Construction of a Wireless-Enabled Endoscopically Implantable Sensor for pH Monitoring with Zero-Bias Schottky Diode-based Receiver

Summary

The manuscript presents a miniature implantable pH sensor with ASK modulated wireless output together with a fully passive receiver circuit based on zero-bias Schottky diodes. This solution can be used as a basis in the development of in vivo calibrated electrostimulation therapy devices and for ambulatory pH monitoring.

Abstract

Ambulatory pH monitoring of pathological reflux is an opportunity to observe the relationship between symptoms and exposure of the esophagus to acidic or non-acidic refluxate. This paper describes a method for the development, manufacturing, and implantation of a miniature wireless-enabled pH sensor. The sensor is designed to be implanted endoscopically with a single hemostatic clip. A fully passive rectenna-based receiver based on a zero-bias Schottky diode is also constructed and tested. To construct the device, a two-layer printed circuit board and off-the-shelf components were used. A miniature microcontroller with integrated analog peripherals is used as an analog front end for the ion-sensitive field-effect transistor (ISFET) sensor and to generate a digital signal which is transmitted with an amplitude shift keying transmitter chip. The device is powered by two primary alkaline cells. The implantable device has a total volume of 0.6 cm³ and a weight of 1.2 grams, and its performance was verified in an ex vivo model (porcine esophagus and stomach). Next, a small footprint passive rectenna-based receiver which can be easily integrated either into an external receiver or the implantable neurostimulator, was constructed and proven to receive the RF signal from the implant when in proximity (20 cm) to it. The small size of the sensor provides continuous pH monitoring with minimal obstruction of the esophagus. The sensor could be used in routine clinical practice for 24/96 h esophageal pH monitoring without the need to insert a nasal catheter. The "zero-power" nature of the receiver also enables the use of the sensor for automatic in-vivo calibration of miniature lower esophageal sphincter neurostimulation devices. An active sensor-based control enables the development of advanced algorithms to minimize the used energy to achieve a desirable clinical outcome. One of the examples of such an algorithm would be a closed-loop system for on-demand neurostimulation therapy of gastroesophageal reflux disease (GERD).

Introduction

The Montreal Consensus defines gastroesophageal reflux disease (GERD) as "a condition that develops when refluxing the contents of the stomach causes unpleasant symptoms and/or complications". It may be associated with other specific complications such as esophageal strictures, Barrett's esophagus, or esophageal adenocarcinoma. GERD affects approximately 20% of the adult population, mainly in countries with high economic status¹.

Ambulatory pH monitoring of pathological reflux (acid exposure time of more than 6%) allows us to distinguish the relationship between symptoms and acidic or non-acidic gastroeso....

Protocol

No living animals were involved in this study. The experiment was performed on an ex vivo model consisting of a porcine esophagus and stomach. The stomach and esophagus were purchased from a local butchery as their standard product. This procedure is in accordance with Czech laws, and we prefer it because of the "3R" principle (Replacement, Reduction, and Refinement).

1. Fabrication of the pH sensor assembly

NOTE: Observe precautions for handling electrostatic discharge (ESD) sensitive components throughout the fabrication of the pH sensor assembly. Be careful when working with the soldering iron.<....

Results

A device capable of autonomous pH sensing and wireless transmitting of the pH value was successfully constructed, as shown in Figure 8. The constructed device is a miniature model; it weighs 1.2 g and has a volume of 0.6 cm³. The approximate dimensions are 18 mm x 8.5 mm x 4.5 mm. As shown in Figure 15, Figure 16, and Figure 17, it can be implanted to the proxi.......

Discussion

This method is suitable for researchers who work on the development of novel active implantable medical devices. It requires a level of proficiency in the manufacturing of electronic prototypes with surface mount components. The critical steps in the protocol are related to the manufacturing of the electronics, especially populating the PCBs, which is prone to operator error in placement and soldering of small components. Then, correct encapsulation is crucial to prolong the lifetime of the device when exposed to moistur.......

Materials

Name	Company	Catalog Number	Comments
AG1 battery	Panasonic	SR621SW	Two batteries per one implant
Battery holder	MYOUNG	MY-521-01
Copper enamel wire for the antenna	pro-POWER	QSE Wire - 0.15 mm diameter, 38 SWG
Epoxy for encapsulation	Loctite	EA M-31 CL	Two-part medical-grade ISO10993 compliant epoxy
FEP cable for pH sensor	Molex / Temp-Flex	100057-0273
Flux cleaner	Shesto	UTFLLU05	Prepare 5% solution in deionized water for cleaning by sonication
Hemostatic clip	Boston Scientific	Resolution
Hot air gun + soldering iron	W.E.P.	Model 706	Any soldering iron capable of soldering with tin and hot-air gun capable of maintaining 260 °C can be used
Impedance matching software	Iowa Hills Software	Smith Chart	Can be downloaded from http://www.iowahills.com/9SmithChartPage.html - alternatively, any RF design software supports calculation of impedance matching components
ISFET pH sensor on a PCB	WinSense	WIPS	Order a model pre-mounted on a PCB with on-chip gold reference electrode
Laboratory pH meter	Hanna Instruments	HI2210-02	Used with HI1131B glass probe
Microcontorller programmer	Microchip	PICkit 3	Other PIC16 compatible programmers can be also used
Pig stomach with esophagus	Local pig farm	Obtained from approx. 40–50 kg pig	It is important that the stomach includes a full length of the esophagus.
Printed circuit board - receiver	Choose preferred PCB supplier	According to pcb2.zip data	One layer, 0.8 mm thickness, FR4, no mask
Printed circuit board - sensor	Choose preferred PCB supplier	According to pcb1.zip data	Two-layer with PTH, 0.6 mm thickness, FR4, 2x mask
Receiver - 0R	Vishay	CRCW04020000Z0EDC	See Figure 12 and Figure 13 for placement
Receiver - 1.5 pF	Murata	GRM0225C1C1R5CA03L	See Figure 12 and Figure 13 for placement
Receiver - 100 pF	Murata	GRM0225C1E101JA02L	See Figure 12 and Figure 13 for placement
Receiver - 33 nH	Pulse Electronics	PE-0402CL330JTT	See Figure 12 and Figure13 for placement
Receiver - RF schottky diodes	MACOM	MA4E2200B1-287T	See Figure 12 and Figure 13 for placement
Receiver - SMA antenna	LPRS	ANT-433MS
Receiver - SMA connector	Linx Technologies	CONSMA001	See Figure 12 and Figure 13 for placement
Sensor - C1	Murata	GRM0225C1H8R0DA03L	8 pF 0402 capacitor
Sensor - C2	Murata	GRM0225C1H8R0DA03L	8 pF 0402 capacitor
Sensor - C3	Murata	GCM155R71H102KA37D	1 nF 0402 capacitor
Sensor - C4	Murata	GRM0225C1H1R8BA03L	1.8 pF
Sensor - C5	Vishay	CRCW04020000Z0EDC	Place 0R 0402 resistor or use to match the antenna
Sensor - C6	Murata	GRM155C81C105KE11J	1 uF 0402 capacitor
Sensor - C7	Murata	GRM155C81C105KE11J	1 uF 0402 capacitor
Sensor - C8	Murata	GRM022R61A104ME01L	100 nF 0402 capacitor
Sensor - IC1	Microchip	MICRF113YM6-TR	MICRF113 RF transmitter
Sensor - IC2	Microchip	PIC16LF1704-I/ML	PIC16LF1704 low-power microcontroller
Sensor - R1	Vishay	CRCW040210K0FKEDC	10 kOhm 0402 resistor
Sensor - R2	Vishay	CRCW040233K0FKEDC	33 kOhm 0402 resistor
Sensor - R3	Vishay	CRCW04021K00FKEDC	1 kOhm 0402 resistor
Sensor - R5	Vishay	CRCW040210K0FKEDC	10 kOhm 0402 resistor
Sensor - X1	ABRACON	ABM8W-13.4916MHZ-8-J2Z-T3	3.2 x 2.5 mm 13.4916 MHz 8 pF crystal
Titanium wire	Sigma-Aldrich	GF36846434	0.125 mm titanium wire
Vector network analyzer	mini RADIO SOLUTIONS	miniVNA Tiny	Other vector network analyzers can be used - the required operation frequency is 300–500 MHz, resolution bandwidth equal or lower than 1 MHz, output power of no more than 0 dBm and dynamic range preferably better than 60 dB for the receiving front-end