducing the medication therein. The 
needle is connected to a tubular connector B which in turn is connected to 
an elongated, flexible tube C. The needle, tubular connector, and flexible 
tube are dimensioned to be received within a biopsy channel of a flexible, 
fiberoptic endoscope. More specifically, they are adapted to slide through 
the biopsy channel from its proximal end to its distal end even when the 
endoscope is disposed within the esophagus of a patient. A coupler D is 
connected with the flexible tube C for coupling it with a means for 
selectively forcing the medications through the flexible tube, the 
connector, and the needle into the esophageal varices. 
The needle A has a sharpened end 10 for puncturing and extending through 
the vein walls. An internal bore 12 extends through the sharpened end 10 
to inject the medications into the veins. Opposite the sharpened end 12, 
an end 14 is connected to the tubular connector B. In the preferred 
embodiment, the needle is a 25 gauge needle which is one centimeter in 
length. 
The tubular connector B has a connector bore 20 through which the 
medications are conveyed. The connector bore 20 is dimensioned to receive 
the end 14 of the needle in a close, sliding engagement. In this manner, 
the connector bore and the needle bore are connected in fluid 
communication. The end 14 of the needle is received by the connector bore 
20 until the exposed length of the needle is sufficiently long to enter 
the vein wall but not long enough to pass through the vein and esophagus 
walls. In the preferred embodiment, the exposed length of the needle is 
about 5 millimeters. Further to the preferred embodiment, the connector B 
and the needle A are affixed by soldering. However, other modes of 
connecting the needle and connector are contemplated including adhesive 
bonding, threaded engagement, and the like. Optionally, the connector bore 
20 may be formed with an internal stop for limiting the sliding receipt of 
the needle. 
The tubular connector is formed with a flange or stop 22 for inhibiting the 
connector from passing with the needle through the puncture in the vein 
wall. The flange 22 is fashioned to have a cross section which is several 
times that of the needle A. However, the flange is fashioned in concert 
with the maximum diameter of an element which may be received slidingly in 
the biopsy channel of the flexible, fiberoptic endoscope. 
The tubular connector B has a tubular shank 24 which is dimensioned to be 
received in the flexible tube C. The shank 24 has a reduced diameter 
portion 26 which has substantially the same outer diameter as the interior 
diameter of the tube and an enlarged portion 28 which is received within 
the tube by expanding it. The shank portion 24 is inserted into the 
flexible tube C until the end of the flexible tube abuts the trailing face 
of the flange 22. A ferrule 30 is crimped around the end of the flexible 
tube C to increase its frictional engagement with the shank 24 of the 
tubular connector. More specifically, the length of the ferrule 30 is 
commensurate with the length of the reduced diameter portion 26. When the 
ferrule 30 is crimped around the end of the tube and the reduced diameter 
portion 26 of the connector, the enlarged portion 28 inhibits the 
connector from being removed from the tubing. In the preferred embodiment, 
the tubular connector including the ferrule 30 are machined of stainless 
steel. Other connector structures are contemplated by the present 
invention. For example, the connector may have two threadingly connected 
sections which cam tightly against the needle or the flexible tube. 
The flexible tube C is sized to extend through the biopsy channel such that 
the distance between a first end 40 which is connected with the connector 
B and a second end 42 is longer than the length of the biopsy channel. In 
the preferred embodiment, the flexible tube C is about 180 centimeters. 
The tube has an internal passage 44 which extends the length of the tube 
and is dimensioned to receive the shank 24 of the tubular connector. In 
the preferred embodiment, the flexible tube is about 1.7 millimeters in 
diameter and is constructed of polyethylene or TEFLON, although other 
flexible materials may be used. 
The coupler D is a Leur-lock fitting in which a tubular extension 50 is 
permanently soldered into a coupler body 52. The tubular extension is 
dimensioned to be received in the interior passage 44 of the tube C in a 
tight, frictional engagement. A compression cap 54 and the tubular 
extension 50 are cammed together to increase the frictional engagement 
with the tube C such that the second end 42 of the tube is securely locked 
to the coupler D. The coupler D has a pair of flanges 56 and 58 which 
allow the injector to be coupled with a twist motion to a Leur-lock 
fitting syringe or other means for selectively forcing medications through 
the interior passage of the flexible tube C, the connector bore 20, and 
the needle bore 12, into the varix. 
To use the invention, a patient is sedated with an intravenous 
tranquilizer. A general anesthesia is unnecessary. The flexible endoscope 
is inserted into the patient's esophagus and its distal end is manipulated 
to examine the esophageal walls. If esophageal varices or other disorders 
which can be cured by injecting medications are observed, the end of the 
tube C with the attached connector B and needle A is inserted into the 
biopsy channel from the proximal end. They are slid through the biopsy 
channel until the needle is adjacent the distal end. The coupler D is 
connected with a syringe containing the appropriate medications. The 
physician operates the endoscope controls to position the distal end so 
that the needle is axially aligned with the esophageal varices to be 
treated. The tube is slid further through the biopsy channel until the 
needle A punctures and penetrates the vein wall and the flange 22 abuts it 
outer surface. The syringe is depressed to inject a measured amount of 
medication into the varix. After the medication is injected, the tube C is 
withdrawn sufficiently to remove the needle from the vein. The procedure 
may be repeated for additional esophageal varices. While the needle is 
within the vein wall, there is commonly movement of the esophagus from 
peristalsis, reflected motion of the heart, breathing, and small movements 
of the endoscope. The flexible injector allows the needle to move with the 
esophagus, thus reducing the chance that a sudden motion might result in 
tearing the varix. 
The invention has been described with reference to a preferred embodiment. 
Obviously, modifications and alterations will occur to others upon reading 
and understanding this specification. It is my intention to include all 
such modifications and alterations insofar as they come within the scope 
of the appended claims or the equivalents thereof.