US20070010865A1 - Everting gastrointestinal sleeve - Google Patents

Everting gastrointestinal sleeve Download PDF

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Publication number
US20070010865A1
US20070010865A1 US11/430,275 US43027506A US2007010865A1 US 20070010865 A1 US20070010865 A1 US 20070010865A1 US 43027506 A US43027506 A US 43027506A US 2007010865 A1 US2007010865 A1 US 2007010865A1
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United States
Prior art keywords
sleeve
attachment
cuff
tissue
stomach
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Abandoned
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US11/430,275
Inventor
Mitchell Dann
Jonathan Kagan
Paul Swain
Joshua Butters
Lee Guterman
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Individual
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Individual
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Priority claimed from US10/698,148 external-priority patent/US9060844B2/en
Priority claimed from US11/124,634 external-priority patent/US8070743B2/en
Application filed by Individual filed Critical Individual
Priority to US11/430,275 priority Critical patent/US20070010865A1/en
Publication of US20070010865A1 publication Critical patent/US20070010865A1/en
Abandoned legal-status Critical Current

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Definitions

  • the present invention relates to devices and methods for attachment of a device within a patient's digestive tract.
  • the present invention relates to devices and methods for treatment of obesity and/or its comorbidities, such as diabetes.
  • Bariatrics is the field of medicine encompassing the study of overweight, its causes, prevention and treatment.
  • Bariatric surgery is a treatment for morbid obesity that involves alteration of a patient's digestive tract to encourage weight loss and to help maintain normal weight.
  • Known bariatric surgery procedures include jejuno-ileal bypass, jejuno-colic shunt, biliopancreatic diversion, gastric bypass, Roux-en-Y gastric bypass, gastroplasty, gastric banding, vertical banded gastroplasty, and silastic ring gastroplasty.
  • a more complete history of bariatric surgery can be found in U.S. Provisional Patent Application No. 60/422,987 Apparatus and Methods for Treatment of Morbid Obesity and also on the website of the American Society for Bariatric Surgery at http://www.asbs.org.
  • Stack et al. describe a satiation device to aid in weight loss by controlling feelings of hunger.
  • the patent application describes an antral tube that expands into the antrum of the stomach to create a feeling of satiation
  • Stack et al. describe a satiation device for inducing weight loss in a patient includes a tubular prosthesis positionable such that an opening at its proximal end receives masticated food from the esophagus, and such that the masticated food passes through the pouch and into the stomach via an opening in its distal end.
  • Starkebaum describes methods and systems for treating patients suffering from eating disorders and obesity using electrical stimulation directly or indirectly to the pylorus of a patient to substantially close the pylorus lumen to inhibit emptying of the stomach.
  • an attachment system for attaching a device to the mucosal side of a wall of the gastrointestinal tract.
  • the wall comprises, among other tissue layers, a muscularis layer and a serosal layer.
  • the system comprises a gastrointestinal attachment cuff having a tubular body, a proximal end and a distal end.
  • At least one attachment structure (sometimes referred to as a tissue anchor) is provided for transmural attachment of the cuff to the mucosal side.
  • the anchor comprises a connecting element (sometimes referred to as a tension element) for extending through the wall and at least one transverse retention surface for positioning in contact with the serosal tissue.
  • the cuff may be a unitary annular component or assembly, or may comprise two or three or more components spaced circumferentially apart about a longitudinal axis.
  • the tension element may comprise a suture.
  • the tension element comprises a proximal end for extending through the mucosal layer and a distal end for carrying the transverse retention surface.
  • the transverse retention surface comprises a proximal surface of a serosal anchor.
  • the serosal anchor may comprise a T-tag, a disk, or an inflatable structure. The serosal anchor is transformable between a first, reduced profile for distal transmural advancement through the wall, and a second, enlarged profile for resisting proximal retraction through the wall.
  • the tension element has a length between the cuff and the transverse retention surface, and the length is generally at least about 2 mm and often no more than about 20 mm. In some implementations of the invention, the length is within the range from about 2 mm to about 10 mm and, depending on the patient, potentially within the range from about 3 mm to about 6 mm. Preferably, the connecting element is at least as long as the uncompressed wall thickness of the tissue at the attachment point.
  • the attachment system may additionally comprise a first engagement surface carried by a first coupler on the attachment cuff for coupling to a second, complementary engagement surface carried by a second coupler on a gastric bypass tube.
  • the first and second couplers may be configured for removable coupling or permanent coupling between the bypass tube and the cuff.
  • the bypass tube may have a length of at least about 50 cm, at least about 75 cm and in certain embodiments at least about 100 cm. The length is generally at least long enough to place the distal end beyond the pyloris, and, preferably, beyond the ligament of Treitz.
  • the system may comprise at least 6 tissue anchors, and, in some applications, at least 12 tissue anchors.
  • the cuff may be omitted and the proximal end of the bypass tube may be attached directly to the adjacent tissue.
  • the use of a cuff may be preferred, however, if removal or replacement of the bypass tube is contemplated, or if it is desirable to separate the steps of tissue attachment and bypass tube placement.
  • a method of attaching a device to the mucosal side of a wall of the gastrointestinal tract, the wall comprising a muscularis layer and a serosal layer comprises the steps of providing a tension element, having a retention element thereon.
  • the retention element is advanced through the wall from the mucosal side and the retention element is placed such that it is spaced apart from the muscularis by serosal tissue, and placed on the serosal surface.
  • the device is directly or indirectly (e.g. through a grommet, with intervening connectors, etc) attached to the tension element, such that the device is positioned adjacent the mucosal surface.
  • mucosal surface is a term of directional orientation and refers to the tissue surface facing the interior of the body lumen such as the lower esophagus or stomach, which may be covered by a mucosal layer.
  • Changes may be caused to the serosal or other tissue following the attaching step.
  • the changes may be caused to the tissue prior to the attaching step.
  • the changes may be caused to the tissue as a biological response to tension on the tension element, biasing the retention element against the serosal surface.
  • the changes may be caused to the serosal tissue in response to the application of an active agent.
  • the active agent may comprise a growth factor, a sclerosing agent, or other agent or process for increasing the tissue density (e.g. initiating a fibrotic response) of the serosal tissue residing between the retention element and the muscularis.
  • a method of treating a patient comprises the steps of providing a gastrointestinal attachment cuff having a tubular body, a proximal end and a distal end.
  • the gastrointestinal cuff is positioned in the patient's digestive tract adjacent a mucosal surface in the vicinity of the gastroesophageal junction, the mucosal surface separated from a serosal surface by a wall thickness.
  • the gastroesophageal cuff is secured adjacent the mucosal surface by advancing at least three tissue anchors through the mucosal surface, across the wall thickness and through the serosal surface to position a transverse retention surface of each tissue anchor in contact with the serosal surface.
  • the foregoing steps are accomplished endoscopically.
  • the securing step may comprise advancing at least 6 tissue anchors through the mucosal surface, and, in certain applications, at least 12 tissue anchors.
  • the tissue anchor comprises a tension element such as a suture for connecting the transverse retention surface to the cuff.
  • the transverse retention surface may be a surface on a T-tag, a disk, or other retention structure.
  • the length of the tension element may be at least about 75% of the wall thickness between the mucosal surface and the serosal surface.
  • the length of the tension element is at least about 95% of the wall thickness, and, optimally, the length of the tension element is at least about equal or greater than the wall thickness. In one embodiment the length of the tension element is at least about 120% of the wall thickness.
  • the method may additionally comprise the step of providing an elongate flexible gastric bypass tube having a proximal end and a distal end, and attaching the proximal end to the cuff.
  • the proximal end of the bypass tube may be attached to the cuff endoscopically.
  • the attaching the proximal end of the bypass tube to the cuff step may comprise removably attaching the proximal end of the bypass tube to the cuff.
  • the distal end of the bypass tube may be positioned in the patient's jejunum, in the patient's ileum, or in the patient's duodenum.
  • the flexible gastric bypass tube may additionally be provided with an optional restrictive opening.
  • the restrictive opening may be positioned anywhere along the length of the sleeve, preferably between the GEJ and the pyloris.
  • the restrictive opening may be provided in any of a variety of ways, such as by including an additional annular component within the tubular sleeve, providing a restrictive band or component on the exterior of the tubular sleeve, or by molding or otherwise forming the restrictive opening as an integral part of the sleeve.
  • FIG. 2 is a cross sectional view taken along the line 2 - 2 in FIG. 1 .
  • FIG. 3 is an enlarged cross sectional view of the cuff of FIG. 1 .
  • FIG. 4 shows a schematic illustration of the GEJ and the SCJ or Z-line and the target tissue zone identified by the present inventors.
  • FIG. 5A shows a schematic illustration of a tissue anchor placed adjacent the serosa at the time of implantation.
  • FIG. 5B shows a schematic illustration as in FIG. 5A , at a post implantation stage when the anchor has relocated into the serosa, and a layer of increased tissue density has formed on a proximal side of the tissue anchor.
  • FIG. 5C is a schematic illustration as in FIG. 5B , with the anchor relocated proximally into the plane of the muscularis.
  • FIG. 8A is a side elevational cross section through a partially inverted sleeve.
  • FIG. 8B is a side elevational cross section through a sleeve, showing an absorbable distal closure.
  • FIG. 9A is a partial cross sectional view of a sleeve having a single invertion.
  • FIG. 9B is a partial cross sectional view of a sleeve having a double invertion.
  • FIGS. 11A-11D show a method of T-tag fastener delivery.
  • FIG. 12 shows a cuff being parachuted into place along a plurality of suture tails.
  • FIG. 13 is a perspective, fragmentary view of a gastrointestinal bypass sleeve connected to an attachment cuff using sutures or clips.
  • FIG. 14 is a perspective, cross sectional view of a gastrointestinal bypass sleeve being advanced distally through a previously attached cuff.
  • FIG. 15 is a perspective, cross sectional view as in FIG. 14 , after the gastrointestinal bypass sleeve has been fully distally advanced into a sealing relationship with the attachment cuff.
  • the present invention provides devices and methods for attaching an implant within the gastrointestinal system.
  • the attachment technology of the present invention can be utilized to support any of a variety of devices which may be desirably positioned within the stomach or elsewhere in the gastrointestinal system.
  • the attachment cuff and/or serosal anchors disclosed herein may be utilized to support any of a variety of valves or constricted openings designed to treat gastroesophageal reflux disease (GERD), by augmenting natural function of the lower esophageal sphincter or replacing that function.
  • GSD gastroesophageal reflux disease
  • Any of a variety of obesity devices may also be attached to the attachment cuff and/or using the serosal anchors disclosed herein, such as electrical stimulation and/or pacing devices, or volume occupying devices which hang from or are otherwise attached to the vicinity of the lower esophageal sphincter into the stomach.
  • Any of a variety of drug delivery reservoirs may also be stabilized within the gastrointestinal system using the cuff and/or anchoring systems disclosed herein. Diagnostic devices, such as pH detectors, analyte detectors, pressure sensors may also be temporarily or permanently secured within the gastrointestinal system using the technologies disclosed herein.
  • the attachment cuff and/or associated serosal anchors may further be utilized to accomplish endolumenal anastomosis, or to span a defect or disease condition, such as an ulceration or other gastrointestinal anomaly.
  • the present invention will be described primarily in the context of gastrointestinal sleeve devices that can mimic a Roux-en-Y gastric bypass by effectively reducing stomach volume, bypassing a portion of the stomach and/or small intestines, reducing nutrient absorption in the stomach and/or small intestines and depositing minimally or undigested food farther than normal into the intestines, thereby stimulating intestinal responses.
  • FIG. 1 shows a gastrointestinal sleeve device 100 attached to an artificial attachment cuff or stoma device 102 implanted within a patient's stomach 104 .
  • the attachment cuff 102 can be implanted in the vicinity of the gastroesophageal junction 106 , or at the outlet of a surgically created gastric pouch (not illustrated).
  • the attachment cuff 102 preferably does not restrict the flow of food, although it may be provided with a restrictive opening if desired.
  • the cuff 102 can have a fixed diameter opening 108 equal to, larger or smaller than the fully open diameter at the native GEJ.
  • the cuff 102 can have an adjustable stoma opening or it can be a “smart” stoma that adjusts the size of the stoma opening in response to various conditions.
  • the gastrointestinal sleeve device 100 is an elongated flexible tubular structure that is permanently or removably attached to the attachment cuff 102 such that food and liquids pass through the cuff 102 and enter the internal lumen of the sleeve device 100 .
  • the attachment cuff 102 and the gastrointestinal sleeve device 100 can be implanted simultaneously, or the attachment cuff 102 can be implanted by itself and then the gastrointestinal sleeve device 100 can be attached to the attachment cuff 102 in the same or a subsequent procedure.
  • a line of staples or other fasteners may be used with any of the devices disclosed herein to create a gastroplasty to reduce the volume of the stomach.
  • the volume of the stomach can be reduced by suturing, stapling, adhesives or other technique using open, transesophageal or laparoscopic techniques.
  • a gastric balloon or other volume displacement device may be used in conjunction with the gastric sleeve to provide a feeling of satiety.
  • adjunctive techniques may have the effect of further reducing nutrient intake (in the case of a stomach reduction and pouch formation upstream of a stoma) and enhancing the effect of peristaltic motions of the stomach for moving food through the gastric sleeve intake (in the case of a stomach reduction downstream of a stoma where there is a gastric sleeve).
  • a gastrointestinal sleeve device 100 is attached at the GEJ with an attachment cuff 102 .
  • Tissue anchors described below, have been omitted from FIG. 1 for simplicity.
  • the cuff 102 may include a plurality of preformed attachment structures 110 for attachment of tissue anchors as is discussed below.
  • the implantable cuff and/or attachment system is preferably configured to avoid causing excessive force or pressure within the tissue by having compliance that is compatible with the gastrointestinal tissues where it is attached.
  • Device compliance can also be important for providing a leak free seal between an implanted device and the tissue at the attachment point.
  • Compliance can be provided in the radial or circumferential direction and/or in the vertical, axial or longitudinal direction.
  • the device may have different compliance in different regions to be compatible with the tissue at the attachment point and at other portions of the gastrointestinal tract through which it runs.
  • the device may have different compliance in different directions to be compatible with the tissue at the attachment point while simultaneously achieving other goals of the device.
  • Compliance can be provided in a number of different ways. One way is by elastic or plastic deformation of the device and/or the attachment means. Another way is by a mechanical decoupling that allows relative movement between the device and the attachment points, and/or between the attachment points themselves, without transmitting excessive force or pressure to the tissue.
  • the attachment cuff 102 is highly flexible or compliant in the radial direction so that expansion and contraction of the stomach and esophagus due to contents and/or muscular action will not place additional, or actually reduce, stress on the attachment points.
  • An elastomeric material such as silicone or polyurethane that provides approximately 150% or more stretch in the radial direction may be used.
  • an attachment ring or other structure for attaching the sleeve, where utilized, may have enough lateral rigidity to act as a mounting platform for the gastrointestinal sleeve device and to resist downward movement due to the weight of the gastrointestinal sleeve device and its contents and peristaltic traction on the sleeve.
  • any sleeve attachment structure can be enhanced with radially oriented bending reinforcements, such as ribs or embedded reinforcement members.
  • the attachment cuff can be flexible and compliant and other means such as hooks, sutures staples, etc., can be used for sleeve attachment.
  • the attachment cuff 102 comprises a highly flexible tubular wall extending between a proximal (superior) end 118 and a distal (interior) end 120 .
  • the wall may be permeable or substantially impermeable to body fluids, and may comprise any of a variety of weave densities and/or aperture patterns either to effect flexibility, fluid transport, or to accommodate attachment as is discussed further below.
  • the axial length of the cuff 102 between the proximal end 118 and distal end 120 can be varied considerably, depending upon the desired attachment configuration. In general, axial lengths within the range of from about 0.25 inches to about 6 inches will be used. Axial lengths within the range of from about 0.5 inches to about 2.0 inches may be sufficient to support a detachable endolumenal bypass sleeve as contemplated herein. In general, the axial length of the attachment cuff 102 may be influenced by the desired location of the seam 103 between the attachment cuff 102 and the sleeve 100 , or other device which is to be attached to the cuff 102 .
  • the attachment cuff 102 may be constructed from any of a variety of materials which are sufficiently flexible and stable in the environment of the stomach. Suitable materials may include woven or nonwoven fibers, fabrics or extrusions using materials such as polyester velour (Dacron), polyurethane, polyamide, ePTFE, various densities of polyethylene, polyethylene terephthalate, silicone, or other materials which in the form presented exhibit sufficient compliance, stretch, strength, and stability in the gastric environment.
  • polyester velour Dacron
  • polyurethane polyamide
  • ePTFE various densities of polyethylene, polyethylene terephthalate, silicone, or other materials which in the form presented exhibit sufficient compliance, stretch, strength, and stability in the gastric environment.
  • the inside diameter of the cuff 102 can also be varied, depending upon the desired clinical performance.
  • the cuff may be provided with a stoma or inside diameter which is less than the inside diameter of the adjacent esophagus.
  • the inside diameter of the cuff 102 may be approximately equal to or even greater than the native esophagus.
  • inside diameters within the range of from about 15 mm to about 40 mm are contemplated, and often within the range of from about 20 mm to about 35 mm for use in human adults.
  • the cuff 102 is provided with a plurality of attachment structures 110 in the form of apertures 122 . These apertures 122 are provided to facilitate anchoring of the cuff 102 to the adjacent tissue.
  • a plurality of tissue anchors will be pre-attached to, or advanced through the wall of the cuff 102 and transmurally through the adjacent tissue as is discussed elsewhere herein. Provision of a plurality of anchoring points such as apertures or other structures which facilitate positioning and/or attachment of tissue anchors may desirably help with anchor location as well as reduce the amount of force necessary to advance t-tags or other anchoring structures through the wall of the cuff 102 .
  • the number of apertures 122 may correspond to or be greater than the total anticipated number of tissue anchors. In general, at least about four apertures 122 and as many as eighteen or twenty are presently contemplated, with from about eight apertures to about sixteen apertures presently preferred. In one embodiment, twelve tissue anchors are used.
  • the apertures 122 in an embodiment of the cuff 102 made from a thin walled woven or non-woven material will be provided with a reinforcement ring (one reinforcing ring per aperture, or one reinforcing ring for the implant, superior to the apertures 122 ) to prevent pull-out of the associated anchoring structures, as will be appreciated by those of skill in the art in view of the disclosure herein.
  • the reinforcement ring may be a separate component such as a grommet attached at each aperture to the cuff 102 such as by thermal bonding, adhesives, mechanical interference or other technique.
  • the reinforcement may be provided by stitching around the perimeter of the aperture 122 in the manner of a buttonhole as is understood in the art.
  • each of the plurality of apertures 122 resides in a common transverse plane, positioned in the patient at or slightly above the gastroesophageal junction.
  • the apertures 122 may be provided in two or three or more transverse planes, such as to permit attachment points in a zig-zag orientation around the circumference of the attachment cuff 102 .
  • a first set of apertures 122 (such as every other aperture) may be axially displaced from a second set of apertures 122 by a distance within the range of from about 1 mm to about 10 mm, to provide a first and a second transverse attachment plane.
  • Axially staggering the location of the attachment apertures 122 may be desirable depending upon the number and configuration of tissue anchors and tissue anchor reinforcement structures as may be apparent to those of skill in the art in view of the disclosure herein.
  • a plurality of attachment points 124 may also be provided on the cuff 102 , for permanently or removably attaching the bypass sleeve 100 .
  • the attachment points 124 each comprise an aperture 126 for receiving a suture hook, clip or other interference coupling, magnet assisted coupling or other link 128 to couple the bypass sleeve 100 to the cuff 102 .
  • the bypass sleeve 100 may be attached to the cuff 102 in any of a variety of ways, such as is discussed elsewhere herein. In general, the present inventors contemplate a releasable attachment between the sleeve 100 and cuff 102 , to permit removal and/or exchange of the sleeve 100 as has been discussed elsewhere herein.
  • FIG. 2 there is illustrated a cross sectional view transverse to the longitudinal axis of the esophagus through the tissue attachment plane.
  • the cuff 102 and tissue anchors appear rigidly geometric in the illustration, it is to be appreciated that the configuration will be subject to constant motion and random configuration, as the wall of the esophagus and stomach collapse and expand, with as little resistance as possible from the cuff 102 and associated attachment structures.
  • the cuff 102 is illustrated as snugly fitted against the mucosal surface 130 of the esophageal or stomach wall 132 .
  • a plurality of anchor assemblies 134 are shown for illustration purposes.
  • the particular anchor assemblies 134 illustrated in FIGS. 2 and 3 may be best suited for surgical implantation, while some of the t-tag embodiments disclosed elsewhere herein may be more readily adapted for endoscopic implantation.
  • the anchor assemblies 134 are therefore provided for illustration purposes, but should be understood as only a single example of the broader transmural, serosal surface anchoring of the present invention.
  • the anchor assembly 134 comprises a transverse retention surface 136 for positioning against the serosal surface 138 of the esophagus or stomach wall (illustrated as a single, homogenous layer for simplicity).
  • the transverse rentetion surface 136 may be a surface on a t-tag, disc, or other structure.
  • the surface 136 is carried by a small circular or oval button 140 , although T-tags and other structures disclosed herein may be used, all of which are adapted to distribute force over predetermined surface area.
  • the button 140 may comprise any of a variety of materials, and, in one embodiment, comprises a silicone disc.
  • a reinforcement element 142 in the form of a smaller disc or transverse structure may be embedded within, or provided on the radially outwardly facing surface of the disc 140 .
  • This reinforcement element 142 allows distribution of force from the tension element 144 across a greater surface area on the disc 140 , to avoid “cheese cutter” effects or other pull through under tension exerted on the tension element 144 .
  • the desirability of including a separate reinforcing element 142 will go down, as the durometer or other rigidity characteristic of the disc 140 increases.
  • Element 142 may comprise any of a variety of materials which will be biocompatible and generally stiffer than the disc 140 , such as any of a variety of polyethylenes, PEEK, PEBAX or other materials well known in the art.
  • the tension element 144 comprises a suture which extends from the inside of the esophagus transmurally to the reinforcing element 142 and loops back through the wall of the esophagus where it is clipped, tied, locked or otherwise secured at a connection point 146 .
  • the tension element may comprise either a single filament, or two or more filaments as illustrated, depending upon the desired installation technique and physical properties of the final construct.
  • a second reinforcing element 148 may also be provided, to serve the analogous function as the first reinforcing element 142 , and resist pull through of the tension element 144 under the influence exerted on the implant by peristalsis and other gastrointestinal movement.
  • the second reinforcing element 148 may be in the form of a disc, T-tag or other structure having a force distributing surface thereon.
  • reinforcing element 148 may be a thickened, treated or reinforced zone on or within the wall of the sleeve. Additional details of t-tag attachment and related structures will be provided below.
  • an attachment zone 160 shown in FIG. 4 , directly above the squamocolumnar junction (SCJ) 162 , also known as the Z-line, ora serrata, and mucosal GEJ, may be such an area.
  • SCJ squamocolumnar junction
  • the SCJ marks the junction of the squamous mucosa of the esophagus and the columnar or glandular mucosa of the stomach.
  • the SCJ may be located at or below the lower esophageal sphincter (LES).
  • the device may, in one preferred embodiment, be attached in an attachment zone 160 no more than about 2 cm and preferably no more than about 1 cm above the SCJ 162 and below the esophagus 164 where the squamous mucosa is thicker than the squamous mucosa of the esophagus 164 and where there exists a serosal outer surface not exhibited at the esophagus 164 .
  • the thicker layer of squamous mucosa in the attachment zone 160 terminates distally at the endoscopically visible transition to the glandular mucosa of the stomach 166 which occurs at the SCJ 162 .
  • the device is also preferably attached at a location in the attachment zone 160 so as to minimize the risk of reflux.
  • the SCJ 162 can be located relative to other anatomical regions. It normally may be found at the gastroesophageal junction (GEJ).
  • the GEJ is the region at which the tubular esophagus joins the saccular stomach.
  • the GEJ can be considered the first part of the stomach 166 or the cardia and is located at the proximal margin of the longitudinal gastric mucosal folds or in the distal 2 cm of the esophagus 164 and proximal stomach 166 . Endoscopically, the location of the GEJ can be approximated by identifying the proximal margin of the gastric folds.
  • a first aspect to the location of attachment of the devices disclosed herein relates to the position of the attachment structures along the axis of the hollow lumen or organ.
  • the attachment location in the axial direction is preferably in the vicinity of the gastroesophageal junction, and particularly just above the SCJ.
  • This attachment site can be located endoscopically by observing the color change which occurs at the SCJ, and retracting or positioning the attachment structures of the endoscope slightly above that line.
  • a second aspect to the location of the attachment structure relates to the depth within the adjacent tissue wall (i.e., in a transverse direction to the longitudinal axis of the esophagus described above) within which the various anchors or retention structures disclosed herein reside. Applicants believe that the location in the transverse direction is subject to migration or other change post-implantation, as described in connection with FIGS. 5A through 5C .
  • tissue wall such as the wall of a hollow organ or lumen in the body, including the wall at the vicinity of the gastroesophageal junction.
  • the tissue wall comprises a serosa 170 and a muscularis 172 . Additional tissue layers have been omitted for simplicity.
  • the serosa 170 is on the outside of or faces away from the stomach, and the muscularis is on the inside, or faces towards the interior of the stomach.
  • the serosa 170 thus includes a serosal surface 174 which faces away from the interior of the stomach, and the muscularis 12 includes a muscularis surface 176 which faces towards the interior of the stomach.
  • the attachment device 178 can take any of a variety of forms, described elsewhere herein.
  • the attachment device 178 includes a retention element 180 having at least one retention surface 182 thereon.
  • the retention element 180 may be integrally formed with or attached to a tension element 184 , which extends through the tissue wall and is secured to the device implanted within the gastrointestinal tract.
  • attachment mechanisms disclosed herein will be defined primarily in the context of an obesity device, which is attached in the vicinity of the GEJ, those of skill in the art will apperciate that the attachment system disclosed herein may be utilized in any of a wide variety of other anatomical locations, such as in the bronchial tubes, urethra, ureters, fallopian tubes, throughout the GI tract, and others which share a serosa or serosa like layer, such as in the kidney, bladder, and other organs, as would be recognized by those skilled in the art.
  • Retention surface 182 may comprise any of a variety of forms, such as a proximal surface on a T-tag, proximal surface on a washer or disc, or any other surface which extends in a generally lateral direction with respect to a longitudinal axis of the tension element 184 .
  • the transverse retention surface 182 may be radially enlargeable or expandable from a first, reduced cross-sectional configuration to provide a low crossing profile such as for deployment through a deployment cannula, and a second, radially expanded or enlarged cross-sectional profile as illustrated in FIG.
  • Transformation between the first configuration and second configuration can be accomplished in any of a variety of ways as is discussed further herein, such as by pivoting the retention element 180 about the attachment point to tension element 184 , by radial expansion, by inflation, or other technique.
  • Tension element 184 may comprise any of a variety of connectors or elements adapted to extend through the tissue wall, such as a suture, or other single stand or multi-strand filament or material.
  • the tension element 184 is formed of a polymer such as PEEK or silicone.
  • the tension element 184 may also, in some embodiments, have elastic properties. In other embodiments the tension element 184 does not have elastic properties. By use of the term tension element, no specific mechanism is suggested, and the element is not required to be under mechanical tension.
  • the attachment device otherwise sometimes referred to herein as a tissue anchor, T-tag or other label, it is illustrated in FIG. 5A in a schematic fashion as it may appear at the time of implantation. Since in certain implementations of the invention the length of the tension element 184 will exceed the uncompressed thickness of the adjacent tissue wall, the retention surface 182 may even be spaced slightly apart from the serosal surface 174 depending upon the transient motion or configuration of the stomach at any given time.
  • the presence of the attachment device may cause or accelerate the formation of a layer 186 of serosal tissue having increased tissue density relative to unaffected or normal serosal tissue.
  • the layer of increased density 186 may result from a process in which the transverse retention surface 182 places pressure against the serosa 170 , causing a localized necrosis due to the restriction of capillary blood flow. The necrosed tissue thereafter fibroses, as a part of a normal healing response.
  • the layer of increased density 186 or fibrosis may also result from a foreign body reaction triggered by the presence of the transverse retention surface 182 . Applicants have observed a greater degree of fibrosis or denser tissue on the side of the T-tag facing the lumen of the stomach, for example on the retention surface 182 .
  • FIG. 5C In certain animal trials conducted by Applicants in which the animals were sacrificed five weeks following implantation of the attachment device 178 , successful anchors appeared similar to the simplified schematic illustration of FIG. 5C .
  • the location of the retention element 180 has changed relative to the serosa 170 and muscularis 172 , and the distal surface 188 of the retention element 180 has been covered with an overgrowth of serosal tissue 190 .
  • a fibrotic layer 186 is positioned in between the retention surface 182 and the muscularis 172 .
  • the fibrotic response appears to some extent to surround and wall off the entire retention element 180 .
  • FIG. 5C A similar response is schematically illustrated in FIG. 5C , in which the layer 186 of high density serosal tissue remains on the proximal side of the retention element 180 , however one or both of the layer 186 and retention element 180 have relocated to below the normal plane 192 separating the serosa 170 from the muscularis 172 and will remain there.
  • the device design and/or retention element 180 design are such that in normal use the retention element 180 relocates to a position in the muscularis 172 and past the serosa 170 before a sufficient fibrotic response, the retention element 180 may relatively easily pass through the muscularis 172 and failure will result.
  • the surfaces of the retention element and tension element may also be provided with an anti-bacterial characteristic, such as by eluting an antibiotic agent, or having a bacteriostatic or bacteria inhibiting coating.
  • Drug eluting coatings are well understood in the coronary stenting arts, and can be adapted for use in the present context by those of skill in the art.
  • Active agents may be applied as a coating to the retention surface 182 or retention element 180 , or may be impregnated into the material of retention element 180 and/or tension element 184 , such as to permit a timed release into adjacent tissue. Incorporation may be accomplished by loading the active agent into tortuous pathways or pores exposed to the surface of the retention element 180 , or by inclusion in a bioabsorbable or bioerodable carrier attached to or positioned in the vicinity of the retention surface 182 . Energy sources may also be utilized, such as to generate heat or otherwise stimulate formation of a fibrotic response, as is discussed further below. Formation of the fibrotic layer 186 may also be facilitated by mechanical means, for example, in one embodiment, by roughening the retention surface 182 with the addition of fibrotic layer enhancement structures such as a plurality of bumps or etched lines.
  • FIG. 6A shows an implanted gastrointestinal sleeve device 200 attached by an attachment cuff 214 with the use of T-tags 207 .
  • FIG. 6B is an enlarged view of the attachment cuff 214 attached with T-tags 207 showing the transverse retention elements 209 of the T-tags 207 embedded in the stomach wall, as may be observed several weeks post implantation.
  • a T-tag is basically a retention element 180 in the form of a cross member or “T” that is attached to a tension element 184 in the form of an elongated member or tail at or near the mid-point of the T.
  • a “stem” may be a structure at the joining point of the T and tail. From the perspective of a peroral attachment technique, in which the attachment devices are preferably advanced through muscularis 172 in the direction of the serosa 170 , the stem or tension element will be referred to herein as relatively proximal to the cross member on the T-tag.
  • T-tag fasteners are generally configured to flex or pivot at the juncture of the T and tail to allow delivery along the axis of the T through a minimal puncture diameter.
  • T-tag fasteners can be configured with an extended tail that may extend out the mouth and optionally be used to parachute devices for attachment into position in vivo.
  • Other T-tag configurations can include, crimp, snap, screw or other means of securing the T-tag tail when appropriate.
  • One embodiment of a T-tag fastener could include a dual tail. Such a dual tail could be combined with extended tails that could then be tied out side the body with the ensuing knots then tightened within the body.
  • Such a dual tail could be constructed of one of a number of non-biodegradable suture materials known in the art including polypropylene, nylon, braided Dacron or silk. In some clinical situations biodegradable tails could be indicated and could be constructed using materials described herein. In a preferred embodiment the tails could be constructed of a monofilament material.
  • the retention surface 182 it may be desirable to increase the effective surface area of the retention surface 182 .
  • This may be accomplished using any of a variety of disc or button shaped attachment devices 178 disclosed herein, or by introducing a buttressing component or element in the nature of a washer or other structure for enlarging the effective surface area.
  • This buttressing structure may sometimes be referred to herein as a pledget.
  • the buttressing material is generally configured perpendicular to the axis of the tension element 184 (e.g. suture, rivet or staple) and therefore best distributes forces along the axis of the attachment means.
  • T-tags or other serosal anchors can be delivered through a hollow needle type delivery system (e.g. T-ANCHOR INTRODUCER GUN (Moss, Moss Tubes)) that has been redesigned/modified so it can be passed through the working channel of an endoscope.
  • a T-tag can be provided with an elongated tail that can extent out through the mouth and be used to parachute structures into place in-vivo.
  • the T-tags are placed such that the sutures of the T-tags could be knotted outside of the body and the knots could be pushed down the working channel or outside of the working channel of the scope until positioned to retain the cuff.
  • the suture tails could subsequently be removed.
  • two T-tags could first be placed to secure the cuff followed by placement of the rest of the T-tags.
  • the T-tag tension elements such as tails, sutures, or other structures as described herein, would terminate in the stomach, such as by tied knots, sliding buttons, or preexisting terminated ends, such that they would not need to be brought outside of the body.
  • any of a variety of suture locks may be utilized to secure the suture with respect to the cuff.
  • a suture lock is provided with a central aperture for moveably receiving the suture therethrough.
  • the lock may be configured for one way advance along the suture, having a spring biased engaging element for resisting movement of the lock in the opposite direction.
  • a central plug may be advanced into the central lumen, to compress the suture within the suture lock and retain the suture lock at a selected position.
  • Any of a variety of clips may also be axially or radially moved into position, to engage the lock with the suture.
  • the suture lock may be advanced down the suture and positioned with the desired tension against the interior surface of the cuff, and activated as necessary to lock the suture lock in place. The remaining suture tail may be severed, using conventional endoscopic techniques.
  • the suture lock may be secured to the cuff 102 such as at each aperture 122 , prior to implantation of the cuff 102 in the patient.
  • T diameter or serosal surface contacting width can vary for example ranging from 0.5 mm to 3.0 mm in diameter for nylon or polypropylene with the typical “T” having a diameter of 1-2 mm.
  • a tail could be the dimension of a standard suture and could generally vary from 5-0 to 0 (USP standard classification) though smaller or larger sizes may be appropriate in certain clinical situations.
  • FIGS. 7A & 7B illustrate a curved T-member 300 for a T-tag fastener.
  • the convex curved tissue-contacting surface 302 of the curved T-member 300 serves to distribute the attachment force for an implanted device smoothly across the tissue to minimize any stress concentrations or higher pressure spots that could cause tissue necrosis and/or erosion.
  • the T member 300 has a double eyelet 304 for attachment of a suture or other filament.
  • the T-member is preferably molded of a fairly rigid, high strength biocompatible polymer such as PEEK.
  • FIGS. 23A-23B of application Ser. No. 11/124,634, previously incorporated by reference, illustrate a T-tag fastener 2200 with a hydrogel disc 2204 that can be placed between the deployed T-member 2208 and the extragastric (serosal) surface.
  • the disc 2204 could be delivered through the T-tag delivery needle, and unroll after passage through the needle.
  • the hydrogel disc 2204 acts as a buttress or pledget to distribute the forces transmitted between the T-member 2208 and the extragastric surface and thereby it strengthens the attachment of the T-tag fastener 2200 .
  • the hydrogel used in FIGS. 23A-23B can optionally be replaced with alternate materials described herein for example silicone, NiTi and fluoropolymers.
  • a Hydrogel or other buttress or Teflon pledget for a T-tag could also deploy in some other manner.
  • the disc configuration shown can be replaced with for example, braided or woven wires or filaments that would expand/deploy after passage through the needle ( FIGS. 24A-24B ), a Malecot-style deployable tubular structure ( FIGS. 25A-25B ) or other expandable or deployable configuration (e.g. FIGS. 26A-26B ).
  • FIGS. 23A-23B , 24 A- 24 B, 25 A- 25 B, and 26 A- 26 B illustrate t-tag fasteners, such as 2200 in FIGS.
  • T-tag fasteners without T-members and just with the hydrogel disc 2204 of FIGS. 23A-23B or the woven filaments, Malecot-style tubular structure, or the expandable structure of FIGS. 24A-24B , 25 A- 25 B, and 26 A- 26 B, respectively, are also contemplated.
  • the cuff 102 and sleeve 100 may be formed as an integral unit, or supplied to the clinical site as a single unit, for installation as one piece. Alternatively, the cuff 102 and sleeve 100 are provided as separate components, with an instruction that the cuff is inserted first as described elsewhere herein, followed by insertion of the sleeve 100 and attachment of the sleeve 100 to the cuff 102 .
  • the sleeve 100 may be attached to the cuff 102 in any of a variety of ways, depending upon the ease with which removal may be desired. For example, stitching or clipping may be accomplished, as described previously. Alternatively, any of a variety of snap fit, interference fit, hooks, loops or other techniques may be utilized.
  • a first retention surface such as an upwardly facing surface 320 on a radially inwardly facing flange 322 or plurality of tabs on the attachment device (cuff) 102 limits distal movement of the sleeve 100 by contacting a second retention surface on the sleeve.
  • the second retention surface may be a downwardly (distally) facing surface 324 such as the distal surface of a radially outwardly facing or inclined annular flange 326 or plurality of tabs on the proximal end of the sleeve 100 .
  • the sleeve may be passed through the cuff and simply “dropped” into place and the first and second retention surfaces limit further distal travel of the sleeve relative to the cuff.
  • the connection between the sleeve 100 and the cuff 102 should be sufficient to resist detachment under normal use conditions.
  • the proximal end of the sleeve 100 may be provided with one or more reinforcing structures such as an annular ring 328 .
  • a corresponding annular ring or band (not illustrated) may be provided on the radially inwardly facing flange 322 .
  • the sleeve cannot be pulled from the cuff 102 unless the force applied is sufficient to deform one or both of the complementary rings.
  • the structural integrity of this type of interfit structure may be optimized, taking into account the likely tension forces applied by the GI system, in view of the desired flexibility and compressibility of the implant as has been discussed.
  • Each of these embodiments permits the sleeve to be dropped into place or snap fit into place by elastic or other deformation of the interlocking retention surfaces.
  • the attachment can be made more secure by the addition of one or two or more staples, stitches of suture adhesives or t-tags. Removal can be accomplished using a removal tool with a stop surface for placing against a surface on the cuff to prevent proximal movement of the cuff, and a grasper for grasping the proximal end of the sleeve and pulling the sleeve to release it from the cuff without straining the connection between the cuff and the tissue. Any additional sutures can be snipped using conventional endoscopic cutting tools. The cuff may also be removed if desired, or a different sleeve may be introduced and secured to the cuff.
  • the gastrointestinal sleeve device 100 preferably has a length such that ingested food and liquids bypass most or all of the stomach and at least a portion of the small intestine. Undigested food and liquids exit the distal end 112 of the sleeve 100 into the small intestine 114 reducing caloric absorption and eliciting physiological responses within the intestines. See FIG. 1 .
  • the gastrointestinal sleeve 100 can have a constant diameter throughout its length or the diameter may vary along the length.
  • the proximal end of the sleeve 100 may be provided with a diameter that corresponds with the diameter of the cuff 102 . This may be in the vicinity of about 25 mm to about 35 mm.
  • the sleeve may be provided with the same diameter throughout its entire length, although this would result in folding of the sleeve longitudinally as it passes through the intestine.
  • the duodenum may have an inside diameter on the order of about 15 mm.
  • one implementation of the invention provides a sleeve having a proximal end having a first cross sectional area, adjacent a tapered or stepped zone across which the cross sectional area reduces to a second, smaller cross sectional area.
  • the axial length of the transition zone may be less than about 2 cm, and some embodiments less than about 5 cm, and in some embodiments no greater than about 10 cm. Alternatively, the length of the transition zone may exceed 10 cm or 20 cm, where wrinkling or longitudinal folding of the sleeve is not sought to be avoided.
  • the sleeve 100 and cuff 102 may be configured to provide a restrictive opening, either within the sleeve 100 or the cuff 102 .
  • the restrictive opening may be effectively provided at the distal end of the transition zone 101 illustrated in FIG. 13 .
  • the stoma may be positioned to provide a volume proximally of the stoma of no greater than about 100 cc, and in some implementations of the invention no greater than about 50 cc, and in certain applications no greater than about 30 cc, depending upon the desired clinical result.
  • additional structures and features may included on the sleeve 100 .
  • one or more structures may be provided on the distal end of the sleeve 100 for facilitating transport of the sleeve 100 through the intestinal system.
  • This may include a balloon or other bulking structure to facilitate preferential operation of peristalsis on the distal end of the sleeve.
  • Any such structures may be absorbable, detachable, or permanent, depending upon the desired clinical performance.
  • any of a variety of grasping structures such as a grasping tab or ring may be provided to facilitate grasping the distal end of the sleeve 100 using an installation tool, which is advanced distally through the intestinal system.
  • the gastrointestinal sleeve 100 can be impermeable along the entire length or some or all of the device may be porous or semipermeable.
  • the wall of the gastrointestinal sleeve 100 is thin and flexible so that peristalsis is coupled to the internal lumen of the sleeve 100 .
  • a gastric sleeve that extends beyond the pylorus 116 , with or without an intestinal sleeve component, can allow use of the pylorus as a natural stoma by configuring the sleeve to close by normal operation of the pylorus 116 and then open to allow passage of food when the muscles of the pylorus relax.
  • the section of the sleeve device 100 that passes through the pylorus 116 will preferably have enough wall flexibility or compliance to allow normal opening and closing of the pylorus to release and retain stomach contents and to allow drainage of stomach secretions around the outside of the sleeve. This can optionally be accomplished by the inclusion of pleats, channels or other structures to facilitate the collapse and sealing of the sleeve as well as passage of gastric secretions along the outside of the sleeve as shown schematically in FIG. 6A .
  • the gastrointestinal sleeve 100 is preferably approximately 60-180 cm in length whereby partially digested or undigested nutrients exit from the sleeve into the jejunum where they can elicit a hormonal, neural and/or osmotic reaction in the jejunum, ileum and/or duodenum.
  • Increasing the length of the sleeve can reduce the absorption of nutrients in a manner similar to that of a Roux-en-Y or bypass device, as will be understood by those skilled in the art.
  • the sleeve may extend sufficiently far into the intestine, such as past the ligament of Treitz, so that it is retained in the intestine and not pushed back into the stomach. Lengths of at least about 50 cm, at least about 75 cm, at least about 100 cm and at least about 120 cm are contemplated, although different lengths may be appropriate depending upon the requirements of a particular patient. Lengths of no greater than about 5 cm or no greater than about 10 cm or no greater than about 20 cm may be desirable for certain patients, depending upon the desired clinical outcome.
  • the releasable attachment of the sleeve to the cuff as disclosed herein facilitates removal and replacement of the sleeve 100 .
  • the response of a particular patient to a first sleeve having a first length can be observed.
  • the first sleeve can be endoscopically removed from the cuff, and replaced by a second sleeve having a second shorter or longer length.
  • Therapy is thus adjustable, which may be desirable if either the initial sleeve length was suboptimal or if it becomes suboptional due to post implantation changes such as stomach remodeling or behavioral changes.
  • the sleeve can include coatings on its interior and/or exterior to enhance the surface properties of the sleeve in clinically relevant manners. Coating examples include: 1) parylene coatings to increase the chemical resistance of a sleeve material, 2) coating with an antimicrobial agent to resist infection and/or 3) coating with an anti-inflammatory agent to reduce tissue inflammatory response, as described herein.
  • the interior and exterior of the sleeve can optionally be coated with a low friction material (e.g. a hydrogel) to reduce friction of food passage (interior) and reduce gastric irritation (exterior).
  • a low friction material is a lubricious coating such as the PHOTOLINK LUBRICIOUS COATING manufactured by Surmodics Inc. and disclosed on pg. 5, paragraph 58, in U.S. utility patent publication 2005-0049718, the disclosure of which is herein incorporated in its entirety by reference.
  • U.S. patent application Ser. No. 10/698,148 describes the use of biodegradable or bioresorbable materials for construction of a gastrointestinal sleeve device to obviate the need for removal of the sleeve device at the end of the treatment period.
  • the entire gastrointestinal sleeve device or a portion of it may be made of biodegradable material.
  • the gastrointestinal sleeve device may be made of biodegradable materials with different rates of degradation or resorbtion.
  • the gastrointestinal sleeve device may be configured with a series of segments that biodegrade sequentially. For example, a first portion on the distal end of the sleeve may degrade first, followed some time later by a second intermediate portion and a third proximal portion.
  • the gastrointestinal sleeve device may be configured with a series of short segments of non-biodegradable material that are attached to one another with biodegradable material.
  • the biodegradable attachment portions may be made of biodegradable materials with different rates of degradation or resorbtion so that they biodegrade sequentially.
  • the biodegradable material would allow a gradual change of therapy over time, without having to revise or replace the implant. The patient could get used to the gradual change in therapy more readily than a sudden change and may be better able to avoid a rebound in weight gain. It may also allow for a safe mode of degradation and elimination. The device would degrade into pieces small enough that they could be eliminated without any danger of bowel obstruction.
  • selected portions of the gastrointestinal sleeve device may be made of biodegradable material.
  • openings in the sleeve can be covered with biodegradable material that will gradually degrade over time, eventually allowing food to mix with digestive secretions.
  • the biodegradable material would allow a gradual change of therapy over time, without having to revise or replace the implant.
  • the gastrointestinal sleeve device with the openings in it could be left in place for long-term maintenance of weight loss or it could eventually be removed.
  • the rate of degradation of the biodegradable material forming the sleeve could be coordinated with the natural pH of the anatomical environment and/or to properties of the material forming the sleeve, to achieve a predetermined sequential degradation of the implant.
  • a distal (intestinal) portion of the sleeve dissolves before the proximal (gastric) portion.
  • the sleeve could be constructed of a material that degrades at a faster rate in a relatively basic environment than in a relatively acidic environment such that the distal portion of the sleeve in the intestine would dissolve before the proximal portion of the sleeve in the stomach.
  • the pH of the sleeve environment could also be altered by an external source, for example by ingestion of a substance that would change the pH of the stomach and/or intestine and thus hasten degradation of the gastric component.
  • the distal and proximal portions of the sleeve could be constructed of two different materials with the material comprising the distal portion dissolving faster than the material comprising the proximal portion.
  • the material forming the sleeve could be thinner at the distal portion than at the proximal portion such that the distal portion would dissolve in less time than the proximal portion. All or any combination of the above alternatives could be used to set the time frames of degradation of the distal and/or proximal portions of the sleeve depending on the desired performance.
  • Biodegradable material suitable for construction of a gastrointestinal sleeve device is sold under the name Plastifilm by OsteoBiologics, Inc., located in San Antonio, Tex. This biodegradable polymeric film material is described in U.S. Pat. No. 6,514,286, which is hereby incorporated by reference. Additional information from the supplier about this material is available at: http://www.obi.com/.
  • Another aspect of the present invention involves devices and methods for delivery and deployment of a gastrointestinal sleeve device into a patient's gastrointestinal tract.
  • One method to facilitate delivery of the device into and through the patient's small intestine is to place a guidewire and/or catheter into the intestine to the depth desired and then push the gastrointestinal sleeve device over the guidewire.
  • Successful techniques for placing a guidewire into the small intestines have been described by G. Long, T. Mills and C. P. Swain in an article entitled Techniques for advancing guide wires and devices in the lumen of the gastrointestinal tract.
  • Another technique that could be adapted for placing a device such as a gastrointestinal sleeve device into the small intestine was described by H. Yamamoto and K.
  • the gastrointestinal bypass sleeve may also be deployed within the intestine using a toposcopic, or everting technique, based upon the method of internal pressurization that is well known in the everting catheter art. Pressurization may be accomplished by placing the proximal end of the axially collapsed sleeve in communication with a source of inflation or everting media, such as a liquid or gas. Liquid such as water or saline may be preferred, and may additionally be provided with a radiopaque additive to permit real time fluoroscopic visualization of the progress of the deployment within the GI system. Additional additives may also be provided, such as antibiotics, nutritional supplements or others as may be desired.
  • FIGS. 8A-8B illustrate one of a number of options for sealing the distal end 112 of a gastrointestinal sleeve 100 during delivery and deployment.
  • FIG. 8A shows the inverted distal end 112 of the gastrointestinal sleeve 100 sealed with a suture or tie 150 which may be degradable and formulated to dissolve within approximately 2 or 6 or 24 hours in the intestines. Dissolution of the biodegradable tie 150 can be aided by introduction of a solvent, or active agent, or inducing a pH change that is ingested or placed in the everting fluid.
  • the distal end 112 may also be releasably secured to a pull line 152 such as a suture or wire, to assist in inverting the sleeve as will be apparent to those of skill in the art.
  • FIG. 8B shows the noninverted distal end 112 of the gastrointestinal sleeve 100 sealed with a biodegradable tie 150 that may be formulated to dissolve within the intestines, prior to proximal retraction of the pull line 152 .
  • the distal end may alternatively be temporarily occluded using adhesives, such as a water soluble adhesive or pressure sensitive adhesive applied to the interior surface of the distal end 112 of the sleeve.
  • adhesives such as a water soluble adhesive or pressure sensitive adhesive applied to the interior surface of the distal end 112 of the sleeve.
  • the distal end of the sleeve may be folded over onto itself with or without the use of adhesives. Solvent bonding, thermal spot welding or other bonding technique may be used to close the distal end 112 , in a manner that a slight increase in pressure can be applied to the inflation media following full deployment, to rupture the seal.
  • a tie line may alternatively extend proximally from the distal end 112 , either inside of the lumen or outside of the sleeve 100 . Proximal retraction of the tie line following sleeve placement will untie a knot or otherwise release the distal end 112 . Otherwise the distal end may be simply left open during
  • FIG. 9A shows a gastrointestinal sleeve 100 loaded in an inverted configuration.
  • FIG. 9B shows a gastrointestinal sleeve 100 loaded in a double-inverted configuration.
  • a full single inversion will reduce the length of the sleeve 100 by about 50%, while a full double inversion will reduce the length of the sleeve 100 to about 25% of its original length. Deployment of the sleeve will thus still require a first step of positioning the distal end 154 of the inverted sleeve 100 at a first position within the GI tract, and then second everting the sleeve to position the everted distal end at a second position within the GI tract, downstream from the first position.
  • the second position will normally be at least about 50 cm and often at least about 75 cm or 100 cm distally of the Pyloris.
  • the first position may be at about the Pyloris, within about 20 cm of the Pyloris, or within about 50 cm of the pyloris, depending upon the device design and desired deployment procedure.
  • Inverting the sleeve simplifies the delivery and deployment of the device, but it adds some additional constraints to the configuration of the device.
  • the inverting segments can have very thin walls and inverting interfaces can be highly lubricious for easy and reliable deployment.
  • blow molded 90 A durometer polyurethane of a wall thickness on the order of 0.005′′ or less, most preferably about 0.002′′, with a lubricious coating will work in this manner.
  • Eversion within the intestine may be accompanied by introduction of an irrigating or lubricating fluid on the outside of the sleeve 100 , and/or provision of a lubricant in between contacting surfaces of the inverted sleeve. Additional details are disclosed in copending application Ser. No. 10/698,148, filed Oct. 31, 2003, entitled Apparatus and Methods for Treatment of Morbid Obesity, the disclosure of which is incorporated in its entirety herein by reference.
  • a GI sleeve can be inserted and/or retrieved using a flexible endoscope.
  • a skilled GI endoscopist can “drive” a special endoscope (an enteroscope) through the duodenum and deep into the jejunum. Because of its small size, a pediatric colonoscope can be used to access an area further down the intestine.
  • the sleeve With proper interfacing structure on a GI sleeve, the sleeve can piggyback on the endoscope as it is driven into the jejunum and then released with its distal end left in the jejunum when the endoscope is retracted and removed from the body. This can be accomplished perorally either before or after attachment of the proximal end of the sleeve to tissue or to a cuff at the GEJ or some other clinically desirable location.
  • Various structures can be used as an interface between the endoscope and the distal end of the GI sleeve device.
  • the sleeve device has a solid distal end or other graspable portion, such as a tab or loop near the distal end, a standard or custom endoscopic snare or grasper can be extended through the endoscope working channel to grasp the sleeve device.
  • the distal end of the sleeve device can be configured with a socket or pocket to engage a flexible pusher, which may be configured as a rod, tube or guidewire.
  • the sleeve device can be configured with a distal end that can be cut off to release the device.
  • the distal end of the sleeve device is grasped with a snare or the like extended through the endoscope working channel. Once the sleeve device is delivered far enough distally in the GI tract, the distal end of the sleeve device is cut off to release the device.
  • delivery of the sleeve device to an area sufficiently far down the intestine is facilitated by attaching a traction structure, such as a mercury ball or liquid filled balloon, that increases the likelihood that the sleeve will be pulled down the intestine, to the distal end of the sleeve.
  • a traction structure such as a mercury ball or liquid filled balloon
  • a remote controlled robotic endoscope comprises a user interface, a control device, and an operating unit. Commands can be inputted by an operator into the user interface to activate the control device which in turn guides the operating unit in three dimensions.
  • the operating unit in one embodiment, can be a fastener deployment head carried by a catheter which is positionable within the gastrointestinal tract and capable of attaching various fastener structures such as sutures and T-tags in response to commands received by the user interface. Monitors that display physical data and images of the anatomy to aid in navigation of the operating unit may also be used with a remote controlled robotic endoscope.
  • Such an endoscope could scale the operator's movements such that large movements of the operator would translate into the smaller movements that may be required to maneuver the endoscope within the gastrointestinal tract.
  • a remote controlled robotic endoscope is described in “Radiocontrolled Movement of a Robot Endoscope in the Human Gastrointestinal Tract,” by P. Swain, T. Mills, B. Kelleher, L. Schmitz, S. Mosse, P. Burke, K. Ikeda, and A. Fritscher-Ravens.
  • T-tag fasteners or other fasteners When placing T-tag fasteners or other fasteners in the region of the GEJ, it is important to avoid other anatomical structures in the vicinity of the stomach and esophagus.
  • One method for this is to create a safe space behind the GEJ for deploying the fasteners.
  • One method to accomplish this is described in the parent application Ser. No. 10/698,148.
  • FIG. 10 also shows an optional stomach traction device 254 deployed through the working channel of an endoscope 256 that helps to facilitate safe deployment of the fasteners 134 in the GEJ region.
  • the traction device 254 can be used to retract the gastric wall laterally 254 A and/or distally 254 B to create a safe place for deployment of the fasteners 134 . Due to anatomic variations and pathology, the position of the diaphragm relative to the stomach and GEJ should be confirmed prior to using this technique.
  • pneumoperitoneum can be used to create a safe space around the stomach and esophagus. Pneumoperitoneal pressure will tend to collapse the stomach away from other surrounding organs and would be balanced by the pressure used to endoscopically insufflate the stomach for improved visualization and access.
  • an “endoscopic compass” can be used to provide a reference for orienting the endoscope when using fastening devices.
  • a small magnetized needle i.e. a compass needle
  • a magnet is placed on the patient to provide a reference point for the compass, for example the reference magnet can be placed on the patient's back directly over the spine.
  • the compass needle will point toward the reference magnet on the spine. Using the compass needle as a reference, the operator will be able to avoid inadvertently puncturing the aorta, which lies directly posterior to the esophagus.
  • Veress needle can be adapted for avoiding puncturing other anatomical structures in the vicinity of the stomach and esophagus during endoscopic attachment of devices near the GEJ.
  • a Veress needle is a needle equipped with a spring-loaded obturator that is often used for insufflation of the abdomen in laparoscopic surgery.
  • a long, flexible device with a needle at the distal end and a spring-loaded obturator within the needle would be used to safely puncture the gastric or esophageal wall.
  • the spring-loaded obturator advances automatically to avoid damage to any surrounding tissues.
  • a delivery cannula can be advanced over the needle and the needle can be exchanged with a fastener delivery device.
  • a small diameter needle with a flow detector (e.g. a Doppler flow sensor) or pressure detector for detecting blood flow or blood pressure.
  • a flow detector or pressure detector can be mounted on a separate guidewire inserted through the needle. The flow detector can be used to detect blood flow before the wall of the aorta is punctured. Alternatively, if backflow of blood or blood pressure is detected, indicating that the needle has punctured the aorta, the needle will be withdrawn and a fastener will not be delivered at that site.
  • the small diameter puncture in the aorta should heal without complications.
  • the organs and other anatomical structures in the vicinity of the stomach and esophagus can be protected during endoscopic attachment techniques by using a depth stop on the needle or delivery cannula to prevent it from penetrating farther than necessary to traverse the gastric or esophageal wall.
  • a depth stop on the needle or delivery cannula to prevent it from penetrating farther than necessary to traverse the gastric or esophageal wall. Examples of fastener delivery devices with a depth stop to protect nearby organs and structures are described in U.S. provisional patent application 60/569,442.
  • FIGS. 11A-11D illustrate a simplified view of delivery of a T-tag fastener showing the serosal anchor and tension element (suture) of a T-tag fastener and the delivery cannula with a pusher therein.
  • the entire delivery assembly would include an endoscopic delivery device (not shown), with the delivery cannula carried piggyback by the endoscope or deployed through the working channel of the endoscopic delivery channel.
  • the T-tag fastener would attach an attachment device such as a cuff to a gastrointestinal sleeve device through a grommet or hole in the cuff and/or sleeve device.
  • All or a portion of the fastener can be coated and/or made with a material that will encourage tissue ingrowth to create a seal and to promote a strong and durable attachment, although tissue ingrowth in the vicinity of the GEJ is not expected to be robust. All or a portion of the fastener can be coated and/or made with a swellable material to create a seal and/or to spread out the force of attachment over a greater surface area, thereby reducing the pressure on the tissue. All or a portion of the fastener can be coated and/or made with a material that is biodegradable or bioresorbable. Examples of such coatings materials are described in the parent application Ser. No 10/698,148.
  • provisional patent application 60/534,056 describes a variation of this method for implanting a device within a patient's digestive tract using T-tag fasteners.
  • suture locks such as those described in U.S. Pat. No. 4,235,238, the disclosure of which is hereby incorporated in its entirety by reference herein, or those used in the BARD Endocinch system can be used to secure the suture prior to cutting.
  • the cuff When parachuted into place along the sutures, the cuff may be folded or compressed to pass through the esophagus or through a delivery tube placed in the esophagus.
  • this parachuting technique it is desirable to minimize the friction between the device and the sutures. This can be done by using a low friction material or a low friction coating on the sutures and/or the device. This is also done by dimensioning and/or orienting structures, e.g. holes, to guide the parachuted device to reduce friction.
  • FIG. 12 shows an implantable device 102 being implanted at the GEJ using a parachuting technique.
  • a fastener delivery device for placement of an implantable device 102 by the parachuting technique is disclosed in U.S. utility patent application Ser. No. 11/025,364, previously incorporated by reference herein.
  • the device 102 may be partially parachuted into place, meaning that 2-4 parachute sutures are used to slide the device 102 into position with the proper orientation. Then additional fasteners, for example T-tag fasteners, are delivered endoscopically to complete the attachment of the device 120 to the tissue.
  • additional fasteners for example T-tag fasteners
  • suture tails are delivered through a closed lumen (e.g. in or attached to an endoscope), the lumen must be removed from around the suture tails before a device can be parachuted over the sutures if the device is too large to pass through the lumen. This can present a challenge related to maintaining the organization of the suture tails and preventing confusion, crossing, winding and/or tangling of the suture tails.
  • T-tag fasteners and their suture tails are passed externally e.g. through an external lumen with a longitudinal slot or in a non-enclosed rail type system, the suture tails can be managed external to the lumen used to place the T-tag fasteners and external to the scope. This facilitates manipulation of the scope, simplifies scope exchanges and simplifies suture tail management.
  • Suture tail management external to the scope or an enclosed lumen can be combined with suture holders external to the patient, similar to those used for parachuting replacement heart valves into place. Snugging the sutures as described above is simpler when the suture tails are external to the scope, as is avoidance of crossing, winding and/or tangling of the suture tails.
  • Suture holders such as slots, clamps or clips, can be combined with a mouth guard for organizing the sutures during a peroral parachuting procedure.
  • suture tail management is that it must happen from one end of the system to the other. Therefore, the method and apparatus must address this issue. For example, after placement of a T-tag fastener, a slight tension on the suture tail can hold the suture against the wall of the lumen or in a straight position where it is less likely to tangle.
  • Apparatus can include means to maintain tension while allowing scope movement and manipulation e.g. tension from a long soft spring, an elastic band or a spring-loaded reel.
  • an overtube is used to line the esophagus and protect it from damage due to insertion and manipulation of the endoscope and related tools and devices.
  • Other practitioners prefer to avoid the use of an overtube.
  • a major issue when parachuting a device into place is friction between the device and the sutures, and collapsing or folding the device may exacerbate the problems with friction.
  • the following method is intended to reduce the problems with friction between the device and the sutures when parachuting a device through the esophagus.
  • the method allows the device to be parachuted through the esophagus in a folded configuration, while it also allows the sutures to pass through the device while it is in an unfolded position.
  • the method allows the sutures to be pulled through the device one at a time, which further reduces the problems with friction.
  • This method can be used, for example, with the t-tag and/or t-tag delivery systems described herein.
  • the gastroesophageal junction is a preferred attachment point for a gastroesophageal sleeve device or attachment device as discussed above. Attachment at the GEJ excludes all gastric secretions from the interior of the gastrointestinal sleeve device to separate ingested food and liquids in the sleeve device from all digestive secretions.
  • the gastroesophageal junction is one of the preferred attachment sites because the tissue wall is relatively thick at this location and it is relatively easy to access via a peroral route.
  • the non-glandular tissue directly above the squamo-columnar junction (a zone of tissue that is considered to be at the beginning of the GEJ) is the strongest tissue in this region and is currently thought to be the best place to attach a device, for example using T-tags, sutures or other fasteners.
  • tissue prior to implantation of a device such as a gastrointestinal sleeve device.
  • energy can be delivered in the form of RF, ultrasound or other known method to induce an inflammatory, coagulative or necrotic tissue strengthening reaction.
  • placement of material in the serosal tissue of the stomach wall could generate a foreign body reaction that would progress from inflammation, to granulation of tissue and then to fibrosis.
  • the tissue may initially weaken due to the inflammatory response, but the resulting fibrotic growth will strengthen the tissue. This effect could be enhanced by the choice of material an/or coatings, e.g. sclerosing agent, an acidic material or coating.
  • the materials could be delivered endoscopically with a needle device through the biopsy channel of an endoscope.
  • the needle delivery device could optionally also deliver an ink, dye or other marking means to facilitate location of the prestrengthened areas.
  • Tissue reaction could take place in days, with 7-14 days being an approximate delay between prestrengthening and attachment procedures.
  • Material injectable to prestrengthen tissue could be: 1) liquid where natural processes would remove/break down or otherwise dispose of the liquid when it has completed its function; 2) biodegradable or dissolvable where natural processes would remove the material when it has completed its function; or 3) permanent where the material might be incorporated into the tissue to provide increased strength. All of the prestrengthening strategies described could be used at the time of the attachment procedure to enhance strength of the attachment.
  • tissue bulking agents are injected at or near the GEJ to treat GERD. Injection of non-bulking materials that initiate tissue thickening could accomplish the same end result. If the thickened tissue was, by itself or in conjunction with a supporting structure, to form a restrictive stoma, there could be specific advantages relative to a mechanical stoma.
  • tissue prestrengthening and/or thickening include: Circumferential ablation (RF, microwave, ultrasound, etc); Over-dilation; Circumferential abrasion; and, Circumferential exposure to agent.
  • Circumferential ablation RF, microwave, ultrasound, etc
  • Over-dilation Circumferential abrasion
  • Circumferential exposure to agent Circumferential exposure to agent.
  • tissue can be treated to reduce its ability to move or stretch. This can be advantageous in that tissue that has limited stretch or motion may have less impediments to attachment. Tissue that has limited stretch or motion may impose fewer forces on an attached device and therefore impose less force or pressure that may lead to attachment failure. Furthermore, tissue that has limited stretch or motion may allow attachment of less compliant devices which can provide for advantages foe example simplified sealing.
  • Techniques described above to strengthen tissue can also help to limited GI tissue stretch and motion.
  • Other methods that could be applied to reducing stretch and motion, and also for pre-strengthening include the application of energy for example, by RF, ultrasound or laser.
  • Means that include time release elements as well known in the art of drug eluting vascular stents and birth control devices can be used to provide and/or maintain a long lasting effect (reducing motion and stretch).
  • Such time release means can optionally be combined with fasteners, permanent or replaceable attachment cuffs or proximal sleeve interfaces.
  • Such time release means can optionally be combined with permanently implanted pre-strengthening materials where the material might be incorporated into the tissue to provide increased strength.
  • the wall of tissue may thicken after placement of the attaching device. In some cases this can progress to encapsulation. This thickening can result in increased tissue strength due to collagen deposition and/or fibrosis.
  • One configuration of material that could have advantageous performance would: 1) not stretch for an initial period, for example 24-48 hours; 2) stretch at a relatively low force for the next period, for example 7-14 days; then 3) not stretch after the second period. This performance would be based upon a clinical situation where tissue proliferation (wall thickening) occurs between days 2 and 14.
  • the material could: 1) not stretch for the initial period, for example 24-48 hours; 2) allow lengthening to 2 ⁇ length at any time after the initial period, for example 48 hours; then 3) not stretch beyond 2 ⁇ length.
  • the length of the suture or other tension element which extends through the wall from the serosal surface to the mucosal surface, particularly when the tension element has a substantially fixed length under normal use conditions may also be important.
  • the present inventors believe that the length of the tension element is in certain applications at least about 75%, often at least about 100%, and preferably at least about 120% and possibly at least about 130% of the thickness of the wall of the stomach through which the tension element is to be placed.
  • suture lengths between the mucosal contacting surface of the implant and the serosal contacting surface of the retention element of at least about 10 mm, and often at least about 15 mm are contemplated.
  • the stomach appears to have unusual abilities to isolate foreign objects. Evidence of this is the lap band which can migrate from the serosal surface of the stomach into the lumen of the stomach without any immediate catastrophic event such as a leak of stomach contents into the body cavity which could be life threatening. The cause of such erosion is unclear but one theory suggests it is at least in part due to pressure.
  • the stomach is also a very active organ with an ability to stretch, compress, churn and move laterally relative to itself. This activity is normal in eating and digestion and can also function to isolate foreign objects.
  • the present inventors have conducted a series of studies to explore the parameters of a successful attachment.
  • Initial designs utilizing rigid rings lost attachment at a majority of points within four weeks.
  • this same technique at five weeks did not maintain 100% attachment.
  • One-Third of the attachment points migrated through the stomach, leaving no identified histological evidence of their path. The t-tags did not appear to be deformed.
  • the inventors then undertook a series of experiments at five weeks controlling for the amount of tension on the tension element, by placing serosal surface attachment devices having tension elements with a predetermined length relative to the thickness of the tissue wall.
  • the thickness of the porcine stomach at the target site was measured, and the average of four tissue thickness measurements at the 3-6-9-12 o'clock positions was used as the nominal thickness.
  • the absolute thickness was somewhat surprising at around 1 cm. This was perceived to be much thicker than what was thought. The reasons for this could be increased thickness in the area of interest of the GEJ, but it could also be due to the highly compressible nature of stomach tissue in that when it is held between the thumb and index finger it does feel 1 cm thick.
  • tension control could be addressed by using suture with limited elastic properties or other structural mechanism that would stretch or elongate and then return to their nominal length.
  • Another way is to use an assumed thickness, based upon an average of actual measurements in humans, and preset the length of the tension element at a predetermined length (e.g., at least 115%, at least 130%) compared to the length of the average. The chances of success for this approach would likely be enhanced if the patient to patient variation is relatively small.
  • a further approach would be to measure the thickness of the target tissue in each patient, and customize the length of the tension element at the clinical site, or provide kits with a cuff and an array of anchor assemblies with tension elements of different predetermined lengths from which the clinician can make a selection. Measurement could be accomplished, for example, with endoscopic ultrasound, like a device available from Boston Scientific.
  • a variety of devices could be used to attach with a controlled length. Many of these devices have been previously described and include t-tags, inflatable silicone discs, molly type devices, radial spoke “umbrella” structures and others. They can be attached to suture with a fixed cuff to retention element length (or other means) or a strut member made of polymer or metal with a nub to fix the length. All of these devices are preferably configured to permit endoscopic delivery through a single fire device, or a multiple fire or rapid reloadable device could be used, to minimize the number of times the delivery device needs to removed from the endoscope to be reloaded.
  • Another application of the present invention involves the placement of a mounting ring, aperture, hook, connector or other attachment device within the gastrointestinal system utilizing the serosal attachment disclosed herein and attaching any of a variety of devices or components to the attachment device.
  • Applications for treating GERD, MO and other disorders of the gastrointestinal tract include placing/attaching a nonrestrictive mounting ring at or near the GEJ and attaching/removing/replacing various therapeutic or diagnostic devices to the mounting ring, such as a valve to prevent reflux, a restriction to food intake, a sleeve, a telemetry or imaging capsule, transmitters for transmitting pH or other data, receivers for receiving therapeutic signals initiated by an external control, etc.

Abstract

The present invention provides devices and methods for attachment of an endolumenal gastrointestinal device, such as an artificial stoma device, a gastrointestinal bypass sleeve or other therapeutic or diagnostic device, within a patient's digestive tract. In one application of the invention, an endolumenal bypass sleeve is removeably attached in the vicinity of the gastroesophageal junction to treat obesity and/or its comorbidities, such as diabetes. The bypass sleeve may be at least partially deployed by eversion.

Description

    CROSS REFERENCE TO RELATED APPLICATIONS
  • This patent application is a continuation of Ser. No. 11/400,724 filed Apr. 7, 2006 which is a continuation-in-part of U.S. patent application Ser. No. 11/124,634 filed May 5, 2005 which claims the benefit of U.S. provisional patent application 60/569,442, filed on May 7, 2004, by Kagan et al. for Devices and Methods for Treating Morbid Obesity and U.S. provisional patent application 60/613,917, filed on Sep. 27, 2004, by Kagan et al. for Devices and Methods for Attachment of a Gastrointestinal Sleeve. This patent application is also a continuation-in-part of U.S. utility patent application Ser. No. 10/698,148, filed on Oct. 31, 2003 by Kagan et al. for Apparatus and Methods for Treatment of Morbid Obesity which claims priority to U.S. provisional patent application 60/480,485, 60/448,817, 60/437,513, 60/430,857, 60/428,483, and 60/422,987. This patent application is also a continuation-in-part of U.S. utility patent application Ser. No. 10/998,424, filed on Nov. 29, 2004 by Kagan et al. for Apparatus and Methods for Treatment of Morbid Obesity and of U.S. utility patent application Ser. No. 11/025,364, filed on Dec. 29, 2004, by Kagan et al. for Devices and Methods for Treating Morbid Obesity. The devices and methods described herein can be combined with and/or used in conjunction with the apparatus and methods described in these prior applications. These and all patents and patent applications referred to herein are hereby expressly incorporated by reference in their entireties herein.
  • BACKGROUND OF THE INVENTION
  • 1. Field of the Invention
  • The present invention relates to devices and methods for attachment of a device within a patient's digestive tract. In particular, the present invention relates to devices and methods for treatment of obesity and/or its comorbidities, such as diabetes.
  • 2. Description of the Related Art
  • Bariatrics is the field of medicine encompassing the study of overweight, its causes, prevention and treatment. Bariatric surgery is a treatment for morbid obesity that involves alteration of a patient's digestive tract to encourage weight loss and to help maintain normal weight. Known bariatric surgery procedures include jejuno-ileal bypass, jejuno-colic shunt, biliopancreatic diversion, gastric bypass, Roux-en-Y gastric bypass, gastroplasty, gastric banding, vertical banded gastroplasty, and silastic ring gastroplasty. A more complete history of bariatric surgery can be found in U.S. Provisional Patent Application No. 60/422,987 Apparatus and Methods for Treatment of Morbid Obesity and also on the website of the American Society for Bariatric Surgery at http://www.asbs.org.
  • Medical sleeve devices for placement in a patient's stomach are described by Rockey in U.S. Pat. Nos. 4,501,264, 4,641,653 and 4,763,653. The medical sleeve described in these patents are said to reduce the surface area available for absorption in the stomach, however it is not configured to effectively reduce the volume of the stomach nor will the device described isolate ingested food from stomach secretions. Other sleeve devices for replacement in a patient's intestines are described in U.S. Pat. No. 4,134,405 (Smit), U.S. Pat. No. 4,315,509 (Smit), U.S. Pat. No. 5,306,300 (Berry), and U.S. Pat. No. 5,820,584 (Crabb). The sleeve devices described in these patents are said to be placed at the lower end of the stomach and therefore do not serve to isolate ingested food from the digestive secretions of the stomach.
  • In U.S. Patent Application US 2003/0040804, Stack et al. describe a satiation device to aid in weight loss by controlling feelings of hunger. The patent application describes an antral tube that expands into the antrum of the stomach to create a feeling of satiation, In U.S. Patent Application US 2003/0040808, Stack et al. describe a satiation device for inducing weight loss in a patient includes a tubular prosthesis positionable such that an opening at its proximal end receives masticated food from the esophagus, and such that the masticated food passes through the pouch and into the stomach via an opening in its distal end.
  • In U.S. Patent Application US 2003/0120265, Deem et al. describe various obesity treatment tools and methods for reducing the size of the stomach pouch to limit the caloric intake as well as to provide an earlier feeling of satiety. The smaller pouches may be made using individual anchoring devices, rotating probes, or volume reduction devices applied directly from the interior of the stomach. A pyloroplasty procedure to render the pyloric sphincter incompetent and a gastric bypass procedure using atraumatic magnetic anastomosis devices are also described.
  • In U.S. Patent Application US 2003/0144708, Starkebaum describes methods and systems for treating patients suffering from eating disorders and obesity using electrical stimulation directly or indirectly to the pylorus of a patient to substantially close the pylorus lumen to inhibit emptying of the stomach.
  • Notwithstanding the foregoing, there remains a need for a perorally deployable device for the treatment of obesity and/or its comorbidities, as well as a way to attach the device and to position a bypass tube within the intestine.
  • SUMMARY OF THE INVENTION
  • There is provided in accordance with one aspect of the present invention, an attachment system for attaching a device to the mucosal side of a wall of the gastrointestinal tract. The wall comprises, among other tissue layers, a muscularis layer and a serosal layer. The system comprises a gastrointestinal attachment cuff having a tubular body, a proximal end and a distal end. At least one attachment structure (sometimes referred to as a tissue anchor) is provided for transmural attachment of the cuff to the mucosal side. The anchor comprises a connecting element (sometimes referred to as a tension element) for extending through the wall and at least one transverse retention surface for positioning in contact with the serosal tissue. The cuff may be a unitary annular component or assembly, or may comprise two or three or more components spaced circumferentially apart about a longitudinal axis.
  • The tension element may comprise a suture. The tension element comprises a proximal end for extending through the mucosal layer and a distal end for carrying the transverse retention surface. The transverse retention surface comprises a proximal surface of a serosal anchor. The serosal anchor may comprise a T-tag, a disk, or an inflatable structure. The serosal anchor is transformable between a first, reduced profile for distal transmural advancement through the wall, and a second, enlarged profile for resisting proximal retraction through the wall.
  • The tension element has a length between the cuff and the transverse retention surface, and the length is generally at least about 2 mm and often no more than about 20 mm. In some implementations of the invention, the length is within the range from about 2 mm to about 10 mm and, depending on the patient, potentially within the range from about 3 mm to about 6 mm. Preferably, the connecting element is at least as long as the uncompressed wall thickness of the tissue at the attachment point.
  • The attachment system may additionally comprise a first engagement surface carried by a first coupler on the attachment cuff for coupling to a second, complementary engagement surface carried by a second coupler on a gastric bypass tube. The first and second couplers may be configured for removable coupling or permanent coupling between the bypass tube and the cuff. The bypass tube may have a length of at least about 50 cm, at least about 75 cm and in certain embodiments at least about 100 cm. The length is generally at least long enough to place the distal end beyond the pyloris, and, preferably, beyond the ligament of Treitz. The system may comprise at least 6 tissue anchors, and, in some applications, at least 12 tissue anchors.
  • The cuff may be omitted and the proximal end of the bypass tube may be attached directly to the adjacent tissue. The use of a cuff may be preferred, however, if removal or replacement of the bypass tube is contemplated, or if it is desirable to separate the steps of tissue attachment and bypass tube placement.
  • There is provided in accordance with another aspect of the present invention, a method of attaching a device to the mucosal side of a wall of the gastrointestinal tract, the wall comprising a muscularis layer and a serosal layer. The method comprises the steps of providing a tension element, having a retention element thereon. The retention element is advanced through the wall from the mucosal side and the retention element is placed such that it is spaced apart from the muscularis by serosal tissue, and placed on the serosal surface. The device is directly or indirectly (e.g. through a grommet, with intervening connectors, etc) attached to the tension element, such that the device is positioned adjacent the mucosal surface. As used herein, mucosal surface is a term of directional orientation and refers to the tissue surface facing the interior of the body lumen such as the lower esophagus or stomach, which may be covered by a mucosal layer.
  • Changes may be caused to the serosal or other tissue following the attaching step. The changes may be caused to the tissue prior to the attaching step. The changes may be caused to the tissue as a biological response to tension on the tension element, biasing the retention element against the serosal surface. Alternatively, the changes may be caused to the serosal tissue in response to the application of an active agent. The active agent may comprise a growth factor, a sclerosing agent, or other agent or process for increasing the tissue density (e.g. initiating a fibrotic response) of the serosal tissue residing between the retention element and the muscularis.
  • In accordance with a further aspect of the present invention, there is provided a method of treating a patient. The method comprises the steps of providing a gastrointestinal attachment cuff having a tubular body, a proximal end and a distal end. The gastrointestinal cuff is positioned in the patient's digestive tract adjacent a mucosal surface in the vicinity of the gastroesophageal junction, the mucosal surface separated from a serosal surface by a wall thickness. The gastroesophageal cuff is secured adjacent the mucosal surface by advancing at least three tissue anchors through the mucosal surface, across the wall thickness and through the serosal surface to position a transverse retention surface of each tissue anchor in contact with the serosal surface. Preferably, the foregoing steps are accomplished endoscopically.
  • The securing step may comprise advancing at least 6 tissue anchors through the mucosal surface, and, in certain applications, at least 12 tissue anchors.
  • The tissue anchor comprises a tension element such as a suture for connecting the transverse retention surface to the cuff. The transverse retention surface may be a surface on a T-tag, a disk, or other retention structure. The length of the tension element may be at least about 75% of the wall thickness between the mucosal surface and the serosal surface. Preferably, the length of the tension element is at least about 95% of the wall thickness, and, optimally, the length of the tension element is at least about equal or greater than the wall thickness. In one embodiment the length of the tension element is at least about 120% of the wall thickness.
  • The method may additionally comprise the step of providing an elongate flexible gastric bypass tube having a proximal end and a distal end, and attaching the proximal end to the cuff. The proximal end of the bypass tube may be attached to the cuff endoscopically. The attaching the proximal end of the bypass tube to the cuff step may comprise removably attaching the proximal end of the bypass tube to the cuff. The distal end of the bypass tube may be positioned in the patient's jejunum, in the patient's ileum, or in the patient's duodenum.
  • The flexible gastric bypass tube may additionally be provided with an optional restrictive opening. The restrictive opening may be positioned anywhere along the length of the sleeve, preferably between the GEJ and the pyloris. The restrictive opening may be provided in any of a variety of ways, such as by including an additional annular component within the tubular sleeve, providing a restrictive band or component on the exterior of the tubular sleeve, or by molding or otherwise forming the restrictive opening as an integral part of the sleeve.
  • Further features and advantages of the present invention will become apparent to those of skill in the art in view of the detailed description of preferred embodiments which follows, when considered together with the attached drawings and claims.
  • BRIEF DESCRIPTION OF THE DRAWINGS
  • FIG. 1 shows a gastrointestinal sleeve device attached to a cuff positioned in the vicinity of the gastroesophageal junction.
  • FIG. 2 is a cross sectional view taken along the line 2-2 in FIG. 1.
  • FIG. 3 is an enlarged cross sectional view of the cuff of FIG. 1.
  • FIG. 4 shows a schematic illustration of the GEJ and the SCJ or Z-line and the target tissue zone identified by the present inventors.
  • FIG. 5A shows a schematic illustration of a tissue anchor placed adjacent the serosa at the time of implantation.
  • FIG. 5B shows a schematic illustration as in FIG. 5A, at a post implantation stage when the anchor has relocated into the serosa, and a layer of increased tissue density has formed on a proximal side of the tissue anchor.
  • FIG. 5C is a schematic illustration as in FIG. 5B, with the anchor relocated proximally into the plane of the muscularis.
  • FIGS. 6A-6B show an attachment cuff attaching a gastrointestinal sleeve device using T-tags secured with a button.
  • FIGS. 7A-7B show two views of a T-tag embodiment of a tissue anchor.
  • FIG. 8A is a side elevational cross section through a partially inverted sleeve.
  • FIG. 8B is a side elevational cross section through a sleeve, showing an absorbable distal closure.
  • FIG. 9A is a partial cross sectional view of a sleeve having a single invertion.
  • FIG. 9B is a partial cross sectional view of a sleeve having a double invertion.
  • FIG. 10 illustrates a method and apparatus for placing T-tag fasteners at the gastroesophageal junction (GEJ).
  • FIGS. 11A-11D show a method of T-tag fastener delivery.
  • FIG. 12 shows a cuff being parachuted into place along a plurality of suture tails.
  • FIG. 13 is a perspective, fragmentary view of a gastrointestinal bypass sleeve connected to an attachment cuff using sutures or clips.
  • FIG. 14 is a perspective, cross sectional view of a gastrointestinal bypass sleeve being advanced distally through a previously attached cuff.
  • FIG. 15 is a perspective, cross sectional view as in FIG. 14, after the gastrointestinal bypass sleeve has been fully distally advanced into a sealing relationship with the attachment cuff.
  • DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENT
  • The present invention provides devices and methods for attaching an implant within the gastrointestinal system. Although described primarily in the context of supporting an endolumenal bypass sleeve, the attachment technology of the present invention can be utilized to support any of a variety of devices which may be desirably positioned within the stomach or elsewhere in the gastrointestinal system. For example, the attachment cuff and/or serosal anchors disclosed herein may be utilized to support any of a variety of valves or constricted openings designed to treat gastroesophageal reflux disease (GERD), by augmenting natural function of the lower esophageal sphincter or replacing that function. Any of a variety of obesity devices may also be attached to the attachment cuff and/or using the serosal anchors disclosed herein, such as electrical stimulation and/or pacing devices, or volume occupying devices which hang from or are otherwise attached to the vicinity of the lower esophageal sphincter into the stomach. Any of a variety of drug delivery reservoirs may also be stabilized within the gastrointestinal system using the cuff and/or anchoring systems disclosed herein. Diagnostic devices, such as pH detectors, analyte detectors, pressure sensors may also be temporarily or permanently secured within the gastrointestinal system using the technologies disclosed herein. The attachment cuff and/or associated serosal anchors may further be utilized to accomplish endolumenal anastomosis, or to span a defect or disease condition, such as an ulceration or other gastrointestinal anomaly.
  • Notwithstanding the foregoing, the present invention will be described primarily in the context of gastrointestinal sleeve devices that can mimic a Roux-en-Y gastric bypass by effectively reducing stomach volume, bypassing a portion of the stomach and/or small intestines, reducing nutrient absorption in the stomach and/or small intestines and depositing minimally or undigested food farther than normal into the intestines, thereby stimulating intestinal responses.
  • FIG. 1 shows a gastrointestinal sleeve device 100 attached to an artificial attachment cuff or stoma device 102 implanted within a patient's stomach 104. The attachment cuff 102 can be implanted in the vicinity of the gastroesophageal junction 106, or at the outlet of a surgically created gastric pouch (not illustrated). The attachment cuff 102 preferably does not restrict the flow of food, although it may be provided with a restrictive opening if desired. The cuff 102 can have a fixed diameter opening 108 equal to, larger or smaller than the fully open diameter at the native GEJ. Alternatively, the cuff 102 can have an adjustable stoma opening or it can be a “smart” stoma that adjusts the size of the stoma opening in response to various conditions.
  • The attachment cuff 102 is preferably configured for peroral delivery and attachment using endoscopic techniques. Alternatively, the cuff 102 can be implanted using laparoscopic or open surgical techniques. Additional details of the cuff, stoma and attachment are found below, and in the related applications previously incorporated by reference herein.
  • The gastrointestinal sleeve device 100 is an elongated flexible tubular structure that is permanently or removably attached to the attachment cuff 102 such that food and liquids pass through the cuff 102 and enter the internal lumen of the sleeve device 100. The attachment cuff 102 and the gastrointestinal sleeve device 100 can be implanted simultaneously, or the attachment cuff 102 can be implanted by itself and then the gastrointestinal sleeve device 100 can be attached to the attachment cuff 102 in the same or a subsequent procedure. Optionally, a line of staples or other fasteners may be used with any of the devices disclosed herein to create a gastroplasty to reduce the volume of the stomach.
  • In conjunction with the cuff and/or gastric sleeve, the volume of the stomach can be reduced by suturing, stapling, adhesives or other technique using open, transesophageal or laparoscopic techniques. Alternatively or in addition, a gastric balloon or other volume displacement device may be used in conjunction with the gastric sleeve to provide a feeling of satiety. These adjunctive techniques may have the effect of further reducing nutrient intake (in the case of a stomach reduction and pouch formation upstream of a stoma) and enhancing the effect of peristaltic motions of the stomach for moving food through the gastric sleeve intake (in the case of a stomach reduction downstream of a stoma where there is a gastric sleeve).
  • Returning to FIG. 1, a gastrointestinal sleeve device 100 is attached at the GEJ with an attachment cuff 102. Tissue anchors, described below, have been omitted from FIG. 1 for simplicity. The cuff 102 may include a plurality of preformed attachment structures 110 for attachment of tissue anchors as is discussed below.
  • The implantable cuff and/or attachment system is preferably configured to avoid causing excessive force or pressure within the tissue by having compliance that is compatible with the gastrointestinal tissues where it is attached. Device compliance can also be important for providing a leak free seal between an implanted device and the tissue at the attachment point. Compliance can be provided in the radial or circumferential direction and/or in the vertical, axial or longitudinal direction. The device may have different compliance in different regions to be compatible with the tissue at the attachment point and at other portions of the gastrointestinal tract through which it runs. The device may have different compliance in different directions to be compatible with the tissue at the attachment point while simultaneously achieving other goals of the device. Compliance can be provided in a number of different ways. One way is by elastic or plastic deformation of the device and/or the attachment means. Another way is by a mechanical decoupling that allows relative movement between the device and the attachment points, and/or between the attachment points themselves, without transmitting excessive force or pressure to the tissue.
  • In some clinical situations, it will be desirable to match compliance between the device and the tissue to which it is attached. In other situations, based upon the clinical situations, it may be desirable to provide a device with higher or lower compliance than the adjacent tissue to achieve certain objectives.
  • Preferably, the attachment cuff 102 is highly flexible or compliant in the radial direction so that expansion and contraction of the stomach and esophagus due to contents and/or muscular action will not place additional, or actually reduce, stress on the attachment points. An elastomeric material, such as silicone or polyurethane that provides approximately 150% or more stretch in the radial direction may be used. At the same time, an attachment ring or other structure for attaching the sleeve, where utilized, may have enough lateral rigidity to act as a mounting platform for the gastrointestinal sleeve device and to resist downward movement due to the weight of the gastrointestinal sleeve device and its contents and peristaltic traction on the sleeve. The lateral rigidity of any sleeve attachment structure can be enhanced with radially oriented bending reinforcements, such as ribs or embedded reinforcement members. Alternatively, the attachment cuff can be flexible and compliant and other means such as hooks, sutures staples, etc., can be used for sleeve attachment.
  • Referring to FIG. 1, the attachment cuff 102 comprises a highly flexible tubular wall extending between a proximal (superior) end 118 and a distal (interior) end 120. The wall may be permeable or substantially impermeable to body fluids, and may comprise any of a variety of weave densities and/or aperture patterns either to effect flexibility, fluid transport, or to accommodate attachment as is discussed further below.
  • The axial length of the cuff 102 between the proximal end 118 and distal end 120 can be varied considerably, depending upon the desired attachment configuration. In general, axial lengths within the range of from about 0.25 inches to about 6 inches will be used. Axial lengths within the range of from about 0.5 inches to about 2.0 inches may be sufficient to support a detachable endolumenal bypass sleeve as contemplated herein. In general, the axial length of the attachment cuff 102 may be influenced by the desired location of the seam 103 between the attachment cuff 102 and the sleeve 100, or other device which is to be attached to the cuff 102.
  • The attachment cuff 102 may be constructed from any of a variety of materials which are sufficiently flexible and stable in the environment of the stomach. Suitable materials may include woven or nonwoven fibers, fabrics or extrusions using materials such as polyester velour (Dacron), polyurethane, polyamide, ePTFE, various densities of polyethylene, polyethylene terephthalate, silicone, or other materials which in the form presented exhibit sufficient compliance, stretch, strength, and stability in the gastric environment.
  • The inside diameter of the cuff 102 can also be varied, depending upon the desired clinical performance. For example, the cuff may be provided with a stoma or inside diameter which is less than the inside diameter of the adjacent esophagus. Alternatively, the inside diameter of the cuff 102 may be approximately equal to or even greater than the native esophagus. In general, inside diameters within the range of from about 15 mm to about 40 mm are contemplated, and often within the range of from about 20 mm to about 35 mm for use in human adults.
  • In the illustrated embodiment, the cuff 102 is provided with a plurality of attachment structures 110 in the form of apertures 122. These apertures 122 are provided to facilitate anchoring of the cuff 102 to the adjacent tissue. In either an endoscopic or surgical implantation, a plurality of tissue anchors will be pre-attached to, or advanced through the wall of the cuff 102 and transmurally through the adjacent tissue as is discussed elsewhere herein. Provision of a plurality of anchoring points such as apertures or other structures which facilitate positioning and/or attachment of tissue anchors may desirably help with anchor location as well as reduce the amount of force necessary to advance t-tags or other anchoring structures through the wall of the cuff 102.
  • In an embodiment which utilizes apertures 122 to facilitate tissue anchoring, the number of apertures 122 may correspond to or be greater than the total anticipated number of tissue anchors. In general, at least about four apertures 122 and as many as eighteen or twenty are presently contemplated, with from about eight apertures to about sixteen apertures presently preferred. In one embodiment, twelve tissue anchors are used.
  • Preferably, the apertures 122 in an embodiment of the cuff 102 made from a thin walled woven or non-woven material will be provided with a reinforcement ring (one reinforcing ring per aperture, or one reinforcing ring for the implant, superior to the apertures 122) to prevent pull-out of the associated anchoring structures, as will be appreciated by those of skill in the art in view of the disclosure herein. The reinforcement ring, where used, may be a separate component such as a grommet attached at each aperture to the cuff 102 such as by thermal bonding, adhesives, mechanical interference or other technique. Alternatively, particularly in the case of a fabric cuff 102, the reinforcement may be provided by stitching around the perimeter of the aperture 122 in the manner of a buttonhole as is understood in the art.
  • In the illustrated embodiment, each of the plurality of apertures 122 resides in a common transverse plane, positioned in the patient at or slightly above the gastroesophageal junction. Alternatively, the apertures 122 may be provided in two or three or more transverse planes, such as to permit attachment points in a zig-zag orientation around the circumference of the attachment cuff 102. For example, a first set of apertures 122 (such as every other aperture) may be axially displaced from a second set of apertures 122 by a distance within the range of from about 1 mm to about 10 mm, to provide a first and a second transverse attachment plane. Axially staggering the location of the attachment apertures 122 may be desirable depending upon the number and configuration of tissue anchors and tissue anchor reinforcement structures as may be apparent to those of skill in the art in view of the disclosure herein.
  • Referring to FIG. 3, a plurality of attachment points 124 may also be provided on the cuff 102, for permanently or removably attaching the bypass sleeve 100. In the illustrated embodiment, the attachment points 124 each comprise an aperture 126 for receiving a suture hook, clip or other interference coupling, magnet assisted coupling or other link 128 to couple the bypass sleeve 100 to the cuff 102. The bypass sleeve 100 may be attached to the cuff 102 in any of a variety of ways, such as is discussed elsewhere herein. In general, the present inventors contemplate a releasable attachment between the sleeve 100 and cuff 102, to permit removal and/or exchange of the sleeve 100 as has been discussed elsewhere herein.
  • Referring to FIG. 2, there is illustrated a cross sectional view transverse to the longitudinal axis of the esophagus through the tissue attachment plane. Although the cuff 102 and tissue anchors appear rigidly geometric in the illustration, it is to be appreciated that the configuration will be subject to constant motion and random configuration, as the wall of the esophagus and stomach collapse and expand, with as little resistance as possible from the cuff 102 and associated attachment structures.
  • In FIG. 2, the cuff 102 is illustrated as snugly fitted against the mucosal surface 130 of the esophageal or stomach wall 132. A plurality of anchor assemblies 134 are shown for illustration purposes. The particular anchor assemblies 134 illustrated in FIGS. 2 and 3 may be best suited for surgical implantation, while some of the t-tag embodiments disclosed elsewhere herein may be more readily adapted for endoscopic implantation. The anchor assemblies 134 are therefore provided for illustration purposes, but should be understood as only a single example of the broader transmural, serosal surface anchoring of the present invention.
  • Referring to FIG. 2, the anchor assembly 134 comprises a transverse retention surface 136 for positioning against the serosal surface 138 of the esophagus or stomach wall (illustrated as a single, homogenous layer for simplicity). The transverse rentetion surface 136 may be a surface on a t-tag, disc, or other structure. In the illustrated embodiment, the surface 136 is carried by a small circular or oval button 140, although T-tags and other structures disclosed herein may be used, all of which are adapted to distribute force over predetermined surface area. The button 140 may comprise any of a variety of materials, and, in one embodiment, comprises a silicone disc.
  • Due to the physical characteristics of silicone, a reinforcement element 142 in the form of a smaller disc or transverse structure may be embedded within, or provided on the radially outwardly facing surface of the disc 140. This reinforcement element 142 allows distribution of force from the tension element 144 across a greater surface area on the disc 140, to avoid “cheese cutter” effects or other pull through under tension exerted on the tension element 144. The desirability of including a separate reinforcing element 142 will go down, as the durometer or other rigidity characteristic of the disc 140 increases. Element 142 may comprise any of a variety of materials which will be biocompatible and generally stiffer than the disc 140, such as any of a variety of polyethylenes, PEEK, PEBAX or other materials well known in the art.
  • In the illustrated embodiment, the tension element 144 comprises a suture which extends from the inside of the esophagus transmurally to the reinforcing element 142 and loops back through the wall of the esophagus where it is clipped, tied, locked or otherwise secured at a connection point 146. The tension element may comprise either a single filament, or two or more filaments as illustrated, depending upon the desired installation technique and physical properties of the final construct.
  • A second reinforcing element 148 may also be provided, to serve the analogous function as the first reinforcing element 142, and resist pull through of the tension element 144 under the influence exerted on the implant by peristalsis and other gastrointestinal movement. The second reinforcing element 148 may be in the form of a disc, T-tag or other structure having a force distributing surface thereon. Alternatively, reinforcing element 148 may be a thickened, treated or reinforced zone on or within the wall of the sleeve. Additional details of t-tag attachment and related structures will be provided below.
  • The present inventors believe that some areas of the esophageal or gastric wall exhibit physical properties more conducive to retaining attachment structures than other areas. For example, an attachment zone 160, shown in FIG. 4, directly above the squamocolumnar junction (SCJ) 162, also known as the Z-line, ora serrata, and mucosal GEJ, may be such an area. The SCJ marks the junction of the squamous mucosa of the esophagus and the columnar or glandular mucosa of the stomach. The SCJ may be located at or below the lower esophageal sphincter (LES).
  • The device may, in one preferred embodiment, be attached in an attachment zone 160 no more than about 2 cm and preferably no more than about 1 cm above the SCJ 162 and below the esophagus 164 where the squamous mucosa is thicker than the squamous mucosa of the esophagus 164 and where there exists a serosal outer surface not exhibited at the esophagus 164. The thicker layer of squamous mucosa in the attachment zone 160 terminates distally at the endoscopically visible transition to the glandular mucosa of the stomach 166 which occurs at the SCJ 162. The device is also preferably attached at a location in the attachment zone 160 so as to minimize the risk of reflux. The SCJ 162 can be located relative to other anatomical regions. It normally may be found at the gastroesophageal junction (GEJ). The GEJ is the region at which the tubular esophagus joins the saccular stomach. The GEJ can be considered the first part of the stomach 166 or the cardia and is located at the proximal margin of the longitudinal gastric mucosal folds or in the distal 2 cm of the esophagus 164 and proximal stomach 166. Endoscopically, the location of the GEJ can be approximated by identifying the proximal margin of the gastric folds.
  • Thus, a first aspect to the location of attachment of the devices disclosed herein relates to the position of the attachment structures along the axis of the hollow lumen or organ. As described above, the attachment location in the axial direction is preferably in the vicinity of the gastroesophageal junction, and particularly just above the SCJ. This attachment site can be located endoscopically by observing the color change which occurs at the SCJ, and retracting or positioning the attachment structures of the endoscope slightly above that line.
  • A second aspect to the location of the attachment structure relates to the depth within the adjacent tissue wall (i.e., in a transverse direction to the longitudinal axis of the esophagus described above) within which the various anchors or retention structures disclosed herein reside. Applicants believe that the location in the transverse direction is subject to migration or other change post-implantation, as described in connection with FIGS. 5A through 5C.
  • Referring to FIG. 5A, there is disclosed a highly simplified schematic cross sectional view of a tissue wall such as the wall of a hollow organ or lumen in the body, including the wall at the vicinity of the gastroesophageal junction. The tissue wall comprises a serosa 170 and a muscularis 172. Additional tissue layers have been omitted for simplicity. In general, as is appreciated by those of skill in the art, the serosa 170 is on the outside of or faces away from the stomach, and the muscularis is on the inside, or faces towards the interior of the stomach. The serosa 170 thus includes a serosal surface 174 which faces away from the interior of the stomach, and the muscularis 12 includes a muscularis surface 176 which faces towards the interior of the stomach.
  • An attachment device or anchor 178 is illustrated in part in FIGS. 5A through 5C. The attachment device 178 can take any of a variety of forms, described elsewhere herein. In general, the attachment device 178 includes a retention element 180 having at least one retention surface 182 thereon. The retention element 180 may be integrally formed with or attached to a tension element 184, which extends through the tissue wall and is secured to the device implanted within the gastrointestinal tract. Although the attachment mechanisms disclosed herein will be defined primarily in the context of an obesity device, which is attached in the vicinity of the GEJ, those of skill in the art will apperciate that the attachment system disclosed herein may be utilized in any of a wide variety of other anatomical locations, such as in the bronchial tubes, urethra, ureters, fallopian tubes, throughout the GI tract, and others which share a serosa or serosa like layer, such as in the kidney, bladder, and other organs, as would be recognized by those skilled in the art.
  • Referring to FIG. 5A, the retention element 180 is illustrated with the retention surface 182 residing against the serosal surface 174. Retention surface 182 may comprise any of a variety of forms, such as a proximal surface on a T-tag, proximal surface on a washer or disc, or any other surface which extends in a generally lateral direction with respect to a longitudinal axis of the tension element 184. The transverse retention surface 182 may be radially enlargeable or expandable from a first, reduced cross-sectional configuration to provide a low crossing profile such as for deployment through a deployment cannula, and a second, radially expanded or enlarged cross-sectional profile as illustrated in FIG. 5A, to provide a retention surface 182 which will engage or interfere with tissue of the serosa 170 or muscularis 172 to resist proximal retraction of the attachment device 178 through the tissue. Transformation between the first configuration and second configuration can be accomplished in any of a variety of ways as is discussed further herein, such as by pivoting the retention element 180 about the attachment point to tension element 184, by radial expansion, by inflation, or other technique.
  • Tension element 184 may comprise any of a variety of connectors or elements adapted to extend through the tissue wall, such as a suture, or other single stand or multi-strand filament or material. In some embodiments the tension element 184 is formed of a polymer such as PEEK or silicone. The tension element 184 may also, in some embodiments, have elastic properties. In other embodiments the tension element 184 does not have elastic properties. By use of the term tension element, no specific mechanism is suggested, and the element is not required to be under mechanical tension.
  • The attachment device, otherwise sometimes referred to herein as a tissue anchor, T-tag or other label, it is illustrated in FIG. 5A in a schematic fashion as it may appear at the time of implantation. Since in certain implementations of the invention the length of the tension element 184 will exceed the uncompressed thickness of the adjacent tissue wall, the retention surface 182 may even be spaced slightly apart from the serosal surface 174 depending upon the transient motion or configuration of the stomach at any given time.
  • Without being limited to any particular structure or mechanism, Applicants believe that the presence of the attachment device may cause or accelerate the formation of a layer 186 of serosal tissue having increased tissue density relative to unaffected or normal serosal tissue. The layer of increased density 186 may result from a process in which the transverse retention surface 182 places pressure against the serosa 170, causing a localized necrosis due to the restriction of capillary blood flow. The necrosed tissue thereafter fibroses, as a part of a normal healing response. The layer of increased density 186 or fibrosis may also result from a foreign body reaction triggered by the presence of the transverse retention surface 182. Applicants have observed a greater degree of fibrosis or denser tissue on the side of the T-tag facing the lumen of the stomach, for example on the retention surface 182.
  • In certain animal trials conducted by Applicants in which the animals were sacrificed five weeks following implantation of the attachment device 178, successful anchors appeared similar to the simplified schematic illustration of FIG. 5C. In this illustration, the location of the retention element 180 has changed relative to the serosa 170 and muscularis 172, and the distal surface 188 of the retention element 180 has been covered with an overgrowth of serosal tissue 190. A fibrotic layer 186 is positioned in between the retention surface 182 and the muscularis 172. Although illustrated only on the proximal side of the retention element 180 where the greatest degree of fibrosis has been found to occur, the fibrotic response appears to some extent to surround and wall off the entire retention element 180.
  • It appears to the present inventors that formation of a sufficient fibrotic response on the proximal side of the retention surface 182 decreases the likelihood that the attachment device 178 will relocate to the inside of the stomach under normal agitation of the stomach, changes in the thickness of the stomach wall, and other conditions normally occurring in the stomach. A similar response is schematically illustrated in FIG. 5C, in which the layer 186 of high density serosal tissue remains on the proximal side of the retention element 180, however one or both of the layer 186 and retention element 180 have relocated to below the normal plane 192 separating the serosa 170 from the muscularis 172 and will remain there.
  • It appears to the present inventors that if the device design and/or retention element 180 design are such that in normal use the retention element 180 relocates to a position in the muscularis 172 and past the serosa 170 before a sufficient fibrotic response, the retention element 180 may relatively easily pass through the muscularis 172 and failure will result. Thus, it may be desirable in certain implementations of the invention to facilitate or accelerate the formation of the fibrotic layer 186. This may be accomplished in any of a variety of ways which will be appreciated by those of skill in the art in view of the present disclosure, such as by the introduction of an active agent which will trigger a fibrotic response. Suitable active agents may include any of a variety of growth factors, and/or chemical sclerosing agents which are well known for other medical applications. The surfaces of the retention element and tension element may also be provided with an anti-bacterial characteristic, such as by eluting an antibiotic agent, or having a bacteriostatic or bacteria inhibiting coating. Drug eluting coatings are well understood in the coronary stenting arts, and can be adapted for use in the present context by those of skill in the art.
  • Active agents may be applied as a coating to the retention surface 182 or retention element 180, or may be impregnated into the material of retention element 180 and/or tension element 184, such as to permit a timed release into adjacent tissue. Incorporation may be accomplished by loading the active agent into tortuous pathways or pores exposed to the surface of the retention element 180, or by inclusion in a bioabsorbable or bioerodable carrier attached to or positioned in the vicinity of the retention surface 182. Energy sources may also be utilized, such as to generate heat or otherwise stimulate formation of a fibrotic response, as is discussed further below. Formation of the fibrotic layer 186 may also be facilitated by mechanical means, for example, in one embodiment, by roughening the retention surface 182 with the addition of fibrotic layer enhancement structures such as a plurality of bumps or etched lines.
  • FIG. 6A shows an implanted gastrointestinal sleeve device 200 attached by an attachment cuff 214 with the use of T-tags 207. FIG. 6B is an enlarged view of the attachment cuff 214 attached with T-tags 207 showing the transverse retention elements 209 of the T-tags 207 embedded in the stomach wall, as may be observed several weeks post implantation.
  • T-tag type fasteners can be used endoscopically to attach many of the structures described herein. A T-tag is basically a retention element 180 in the form of a cross member or “T” that is attached to a tension element 184 in the form of an elongated member or tail at or near the mid-point of the T. A “stem” may be a structure at the joining point of the T and tail. From the perspective of a peroral attachment technique, in which the attachment devices are preferably advanced through muscularis 172 in the direction of the serosa 170, the stem or tension element will be referred to herein as relatively proximal to the cross member on the T-tag. The T-tag is a member of a more general family of tissue anchors, in which a proximally facing surface 182 (such as the proximal surface of the cross member) is adapted to be bent, folded, or otherwise reduced in crossing profile to a first configuration in which it can be advanced distally through a relatively small tissue opening, to a second configuration in which it presents a proximal serosal surface contacting area for resisting proximal retraction through the access pathway. Thus, although described primarily in the context of a T-tag and variations thereof, the present invention relates more broadly to tissue anchors of the type for presenting a retention surface which may have any of a wide variety of configurations. Some are described in additional detail below. The stem may also be referred to herein as a tension member, and may comprise a suture, or other single strand or multi-strand element for drawing the tissue anchor against the serosal tissue and/or connecting the tissue anchor to the implantable cuff or other endolumenal implant.
  • T-tag fasteners are generally configured to flex or pivot at the juncture of the T and tail to allow delivery along the axis of the T through a minimal puncture diameter. T-tag fasteners can be configured with an extended tail that may extend out the mouth and optionally be used to parachute devices for attachment into position in vivo. Other T-tag configurations can include, crimp, snap, screw or other means of securing the T-tag tail when appropriate. One embodiment of a T-tag fastener could include a dual tail. Such a dual tail could be combined with extended tails that could then be tied out side the body with the ensuing knots then tightened within the body. Such a dual tail could be constructed of one of a number of non-biodegradable suture materials known in the art including polypropylene, nylon, braided Dacron or silk. In some clinical situations biodegradable tails could be indicated and could be constructed using materials described herein. In a preferred embodiment the tails could be constructed of a monofilament material.
  • In certain implementations of the present invention, it may be desirable to increase the effective surface area of the retention surface 182. This may be accomplished using any of a variety of disc or button shaped attachment devices 178 disclosed herein, or by introducing a buttressing component or element in the nature of a washer or other structure for enlarging the effective surface area. This buttressing structure may sometimes be referred to herein as a pledget. The buttressing material is generally configured perpendicular to the axis of the tension element 184 (e.g. suture, rivet or staple) and therefore best distributes forces along the axis of the attachment means.
  • T-tags or other serosal anchors can be delivered through a hollow needle type delivery system (e.g. T-ANCHOR INTRODUCER GUN (Moss, Moss Tubes)) that has been redesigned/modified so it can be passed through the working channel of an endoscope. A T-tag can be provided with an elongated tail that can extent out through the mouth and be used to parachute structures into place in-vivo.
  • In one embodiment the T-tags are placed such that the sutures of the T-tags could be knotted outside of the body and the knots could be pushed down the working channel or outside of the working channel of the scope until positioned to retain the cuff. The suture tails could subsequently be removed. To facilitate management of all the suture tails, two T-tags could first be placed to secure the cuff followed by placement of the rest of the T-tags. In a preferred embodiment the T-tag tension elements, such as tails, sutures, or other structures as described herein, would terminate in the stomach, such as by tied knots, sliding buttons, or preexisting terminated ends, such that they would not need to be brought outside of the body.
  • As an alternative to tying sutures outside of the body, any of a variety of suture locks may be utilized to secure the suture with respect to the cuff. In general, a suture lock is provided with a central aperture for moveably receiving the suture therethrough. The lock may be configured for one way advance along the suture, having a spring biased engaging element for resisting movement of the lock in the opposite direction. Alternatively, a central plug may be advanced into the central lumen, to compress the suture within the suture lock and retain the suture lock at a selected position. Any of a variety of clips may also be axially or radially moved into position, to engage the lock with the suture. The suture lock may be advanced down the suture and positioned with the desired tension against the interior surface of the cuff, and activated as necessary to lock the suture lock in place. The remaining suture tail may be severed, using conventional endoscopic techniques.
  • Alternatively, the suture lock may be secured to the cuff 102 such as at each aperture 122, prior to implantation of the cuff 102 in the patient.
  • Many of the serosal anchors described herein can be formed using a single piece of Polypropylene, Nylon, PEEK, silicone, or other polymeric material well known in the art for use in construction sutures, which forms the “T” and tail as a single unit. Alternately two different materials can be combined, for example by insert molding, to achieve different properties of the “T” and tail. In another embodiment this could be combined with a “T” portion that is coated with a material selected for specific clinical properties such as encouraging or discouraging either in-growth or adhesion. The “T” portion may also be surrounded by another material such as ePTFE or Dacron graft material. “T” diameter or serosal surface contacting width can vary for example ranging from 0.5 mm to 3.0 mm in diameter for nylon or polypropylene with the typical “T” having a diameter of 1-2 mm. A tail could be the dimension of a standard suture and could generally vary from 5-0 to 0 (USP standard classification) though smaller or larger sizes may be appropriate in certain clinical situations.
  • FIGS. 7A & 7B illustrate a curved T-member 300 for a T-tag fastener. The convex curved tissue-contacting surface 302 of the curved T-member 300 serves to distribute the attachment force for an implanted device smoothly across the tissue to minimize any stress concentrations or higher pressure spots that could cause tissue necrosis and/or erosion. The T member 300 has a double eyelet 304 for attachment of a suture or other filament. The T-member is preferably molded of a fairly rigid, high strength biocompatible polymer such as PEEK.
  • FIGS. 23A-23B of application Ser. No. 11/124,634, previously incorporated by reference, illustrate a T-tag fastener 2200 with a hydrogel disc 2204 that can be placed between the deployed T-member 2208 and the extragastric (serosal) surface. The disc 2204 could be delivered through the T-tag delivery needle, and unroll after passage through the needle. The hydrogel disc 2204 acts as a buttress or pledget to distribute the forces transmitted between the T-member 2208 and the extragastric surface and thereby it strengthens the attachment of the T-tag fastener 2200. The hydrogel used in FIGS. 23A-23B can optionally be replaced with alternate materials described herein for example silicone, NiTi and fluoropolymers. A Hydrogel or other buttress or Teflon pledget for a T-tag could also deploy in some other manner. The disc configuration shown can be replaced with for example, braided or woven wires or filaments that would expand/deploy after passage through the needle (FIGS. 24A-24B), a Malecot-style deployable tubular structure (FIGS. 25A-25B) or other expandable or deployable configuration (e.g. FIGS. 26A-26B). Although FIGS. 23A-23B, 24A-24B, 25A-25B, and 26A-26B illustrate t-tag fasteners, such as 2200 in FIGS. 23A-23B used with T-members 2208, uses of the T-tag fasteners without T-members and just with the hydrogel disc 2204 of FIGS. 23A-23B or the woven filaments, Malecot-style tubular structure, or the expandable structure of FIGS. 24A-24B, 25A-25B, and 26A-26B, respectively, are also contemplated.
  • In the above examples where it has been suggested that a fixed distance between the T-member and the device it is being used to attach is desirable it has been suggested that in some cases a distance greater than the thickness of the captured gastric wall may be clinically indicated. This is due to the ability/tendency/possibility that the gastric wall could react to the presence of a foreign body (the attachment structures) by thickening. In this event, in some cases, it can be clinically preferable that the preset distance accommodate some or all of this increase in wall thickness.
  • The cuff 102 and sleeve 100 may be formed as an integral unit, or supplied to the clinical site as a single unit, for installation as one piece. Alternatively, the cuff 102 and sleeve 100 are provided as separate components, with an instruction that the cuff is inserted first as described elsewhere herein, followed by insertion of the sleeve 100 and attachment of the sleeve 100 to the cuff 102. The sleeve 100 may be attached to the cuff 102 in any of a variety of ways, depending upon the ease with which removal may be desired. For example, stitching or clipping may be accomplished, as described previously. Alternatively, any of a variety of snap fit, interference fit, hooks, loops or other techniques may be utilized.
  • Referring to FIG. 13, there is illustrated a perspective fragmentary view of a device as seen in FIG. 1. In this implementation, a plurality of connectors 128 are provided, for connecting the sleeve 100 to the cuff 102. Connectors 128 are preferably configured for deployment through an endoscope, and may be conventional sutures, or hooks or clips which may be manipulated endoscopically.
  • FIGS. 14 and 15 show two steps in an installation sequence. In FIG. 14, a cuff 102 has been previously attached at a treatment site within the body, such as in the vicinity of the GEJ. The distal end (not shown) of a sleeve 100 has been advanced through the central lumen of the cuff 102, and manipulated down the intestine as disclosed elsewhere herein. The proximal end of the sleeve 102 is provided with an annular radially outwardly extending stop surface as described below. As seen in FIG. 15, the sleeve 100 may be advanced distally until the stop surface on the sleeve engages a corresponding stop surface supported by the cuff 102.
  • In general, a first retention surface such as an upwardly facing surface 320 on a radially inwardly facing flange 322 or plurality of tabs on the attachment device (cuff) 102 limits distal movement of the sleeve 100 by contacting a second retention surface on the sleeve. The second retention surface may be a downwardly (distally) facing surface 324 such as the distal surface of a radially outwardly facing or inclined annular flange 326 or plurality of tabs on the proximal end of the sleeve 100. In this configuration, the sleeve may be passed through the cuff and simply “dropped” into place and the first and second retention surfaces limit further distal travel of the sleeve relative to the cuff.
  • Peristalsis and normal gastrointestinal tract activity will place tension or other forces on the sleeve 100. Thus, the connection between the sleeve 100 and the cuff 102 should be sufficient to resist detachment under normal use conditions. For this purpose, the proximal end of the sleeve 100 may be provided with one or more reinforcing structures such as an annular ring 328. A corresponding annular ring or band (not illustrated) may be provided on the radially inwardly facing flange 322. If the outside diameter of the ring 328 exceeds the inside diameter of the ring or other reinforcing structure carried by flange 322, the sleeve cannot be pulled from the cuff 102 unless the force applied is sufficient to deform one or both of the complementary rings. The structural integrity of this type of interfit structure may be optimized, taking into account the likely tension forces applied by the GI system, in view of the desired flexibility and compressibility of the implant as has been discussed.
  • In other variations of these embodiments, the tubular wall of the cuff can taper inward in the distal direction for attaching a sleeve with a smaller diameter than the cuff or the wall of the cuff can taper outward in the distal direction for attaching a sleeve with a larger diameter than the cuff.
  • Each of these embodiments permits the sleeve to be dropped into place or snap fit into place by elastic or other deformation of the interlocking retention surfaces. The attachment can be made more secure by the addition of one or two or more staples, stitches of suture adhesives or t-tags. Removal can be accomplished using a removal tool with a stop surface for placing against a surface on the cuff to prevent proximal movement of the cuff, and a grasper for grasping the proximal end of the sleeve and pulling the sleeve to release it from the cuff without straining the connection between the cuff and the tissue. Any additional sutures can be snipped using conventional endoscopic cutting tools. The cuff may also be removed if desired, or a different sleeve may be introduced and secured to the cuff.
  • The gastrointestinal sleeve device 100 preferably has a length such that ingested food and liquids bypass most or all of the stomach and at least a portion of the small intestine. Undigested food and liquids exit the distal end 112 of the sleeve 100 into the small intestine 114 reducing caloric absorption and eliciting physiological responses within the intestines. See FIG. 1. The gastrointestinal sleeve 100 can have a constant diameter throughout its length or the diameter may vary along the length.
  • For example, the proximal end of the sleeve 100 may be provided with a diameter that corresponds with the diameter of the cuff 102. This may be in the vicinity of about 25 mm to about 35 mm. The sleeve may be provided with the same diameter throughout its entire length, although this would result in folding of the sleeve longitudinally as it passes through the intestine. For example, the duodenum may have an inside diameter on the order of about 15 mm. As a consequence, one implementation of the invention provides a sleeve having a proximal end having a first cross sectional area, adjacent a tapered or stepped zone across which the cross sectional area reduces to a second, smaller cross sectional area. The axial length of the transition zone may be less than about 2 cm, and some embodiments less than about 5 cm, and in some embodiments no greater than about 10 cm. Alternatively, the length of the transition zone may exceed 10 cm or 20 cm, where wrinkling or longitudinal folding of the sleeve is not sought to be avoided.
  • The sleeve 100 and cuff 102 may be configured to provide a restrictive opening, either within the sleeve 100 or the cuff 102. The restrictive opening may be effectively provided at the distal end of the transition zone 101 illustrated in FIG. 13. The stoma may be positioned to provide a volume proximally of the stoma of no greater than about 100 cc, and in some implementations of the invention no greater than about 50 cc, and in certain applications no greater than about 30 cc, depending upon the desired clinical result.
  • As has been discussed in the parent applications previously incorporated herein by reference, additional structures and features may included on the sleeve 100. For example, one or more structures may be provided on the distal end of the sleeve 100 for facilitating transport of the sleeve 100 through the intestinal system. This may include a balloon or other bulking structure to facilitate preferential operation of peristalsis on the distal end of the sleeve. Any such structures may be absorbable, detachable, or permanent, depending upon the desired clinical performance. Alternatively, any of a variety of grasping structures such as a grasping tab or ring may be provided to facilitate grasping the distal end of the sleeve 100 using an installation tool, which is advanced distally through the intestinal system.
  • The gastrointestinal sleeve 100 can be impermeable along the entire length or some or all of the device may be porous or semipermeable. Preferably, the wall of the gastrointestinal sleeve 100 is thin and flexible so that peristalsis is coupled to the internal lumen of the sleeve 100. A gastric sleeve that extends beyond the pylorus 116, with or without an intestinal sleeve component, can allow use of the pylorus as a natural stoma by configuring the sleeve to close by normal operation of the pylorus 116 and then open to allow passage of food when the muscles of the pylorus relax. The section of the sleeve device 100 that passes through the pylorus 116 will preferably have enough wall flexibility or compliance to allow normal opening and closing of the pylorus to release and retain stomach contents and to allow drainage of stomach secretions around the outside of the sleeve. This can optionally be accomplished by the inclusion of pleats, channels or other structures to facilitate the collapse and sealing of the sleeve as well as passage of gastric secretions along the outside of the sleeve as shown schematically in FIG. 6A.
  • Dimensions, materials and other specifications described in U.S. patent application Ser. No. 11/124,634 can be selected and adjusted based upon the clinical situation. For example, the gastrointestinal sleeve 100 is preferably approximately 60-180 cm in length whereby partially digested or undigested nutrients exit from the sleeve into the jejunum where they can elicit a hormonal, neural and/or osmotic reaction in the jejunum, ileum and/or duodenum. Increasing the length of the sleeve can reduce the absorption of nutrients in a manner similar to that of a Roux-en-Y or bypass device, as will be understood by those skilled in the art. The sleeve may extend sufficiently far into the intestine, such as past the ligament of Treitz, so that it is retained in the intestine and not pushed back into the stomach. Lengths of at least about 50 cm, at least about 75 cm, at least about 100 cm and at least about 120 cm are contemplated, although different lengths may be appropriate depending upon the requirements of a particular patient. Lengths of no greater than about 5 cm or no greater than about 10 cm or no greater than about 20 cm may be desirable for certain patients, depending upon the desired clinical outcome.
  • The releasable attachment of the sleeve to the cuff as disclosed herein facilitates removal and replacement of the sleeve 100. Thus, the response of a particular patient to a first sleeve having a first length can be observed. If more or less intestinal absorption is desired, the first sleeve can be endoscopically removed from the cuff, and replaced by a second sleeve having a second shorter or longer length. Therapy is thus adjustable, which may be desirable if either the initial sleeve length was suboptimal or if it becomes suboptional due to post implantation changes such as stomach remodeling or behavioral changes.
  • Optionally, the sleeve can include coatings on its interior and/or exterior to enhance the surface properties of the sleeve in clinically relevant manners. Coating examples include: 1) parylene coatings to increase the chemical resistance of a sleeve material, 2) coating with an antimicrobial agent to resist infection and/or 3) coating with an anti-inflammatory agent to reduce tissue inflammatory response, as described herein. Similarly, the interior and exterior of the sleeve can optionally be coated with a low friction material (e.g. a hydrogel) to reduce friction of food passage (interior) and reduce gastric irritation (exterior). One example of such a low friction material is a lubricious coating such as the PHOTOLINK LUBRICIOUS COATING manufactured by Surmodics Inc. and disclosed on pg. 5, paragraph 58, in U.S. utility patent publication 2005-0049718, the disclosure of which is herein incorporated in its entirety by reference.
  • U.S. patent application Ser. No. 10/698,148 describes the use of biodegradable or bioresorbable materials for construction of a gastrointestinal sleeve device to obviate the need for removal of the sleeve device at the end of the treatment period. The entire gastrointestinal sleeve device or a portion of it may be made of biodegradable material. The gastrointestinal sleeve device may be made of biodegradable materials with different rates of degradation or resorbtion. The gastrointestinal sleeve device may be configured with a series of segments that biodegrade sequentially. For example, a first portion on the distal end of the sleeve may degrade first, followed some time later by a second intermediate portion and a third proximal portion. Next the attachment between the sleeve 100 and cuff 102 would degrade and, finally, the T-tags or other fasteners would degrade. Alternatively, the gastrointestinal sleeve device may be configured with a series of short segments of non-biodegradable material that are attached to one another with biodegradable material. The biodegradable attachment portions may be made of biodegradable materials with different rates of degradation or resorbtion so that they biodegrade sequentially. In either case, the biodegradable material would allow a gradual change of therapy over time, without having to revise or replace the implant. The patient could get used to the gradual change in therapy more readily than a sudden change and may be better able to avoid a rebound in weight gain. It may also allow for a safe mode of degradation and elimination. The device would degrade into pieces small enough that they could be eliminated without any danger of bowel obstruction.
  • Alternatively, selected portions of the gastrointestinal sleeve device may be made of biodegradable material. For example, openings in the sleeve can be covered with biodegradable material that will gradually degrade over time, eventually allowing food to mix with digestive secretions. The biodegradable material would allow a gradual change of therapy over time, without having to revise or replace the implant. The gastrointestinal sleeve device with the openings in it could be left in place for long-term maintenance of weight loss or it could eventually be removed.
  • In some embodiments the rate of degradation of the biodegradable material forming the sleeve could be coordinated with the natural pH of the anatomical environment and/or to properties of the material forming the sleeve, to achieve a predetermined sequential degradation of the implant. In accordance with one degradation sequence, a distal (intestinal) portion of the sleeve dissolves before the proximal (gastric) portion. For example, the sleeve could be constructed of a material that degrades at a faster rate in a relatively basic environment than in a relatively acidic environment such that the distal portion of the sleeve in the intestine would dissolve before the proximal portion of the sleeve in the stomach. The pH of the sleeve environment could also be altered by an external source, for example by ingestion of a substance that would change the pH of the stomach and/or intestine and thus hasten degradation of the gastric component. Alternatively, the distal and proximal portions of the sleeve could be constructed of two different materials with the material comprising the distal portion dissolving faster than the material comprising the proximal portion. Alternatively, the material forming the sleeve could be thinner at the distal portion than at the proximal portion such that the distal portion would dissolve in less time than the proximal portion. All or any combination of the above alternatives could be used to set the time frames of degradation of the distal and/or proximal portions of the sleeve depending on the desired performance.
  • Biodegradable material suitable for construction of a gastrointestinal sleeve device is sold under the name Plastifilm by OsteoBiologics, Inc., located in San Antonio, Tex. This biodegradable polymeric film material is described in U.S. Pat. No. 6,514,286, which is hereby incorporated by reference. Additional information from the supplier about this material is available at: http://www.obi.com/.
  • Another aspect of the present invention involves devices and methods for delivery and deployment of a gastrointestinal sleeve device into a patient's gastrointestinal tract. One method to facilitate delivery of the device into and through the patient's small intestine is to place a guidewire and/or catheter into the intestine to the depth desired and then push the gastrointestinal sleeve device over the guidewire. Successful techniques for placing a guidewire into the small intestines have been described by G. Long, T. Mills and C. P. Swain in an article entitled Techniques for advancing guide wires and devices in the lumen of the gastrointestinal tract. Another technique that could be adapted for placing a device such as a gastrointestinal sleeve device into the small intestine was described by H. Yamamoto and K. Sugano in an article entitled A new method of enteroscopy—the double-balloon method, Can J Gastroenterol. April 2003; 17(4):273-4. These techniques can be used in combination with many of the delivery and deployment methods described herein and in the prior application.
  • The gastrointestinal bypass sleeve may also be deployed within the intestine using a toposcopic, or everting technique, based upon the method of internal pressurization that is well known in the everting catheter art. Pressurization may be accomplished by placing the proximal end of the axially collapsed sleeve in communication with a source of inflation or everting media, such as a liquid or gas. Liquid such as water or saline may be preferred, and may additionally be provided with a radiopaque additive to permit real time fluoroscopic visualization of the progress of the deployment within the GI system. Additional additives may also be provided, such as antibiotics, nutritional supplements or others as may be desired.
  • To maintain the internal fluid pressure used to assist in everting the inverted gastrointestinal sleeve, the distal end of the sleeve may be temporarily occluded or sealed during deployment. FIGS. 8A-8B illustrate one of a number of options for sealing the distal end 112 of a gastrointestinal sleeve 100 during delivery and deployment. FIG. 8A shows the inverted distal end 112 of the gastrointestinal sleeve 100 sealed with a suture or tie 150 which may be degradable and formulated to dissolve within approximately 2 or 6 or 24 hours in the intestines. Dissolution of the biodegradable tie 150 can be aided by introduction of a solvent, or active agent, or inducing a pH change that is ingested or placed in the everting fluid. The distal end 112 may also be releasably secured to a pull line 152 such as a suture or wire, to assist in inverting the sleeve as will be apparent to those of skill in the art. FIG. 8B shows the noninverted distal end 112 of the gastrointestinal sleeve 100 sealed with a biodegradable tie 150 that may be formulated to dissolve within the intestines, prior to proximal retraction of the pull line 152.
  • The distal end may alternatively be temporarily occluded using adhesives, such as a water soluble adhesive or pressure sensitive adhesive applied to the interior surface of the distal end 112 of the sleeve. Alternatively, the distal end of the sleeve may be folded over onto itself with or without the use of adhesives. Solvent bonding, thermal spot welding or other bonding technique may be used to close the distal end 112, in a manner that a slight increase in pressure can be applied to the inflation media following full deployment, to rupture the seal. A tie line may alternatively extend proximally from the distal end 112, either inside of the lumen or outside of the sleeve 100. Proximal retraction of the tie line following sleeve placement will untie a knot or otherwise release the distal end 112. Otherwise the distal end may be simply left open during the deployment process.
  • FIG. 9A shows a gastrointestinal sleeve 100 loaded in an inverted configuration. FIG. 9B shows a gastrointestinal sleeve 100 loaded in a double-inverted configuration. A full single inversion will reduce the length of the sleeve 100 by about 50%, while a full double inversion will reduce the length of the sleeve 100 to about 25% of its original length. Deployment of the sleeve will thus still require a first step of positioning the distal end 154 of the inverted sleeve 100 at a first position within the GI tract, and then second everting the sleeve to position the everted distal end at a second position within the GI tract, downstream from the first position. The second position will normally be at least about 50 cm and often at least about 75 cm or 100 cm distally of the Pyloris. The first position may be at about the Pyloris, within about 20 cm of the Pyloris, or within about 50 cm of the pyloris, depending upon the device design and desired deployment procedure.
  • Inverting the sleeve simplifies the delivery and deployment of the device, but it adds some additional constraints to the configuration of the device. The inverting segments can have very thin walls and inverting interfaces can be highly lubricious for easy and reliable deployment. For example blow molded 90A durometer polyurethane of a wall thickness on the order of 0.005″ or less, most preferably about 0.002″, with a lubricious coating will work in this manner. Eversion within the intestine may be accompanied by introduction of an irrigating or lubricating fluid on the outside of the sleeve 100, and/or provision of a lubricant in between contacting surfaces of the inverted sleeve. Additional details are disclosed in copending application Ser. No. 10/698,148, filed Oct. 31, 2003, entitled Apparatus and Methods for Treatment of Morbid Obesity, the disclosure of which is incorporated in its entirety herein by reference.
  • Methods of insertion and retrieval of a gastrointestinal sleeve device are also described in the parent application. In addition to the methods described therein, a GI sleeve can be inserted and/or retrieved using a flexible endoscope. A skilled GI endoscopist can “drive” a special endoscope (an enteroscope) through the duodenum and deep into the jejunum. Because of its small size, a pediatric colonoscope can be used to access an area further down the intestine. With proper interfacing structure on a GI sleeve, the sleeve can piggyback on the endoscope as it is driven into the jejunum and then released with its distal end left in the jejunum when the endoscope is retracted and removed from the body. This can be accomplished perorally either before or after attachment of the proximal end of the sleeve to tissue or to a cuff at the GEJ or some other clinically desirable location.
  • Various structures can be used as an interface between the endoscope and the distal end of the GI sleeve device. If the sleeve device has a solid distal end or other graspable portion, such as a tab or loop near the distal end, a standard or custom endoscopic snare or grasper can be extended through the endoscope working channel to grasp the sleeve device. Alternatively, the distal end of the sleeve device can be configured with a socket or pocket to engage a flexible pusher, which may be configured as a rod, tube or guidewire. As another alternative, the sleeve device can be configured with a distal end that can be cut off to release the device. The distal end of the sleeve device is grasped with a snare or the like extended through the endoscope working channel. Once the sleeve device is delivered far enough distally in the GI tract, the distal end of the sleeve device is cut off to release the device.
  • In one embodiment, delivery of the sleeve device to an area sufficiently far down the intestine is facilitated by attaching a traction structure, such as a mercury ball or liquid filled balloon, that increases the likelihood that the sleeve will be pulled down the intestine, to the distal end of the sleeve. During peristalsis the intestinal wall grabs hold of the traction structure and pulls it along with the distal end of the sleeve down the intestine.
  • In one embodiment deployment of the sleeve device and/or T-tags is achieved with the use of a remote controlled robotic endoscope. Generally, a remote controlled robotic endoscope comprises a user interface, a control device, and an operating unit. Commands can be inputted by an operator into the user interface to activate the control device which in turn guides the operating unit in three dimensions. The operating unit, in one embodiment, can be a fastener deployment head carried by a catheter which is positionable within the gastrointestinal tract and capable of attaching various fastener structures such as sutures and T-tags in response to commands received by the user interface. Monitors that display physical data and images of the anatomy to aid in navigation of the operating unit may also be used with a remote controlled robotic endoscope. Such an endoscope could scale the operator's movements such that large movements of the operator would translate into the smaller movements that may be required to maneuver the endoscope within the gastrointestinal tract. One embodiment of a remote controlled robotic endoscope is described in “Radiocontrolled Movement of a Robot Endoscope in the Human Gastrointestinal Tract,” by P. Swain, T. Mills, B. Kelleher, L. Schmitz, S. Mosse, P. Burke, K. Ikeda, and A. Fritscher-Ravens.
  • When placing T-tag fasteners or other fasteners in the region of the GEJ, it is important to avoid other anatomical structures in the vicinity of the stomach and esophagus. One method for this is to create a safe space behind the GEJ for deploying the fasteners. One method to accomplish this is described in the parent application Ser. No. 10/698,148. Alternatively, one can take advantage of the fact that the proximal stomach generally lies just below the diaphragm when the patient is in a head-up position. Space will be created between the stomach and diaphragm into which transmural fasteners can be safely placed. This safe space can be increased by having the patient inhale deeply while in a head-up position to push the stomach down with the diaphragm, then exhale to lift the diaphragm up off of the stomach. Preferably, the fasteners 134 will be delivered parallel to the diaphragm 252, as shown in FIG. 10, though other orientations are possible. FIG. 10 also shows an optional stomach traction device 254 deployed through the working channel of an endoscope 256 that helps to facilitate safe deployment of the fasteners 134 in the GEJ region. The traction device 254 can be used to retract the gastric wall laterally 254A and/or distally 254B to create a safe place for deployment of the fasteners 134. Due to anatomic variations and pathology, the position of the diaphragm relative to the stomach and GEJ should be confirmed prior to using this technique.
  • Alternatively or in addition, pneumoperitoneum can be used to create a safe space around the stomach and esophagus. Pneumoperitoneal pressure will tend to collapse the stomach away from other surrounding organs and would be balanced by the pressure used to endoscopically insufflate the stomach for improved visualization and access.
  • Other tactics to avoid other anatomical structures in the vicinity of the stomach and esophagus include the use of imaging techniques such as fluoroscopy, esophageal ultrasound imaging, external ultrasound imaging and/or Doppler imaging when placing fasteners. Alternatively or in addition an “endoscopic compass” can be used to provide a reference for orienting the endoscope when using fastening devices. A small magnetized needle (i.e. a compass needle) is placed near the distal end of the endoscope where it can be viewed by the operator through the endoscope. A magnet is placed on the patient to provide a reference point for the compass, for example the reference magnet can be placed on the patient's back directly over the spine. The compass needle will point toward the reference magnet on the spine. Using the compass needle as a reference, the operator will be able to avoid inadvertently puncturing the aorta, which lies directly posterior to the esophagus.
  • The concept of the Veress needle can be adapted for avoiding puncturing other anatomical structures in the vicinity of the stomach and esophagus during endoscopic attachment of devices near the GEJ. A Veress needle is a needle equipped with a spring-loaded obturator that is often used for insufflation of the abdomen in laparoscopic surgery. A long, flexible device with a needle at the distal end and a spring-loaded obturator within the needle would be used to safely puncture the gastric or esophageal wall. Once the needle has passed through the wall, the spring-loaded obturator advances automatically to avoid damage to any surrounding tissues. A delivery cannula can be advanced over the needle and the needle can be exchanged with a fastener delivery device. Alternatively, this concept can be adapted directly into the fastener delivery device. A T-tag fastener or the like would be spring-loaded into the lumen of a delivery cannula so that it would be ejected out of the lumen immediately after the cannula has traversed the gastric or esophageal wall.
  • Another method for avoiding deploying fasteners into the aorta would involve a small diameter needle with a flow detector (e.g. a Doppler flow sensor) or pressure detector for detecting blood flow or blood pressure. Alternatively, a flow detector or pressure detector can be mounted on a separate guidewire inserted through the needle. The flow detector can be used to detect blood flow before the wall of the aorta is punctured. Alternatively, if backflow of blood or blood pressure is detected, indicating that the needle has punctured the aorta, the needle will be withdrawn and a fastener will not be delivered at that site. The small diameter puncture in the aorta should heal without complications.
  • Alternatively or in addition, the organs and other anatomical structures in the vicinity of the stomach and esophagus can be protected during endoscopic attachment techniques by using a depth stop on the needle or delivery cannula to prevent it from penetrating farther than necessary to traverse the gastric or esophageal wall. Examples of fastener delivery devices with a depth stop to protect nearby organs and structures are described in U.S. provisional patent application 60/569,442.
  • FIGS. 11A-11D illustrate a simplified view of delivery of a T-tag fastener showing the serosal anchor and tension element (suture) of a T-tag fastener and the delivery cannula with a pusher therein. In actual application, the entire delivery assembly would include an endoscopic delivery device (not shown), with the delivery cannula carried piggyback by the endoscope or deployed through the working channel of the endoscopic delivery channel. Also, in actual application the T-tag fastener would attach an attachment device such as a cuff to a gastrointestinal sleeve device through a grommet or hole in the cuff and/or sleeve device.
  • All or a portion of the fastener can be coated and/or made with a material that will encourage tissue ingrowth to create a seal and to promote a strong and durable attachment, although tissue ingrowth in the vicinity of the GEJ is not expected to be robust. All or a portion of the fastener can be coated and/or made with a swellable material to create a seal and/or to spread out the force of attachment over a greater surface area, thereby reducing the pressure on the tissue. All or a portion of the fastener can be coated and/or made with a material that is biodegradable or bioresorbable. Examples of such coatings materials are described in the parent application Ser. No 10/698,148.
  • One method for placing an implantable device within a patient's body has been described as a “parachuting” technique. In this technique, multiple elongated sutures extend from a plurality of implanted serosal anchors where the device is to be implanted with the ends of the sutures extending out of the patient's body. The ends of the sutures are passed through a sewing ring or similar structure on the device while the device is still outside of the patient's body, then the cuff is parachuted or slid into place along the sutures. The cuff is typically secured in place by knotting the elongated sutures with the help of a knot pusher or similar device and then the sutures are cut off close to the knots. U.S. provisional patent application 60/534,056 describes a variation of this method for implanting a device within a patient's digestive tract using T-tag fasteners. Alternatively, suture locks such as those described in U.S. Pat. No. 4,235,238, the disclosure of which is hereby incorporated in its entirety by reference herein, or those used in the BARD Endocinch system can be used to secure the suture prior to cutting.
  • When parachuted into place along the sutures, the cuff may be folded or compressed to pass through the esophagus or through a delivery tube placed in the esophagus. When using this parachuting technique it is desirable to minimize the friction between the device and the sutures. This can be done by using a low friction material or a low friction coating on the sutures and/or the device. This is also done by dimensioning and/or orienting structures, e.g. holes, to guide the parachuted device to reduce friction.
  • FIG. 12 shows an implantable device 102 being implanted at the GEJ using a parachuting technique. One method of using a fastener delivery device for placement of an implantable device 102 by the parachuting technique is disclosed in U.S. utility patent application Ser. No. 11/025,364, previously incorporated by reference herein.
  • Alternatively, the device 102 may be partially parachuted into place, meaning that 2-4 parachute sutures are used to slide the device 102 into position with the proper orientation. Then additional fasteners, for example T-tag fasteners, are delivered endoscopically to complete the attachment of the device 120 to the tissue.
  • If suture tails are delivered through a closed lumen (e.g. in or attached to an endoscope), the lumen must be removed from around the suture tails before a device can be parachuted over the sutures if the device is too large to pass through the lumen. This can present a challenge related to maintaining the organization of the suture tails and preventing confusion, crossing, winding and/or tangling of the suture tails. If T-tag fasteners and their suture tails are passed externally e.g. through an external lumen with a longitudinal slot or in a non-enclosed rail type system, the suture tails can be managed external to the lumen used to place the T-tag fasteners and external to the scope. This facilitates manipulation of the scope, simplifies scope exchanges and simplifies suture tail management.
  • Suture tail management external to the scope or an enclosed lumen can be combined with suture holders external to the patient, similar to those used for parachuting replacement heart valves into place. Snugging the sutures as described above is simpler when the suture tails are external to the scope, as is avoidance of crossing, winding and/or tangling of the suture tails. Suture holders, such as slots, clamps or clips, can be combined with a mouth guard for organizing the sutures during a peroral parachuting procedure.
  • One aspect of suture tail management is that it must happen from one end of the system to the other. Therefore, the method and apparatus must address this issue. For example, after placement of a T-tag fastener, a slight tension on the suture tail can hold the suture against the wall of the lumen or in a straight position where it is less likely to tangle. Apparatus can include means to maintain tension while allowing scope movement and manipulation e.g. tension from a long soft spring, an elastic band or a spring-loaded reel.
  • Sometimes, when performing an endoscopic procedure, an overtube is used to line the esophagus and protect it from damage due to insertion and manipulation of the endoscope and related tools and devices. Other practitioners prefer to avoid the use of an overtube. In either case, it may be desirable to secure an implant being parachuted down the esphagus in a collapsed, folded or otherwise reduced configuration. A major issue when parachuting a device into place is friction between the device and the sutures, and collapsing or folding the device may exacerbate the problems with friction.
  • The following method is intended to reduce the problems with friction between the device and the sutures when parachuting a device through the esophagus. The method allows the device to be parachuted through the esophagus in a folded configuration, while it also allows the sutures to pass through the device while it is in an unfolded position. In addition, the method allows the sutures to be pulled through the device one at a time, which further reduces the problems with friction. This method can be used, for example, with the t-tag and/or t-tag delivery systems described herein.
  • 1) Place fasteners (e.g. 6-10) in or through gastric wall with suture tails extending out through the patient's mouth; the sutures should have a length that is about 100-140 cm longer than required to exit the mouth;
  • 2) thread suture tails through the device to be parachuted into place, e.g. an implant mounting ring or cuff;
  • 3) slide the cuff down the sutures until it is just outside of the patient's mouth, with 100-140 cm of suture extending beyond the device;
  • 4) fold or collapse the cuff and secure it in the collapsed position, e.g. with a removable sack or tied with a suture;
  • 5) slide the cuff through the esophagus or the scope overtube (the cuff is not slid down the sutures, but instead the sutures are allowed to move with the cuff into the esophagus with the ends of the sutures remaining outside the patient);
  • 6) once the cuff is through the esophagus and at the deployment site, the cuff is released from its collapsed position, and any restraining device that was used is removed perorally;
  • 7) while controlling the cuff (e.g. with a grasper), and preferably under direct vision, pull each suture through the cuff until all the slack is removed and the cuff is at or near its intended position in the stomach;
  • 8) position and secure the cuff in its intended position in the stomach.
  • In some clinical situations the gastroesophageal junction, or GEJ, is a preferred attachment point for a gastroesophageal sleeve device or attachment device as discussed above. Attachment at the GEJ excludes all gastric secretions from the interior of the gastrointestinal sleeve device to separate ingested food and liquids in the sleeve device from all digestive secretions. The gastroesophageal junction is one of the preferred attachment sites because the tissue wall is relatively thick at this location and it is relatively easy to access via a peroral route. More specifically, the non-glandular tissue directly above the squamo-columnar junction (a zone of tissue that is considered to be at the beginning of the GEJ) is the strongest tissue in this region and is currently thought to be the best place to attach a device, for example using T-tags, sutures or other fasteners.
  • In some clinical situations it may be beneficial to prestrengthen the tissue prior to implantation of a device such as a gastrointestinal sleeve device. For example, energy can be delivered in the form of RF, ultrasound or other known method to induce an inflammatory, coagulative or necrotic tissue strengthening reaction. Alternatively, placement of material in the serosal tissue of the stomach wall could generate a foreign body reaction that would progress from inflammation, to granulation of tissue and then to fibrosis. The tissue may initially weaken due to the inflammatory response, but the resulting fibrotic growth will strengthen the tissue. This effect could be enhanced by the choice of material an/or coatings, e.g. sclerosing agent, an acidic material or coating. The materials could be delivered endoscopically with a needle device through the biopsy channel of an endoscope. The needle delivery device could optionally also deliver an ink, dye or other marking means to facilitate location of the prestrengthened areas. Tissue reaction could take place in days, with 7-14 days being an approximate delay between prestrengthening and attachment procedures.
  • Material injectable to prestrengthen tissue could be: 1) liquid where natural processes would remove/break down or otherwise dispose of the liquid when it has completed its function; 2) biodegradable or dissolvable where natural processes would remove the material when it has completed its function; or 3) permanent where the material might be incorporated into the tissue to provide increased strength. All of the prestrengthening strategies described could be used at the time of the attachment procedure to enhance strength of the attachment.
  • The methods and apparatus described for tissue strengthening would be expected to result in some degree of tissue thickening as new collagen and fibrotic material will be deposited and/or generated at the location of the foreign body reaction. The duration of exposure can be controlled by use of timed release chemical stimulants and stimulants with known and potentially controllable half lives. Tissue thickening and tissue strength may be related and may facilitate durable attachment, however tissue thickening may be an inherently desirable result in some clinical situations.
  • Currently, tissue bulking agents are injected at or near the GEJ to treat GERD. Injection of non-bulking materials that initiate tissue thickening could accomplish the same end result. If the thickened tissue was, by itself or in conjunction with a supporting structure, to form a restrictive stoma, there could be specific advantages relative to a mechanical stoma.
  • Other approaches to induce tissue prestrengthening and/or thickening include: Circumferential ablation (RF, microwave, ultrasound, etc); Over-dilation; Circumferential abrasion; and, Circumferential exposure to agent. An advantage of a continuous or segmented circumferential area of tissue strengthening is that it only needs to be located along a vertical axis for subsequent attachment procedures.
  • Alternately or in addition to the above pre-strengthening of tissue, tissue can be treated to reduce its ability to move or stretch. This can be advantageous in that tissue that has limited stretch or motion may have less impediments to attachment. Tissue that has limited stretch or motion may impose fewer forces on an attached device and therefore impose less force or pressure that may lead to attachment failure. Furthermore, tissue that has limited stretch or motion may allow attachment of less compliant devices which can provide for advantages foe example simplified sealing.
  • Techniques described above to strengthen tissue can also help to limited GI tissue stretch and motion. Other methods that could be applied to reducing stretch and motion, and also for pre-strengthening, include the application of energy for example, by RF, ultrasound or laser. Means that include time release elements as well known in the art of drug eluting vascular stents and birth control devices can be used to provide and/or maintain a long lasting effect (reducing motion and stretch). Such time release means can optionally be combined with fasteners, permanent or replaceable attachment cuffs or proximal sleeve interfaces. Such time release means can optionally be combined with permanently implanted pre-strengthening materials where the material might be incorporated into the tissue to provide increased strength.
  • In some clinical situations when using a transmural attachment, the wall of tissue may thicken after placement of the attaching device. In some cases this can progress to encapsulation. This thickening can result in increased tissue strength due to collagen deposition and/or fibrosis.
  • In some clinical situations it can be advantageous to maintain the attachment on the surface of the tissue to take advantage of the added strength of the thickened wall. This may be accomplished by permitting controlled suture lengthening to compensate for tissue thickening. One manner in which this could be accomplished would be by using a suture connecting the attachments on either side of the tissue wall that would stretch as the tissue thickens.
  • One configuration of material that could have advantageous performance would: 1) not stretch for an initial period, for example 24-48 hours; 2) stretch at a relatively low force for the next period, for example 7-14 days; then 3) not stretch after the second period. This performance would be based upon a clinical situation where tissue proliferation (wall thickening) occurs between days 2 and 14. Alternatively, the material could: 1) not stretch for the initial period, for example 24-48 hours; 2) allow lengthening to 2× length at any time after the initial period, for example 48 hours; then 3) not stretch beyond 2× length.
  • The length of the suture or other tension element which extends through the wall from the serosal surface to the mucosal surface, particularly when the tension element has a substantially fixed length under normal use conditions may also be important. The present inventors believe that the length of the tension element is in certain applications at least about 75%, often at least about 100%, and preferably at least about 120% and possibly at least about 130% of the thickness of the wall of the stomach through which the tension element is to be placed. Thus, for a patient having a wall thickness in the vicinity of the gastroesophageal junction of approximately 10-15 mm, suture lengths between the mucosal contacting surface of the implant and the serosal contacting surface of the retention element of at least about 10 mm, and often at least about 15 mm are contemplated.
  • The stomach appears to have unusual abilities to isolate foreign objects. Evidence of this is the lap band which can migrate from the serosal surface of the stomach into the lumen of the stomach without any immediate catastrophic event such as a leak of stomach contents into the body cavity which could be life threatening. The cause of such erosion is unclear but one theory suggests it is at least in part due to pressure.
  • The stomach is also a very active organ with an ability to stretch, compress, churn and move laterally relative to itself. This activity is normal in eating and digestion and can also function to isolate foreign objects.
  • These anatomical aspects make attachment of medical devices to the stomach quite challenging. A recent study at the Cleveland Clinic which sutured a prosthetic cuff to the GEJ showed that by 7 days 80% of the cuffs had become primarily detached. In one animal that was survived for two months, the device remained attached at 4 weeks but was only 25% attached by 60 days.
  • The present inventors have conducted a series of studies to explore the parameters of a successful attachment. Initial designs utilizing rigid rings lost attachment at a majority of points within four weeks. Short term success at two weeks with a flexible cuff, with elastic ability, was achieved by using t-tags and placing them in the non-glandular tissue region of the GEJ. However this same technique at five weeks did not maintain 100% attachment. One-Third of the attachment points migrated through the stomach, leaving no identified histological evidence of their path. The t-tags did not appear to be deformed.
  • The inventors then undertook a series of experiments at five weeks controlling for the amount of tension on the tension element, by placing serosal surface attachment devices having tension elements with a predetermined length relative to the thickness of the tissue wall. The thickness of the porcine stomach at the target site was measured, and the average of four tissue thickness measurements at the 3-6-9-12 o'clock positions was used as the nominal thickness. The absolute thickness was somewhat surprising at around 1 cm. This was perceived to be much thicker than what was thought. The reasons for this could be increased thickness in the area of interest of the GEJ, but it could also be due to the highly compressible nature of stomach tissue in that when it is held between the thumb and index finger it does feel 1 cm thick.
  • In three experiments conducted there was a clear trend that the looser the attachment (i.e., the longer the length of the tension element compared to the local wall thickness) the more attachment points held at five weeks. Results ranged from 10/12 migrations for the sutures sized at 50% of nominal thickness to 2/12 migrations for sutures sized at 100% of nominal thickness.
  • Another variable which was explored in the porcine model was the effect of changes in the surface area of the retention element. Silicone buttons having a 1 cm diameter were used instead of the t-tags. In one experiment conducted to date at a suture length of 75% of nominal thickness, 4/12 silicone buttons migrated through.
  • What seemed different about the silicone buttons is with two-thirds of the attachments in place it appeared upon gross inspection to be very strongly functionally attached, with high weight bearing abilities, perceptually greater than the t-tags.
  • From the experiments to date it appears that tension control is as important (if not more so) as the geometry of the serosal attachment device.
  • As discussed elsewhere herein, tension control could be addressed by using suture with limited elastic properties or other structural mechanism that would stretch or elongate and then return to their nominal length. Another way is to use an assumed thickness, based upon an average of actual measurements in humans, and preset the length of the tension element at a predetermined length (e.g., at least 115%, at least 130%) compared to the length of the average. The chances of success for this approach would likely be enhanced if the patient to patient variation is relatively small. A further approach would be to measure the thickness of the target tissue in each patient, and customize the length of the tension element at the clinical site, or provide kits with a cuff and an array of anchor assemblies with tension elements of different predetermined lengths from which the clinician can make a selection. Measurement could be accomplished, for example, with endoscopic ultrasound, like a device available from Boston Scientific.
  • Once the measurement is taken a variety of devices could be used to attach with a controlled length. Many of these devices have been previously described and include t-tags, inflatable silicone discs, molly type devices, radial spoke “umbrella” structures and others. They can be attached to suture with a fixed cuff to retention element length (or other means) or a strut member made of polymer or metal with a nub to fix the length. All of these devices are preferably configured to permit endoscopic delivery through a single fire device, or a multiple fire or rapid reloadable device could be used, to minimize the number of times the delivery device needs to removed from the endoscope to be reloaded.
  • Another application of the present invention involves the placement of a mounting ring, aperture, hook, connector or other attachment device within the gastrointestinal system utilizing the serosal attachment disclosed herein and attaching any of a variety of devices or components to the attachment device. Applications for treating GERD, MO and other disorders of the gastrointestinal tract include placing/attaching a nonrestrictive mounting ring at or near the GEJ and attaching/removing/replacing various therapeutic or diagnostic devices to the mounting ring, such as a valve to prevent reflux, a restriction to food intake, a sleeve, a telemetry or imaging capsule, transmitters for transmitting pH or other data, receivers for receiving therapeutic signals initiated by an external control, etc.
  • While the present invention has been described herein with respect to the exemplary embodiments and the best mode for practicing the invention, it will be apparent to one of ordinary skill in the art that many modifications, improvements and subcombinations of the various embodiments, adaptations and variations can be made to the invention without departing from the spirit and scope thereof.

Claims (1)

1. A system for treating a patient, comprising:
a gastrointestinal attachment cuff having a tubular body, a proximal end and a distal end; and
a gastrointestinal bypass sleeve at least partially inverted within itself, and adapted for eversion within the gastrointestinal tract.
US11/430,275 2002-11-01 2006-05-08 Everting gastrointestinal sleeve Abandoned US20070010865A1 (en)

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US42298702P 2002-11-01 2002-11-01
US42848302P 2002-11-22 2002-11-22
US43085702P 2002-12-03 2002-12-03
US43751302P 2002-12-30 2002-12-30
US44881703P 2003-02-21 2003-02-21
US48048503P 2003-06-21 2003-06-21
US10/698,148 US9060844B2 (en) 2002-11-01 2003-10-31 Apparatus and methods for treatment of morbid obesity
US56944204P 2004-05-07 2004-05-07
US61391704P 2004-09-27 2004-09-27
US10/998,424 US20050096750A1 (en) 2002-11-01 2004-11-29 Apparatus and methods for treatment of morbid obesity
US11/124,634 US8070743B2 (en) 2002-11-01 2005-05-05 Devices and methods for attaching an endolumenal gastrointestinal implant
US11/400,724 US7837669B2 (en) 2002-11-01 2006-04-07 Devices and methods for endolumenal gastrointestinal bypass
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US11/429,934 Abandoned US20070010864A1 (en) 2002-11-01 2006-05-08 Gastrointestinal implant system
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Cited By (47)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US20040092892A1 (en) * 2002-11-01 2004-05-13 Jonathan Kagan Apparatus and methods for treatment of morbid obesity
US20050049718A1 (en) * 2002-11-01 2005-03-03 Valentx, Inc. Gastrointestinal sleeve device and methods for treatment of morbid obesity
US20050177181A1 (en) * 2002-11-01 2005-08-11 Jonathan Kagan Devices and methods for treating morbid obesity
US20060015125A1 (en) * 2004-05-07 2006-01-19 Paul Swain Devices and methods for gastric surgery
US20060020247A1 (en) * 2002-11-01 2006-01-26 Jonathan Kagan Devices and methods for attaching an endolumenal gastrointestinal implant
US20060178691A1 (en) * 2004-02-26 2006-08-10 Binmoeller Kenneth F Methods and devices to curb appetite and/or reduce food intake
US20060282107A1 (en) * 2005-05-09 2006-12-14 Kiyoshi Hashiba Intragastric device for treating obesity
US20070010794A1 (en) * 2002-11-01 2007-01-11 Mitchell Dann Devices and methods for endolumenal gastrointestinal bypass
US20070198039A1 (en) * 2006-01-27 2007-08-23 Wilson-Cook Medical, Inc. Intragastric device for treating obesity
US20070239284A1 (en) * 2005-12-22 2007-10-11 Skerven Gregory J Coiled intragastric member for treating obesity
US20070276428A1 (en) * 2005-12-22 2007-11-29 Haller Frederick B Intragastric bag for treating obesity
US20070293885A1 (en) * 2004-02-26 2007-12-20 Binmoeller Kenneth F Methods and devices to curb appetite and/or to reduce food intake
US20080058887A1 (en) * 2006-04-25 2008-03-06 Bobby Griffin Methods and devices for gastrointestinal stimulation
US20080167606A1 (en) * 2006-09-25 2008-07-10 Valentx, Inc. Toposcopic access and delivery devices
WO2008095046A2 (en) * 2007-01-30 2008-08-07 Loma Vista Medical, Inc., Biological navigation device
US20080281257A1 (en) * 2007-05-10 2008-11-13 Waller David F Intragastric bag apparatus and method of delivery for treating obesity
US20090012356A1 (en) * 2007-06-11 2009-01-08 Valen Tx, Inc. Endoscopic delivery devices and methods
US20090012544A1 (en) * 2007-06-08 2009-01-08 Valen Tx, Inc. Gastrointestinal bypass sleeve as an adjunct to bariatric surgery
US20090012553A1 (en) * 2007-06-08 2009-01-08 Valentx, Inc. Methods and devices for intragastric support of functional or prosthetic gastrointestinal devices
US20090149879A1 (en) * 2007-12-10 2009-06-11 Dillon Travis E Dynamic volume displacement weight loss device
US20090164028A1 (en) * 2007-12-21 2009-06-25 Wilson-Cook Medical Inc. Method of delivering an intragastric device for treating obesity
US20090171382A1 (en) * 2007-12-27 2009-07-02 Wilson-Cook Medical Inc. Delivery system and method of delivery for treating obesity
US20090259238A1 (en) * 2008-04-09 2009-10-15 Stryker Development Llc Pyloric valve devices and methods
US20090259240A1 (en) * 2008-04-09 2009-10-15 Stryker Development Llc Pyloric valve
US20090301643A1 (en) * 2008-06-02 2009-12-10 Loma Vista Medical, Inc. Inflatable medical devices
EP2165665A1 (en) * 2008-09-22 2010-03-24 Tyco Healthcare Group, LP Devices for compression of an anastomotic sheath
US20100191167A1 (en) * 2006-03-02 2010-07-29 Lytn Gastrointestinal implant and methods for use
US20100256775A1 (en) * 2009-04-03 2010-10-07 Metamodix, Inc. Modular gastrointestinal prostheses
US20110009690A1 (en) * 2009-07-10 2011-01-13 Metamodix, Inc. External Anchoring Configurations for Modular Gastrointestinal Prostheses
US7931693B2 (en) 2004-02-26 2011-04-26 Endosphere, Inc. Method and apparatus for reducing obesity
US20110137227A1 (en) * 2007-07-16 2011-06-09 Mckinley James T Methods and devices for delivering or delaying lipids within a duodenum
US7967818B2 (en) 2005-06-10 2011-06-28 Cook Medical Technologies Llc Cautery catheter
US8702641B2 (en) 2009-04-03 2014-04-22 Metamodix, Inc. Gastrointestinal prostheses having partial bypass configurations
US8956318B2 (en) 2012-05-31 2015-02-17 Valentx, Inc. Devices and methods for gastrointestinal bypass
US9060835B2 (en) 2006-05-26 2015-06-23 Endosphere, Inc. Conformationally-stabilized intraluminal device for medical applications
US9173760B2 (en) 2009-04-03 2015-11-03 Metamodix, Inc. Delivery devices and methods for gastrointestinal implants
US9278019B2 (en) 2009-04-03 2016-03-08 Metamodix, Inc Anchors and methods for intestinal bypass sleeves
US9451960B2 (en) 2012-05-31 2016-09-27 Valentx, Inc. Devices and methods for gastrointestinal bypass
US9592119B2 (en) 2010-07-13 2017-03-14 C.R. Bard, Inc. Inflatable medical devices
US9622897B1 (en) 2016-03-03 2017-04-18 Metamodix, Inc. Pyloric anchors and methods for intestinal bypass sleeves
US9675489B2 (en) 2012-05-31 2017-06-13 Valentx, Inc. Devices and methods for gastrointestinal bypass
US9757264B2 (en) 2013-03-13 2017-09-12 Valentx, Inc. Devices and methods for gastrointestinal bypass
US10159699B2 (en) 2013-01-15 2018-12-25 Metamodix, Inc. System and method for affecting intestinal microbial flora
US10188436B2 (en) 2010-11-09 2019-01-29 Loma Vista Medical, Inc. Inflatable medical devices
WO2020141023A1 (en) * 2019-01-03 2020-07-09 Butz Alexander Gastrointestinal implant and positioning device for same
US10751209B2 (en) 2016-05-19 2020-08-25 Metamodix, Inc. Pyloric anchor retrieval tools and methods
WO2022128117A1 (en) * 2020-12-18 2022-06-23 Butz Alexander Gastrointestinal implant

Families Citing this family (136)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US20050131465A1 (en) 2000-02-04 2005-06-16 Freeman Gary A. Integrated resuscitation
EP1251908B1 (en) 2000-02-04 2017-04-05 Zoll Medical Corporation Integrated resuscitation
US6845776B2 (en) * 2001-08-27 2005-01-25 Richard S. Stack Satiation devices and methods
CN101810521B (en) 2001-08-27 2015-05-13 辛尼科有限责任公司 Satiation devices and methods
US20040117031A1 (en) * 2001-08-27 2004-06-17 Stack Richard S. Satiation devices and methods
US7097665B2 (en) * 2003-01-16 2006-08-29 Synecor, Llc Positioning tools and methods for implanting medical devices
US6675809B2 (en) 2001-08-27 2004-01-13 Richard S. Stack Satiation devices and methods
US7146984B2 (en) * 2002-04-08 2006-12-12 Synecor, Llc Method and apparatus for modifying the exit orifice of a satiation pouch
US20110092988A1 (en) * 2002-10-29 2011-04-21 Microfabrica Inc. Microdevices for Tissue Approximation and Retention, Methods for Using, and Methods for Making
CA2512203C (en) 2002-12-02 2012-10-23 Gi Dynamics, Inc. Bariatric sleeve
US7608114B2 (en) 2002-12-02 2009-10-27 Gi Dynamics, Inc. Bariatric sleeve
US7025791B2 (en) * 2002-12-02 2006-04-11 Gi Dynamics, Inc. Bariatric sleeve
US7695446B2 (en) 2002-12-02 2010-04-13 Gi Dynamics, Inc. Methods of treatment using a bariatric sleeve
US7766973B2 (en) * 2005-01-19 2010-08-03 Gi Dynamics, Inc. Eversion resistant sleeves
US7678068B2 (en) 2002-12-02 2010-03-16 Gi Dynamics, Inc. Atraumatic delivery devices
US20040143342A1 (en) 2003-01-16 2004-07-22 Stack Richard S. Satiation pouches and methods of use
EP1610719B1 (en) * 2003-03-28 2010-01-13 GI Dynamics, Inc. Sleeve for delayed introduction of enzymes into the intestine
US20040220682A1 (en) * 2003-03-28 2004-11-04 Gi Dynamics, Inc. Anti-obesity devices
US20050247320A1 (en) 2003-10-10 2005-11-10 Stack Richard S Devices and methods for retaining a gastro-esophageal implant
US8206456B2 (en) 2003-10-10 2012-06-26 Barosense, Inc. Restrictive and/or obstructive implant system for inducing weight loss
EP1708655A1 (en) * 2003-12-09 2006-10-11 GI Dynamics, Inc. Apparatus to be anchored within the gastrointestinal tract and anchoring method
US8057420B2 (en) 2003-12-09 2011-11-15 Gi Dynamics, Inc. Gastrointestinal implant with drawstring
US7379672B2 (en) * 2004-02-12 2008-05-27 Northrop Grumman Corporation Photonic RF distribution system
WO2005105003A1 (en) 2004-04-26 2005-11-10 Synecor, Llc Restrictive and/or obstructive implant for inducing weight loss
US7955357B2 (en) 2004-07-02 2011-06-07 Ellipse Technologies, Inc. Expandable rod system to treat scoliosis and method of using the same
US20060155375A1 (en) * 2004-09-27 2006-07-13 Jonathan Kagan Devices and methods for attachment of a gastrointestinal sleeve
JP4856082B2 (en) * 2004-10-15 2012-01-18 ビーエフケイダブリュ・エルエルシー Obesity device
KR101696006B1 (en) 2004-10-15 2017-01-13 비에프케이더블유, 엘엘씨 Bariatric device and method for recipient with altered anatomy
US7771382B2 (en) * 2005-01-19 2010-08-10 Gi Dynamics, Inc. Resistive anti-obesity devices
JP2008526461A (en) * 2005-01-19 2008-07-24 センティネル・グループ・エルエルシー Drug delivery system and method
US7650181B2 (en) * 2005-09-14 2010-01-19 Zoll Medical Corporation Synchronization of repetitive therapeutic interventions
US9055942B2 (en) 2005-10-03 2015-06-16 Boston Scienctific Scimed, Inc. Endoscopic plication devices and methods
US20080190989A1 (en) * 2005-10-03 2008-08-14 Crews Samuel T Endoscopic plication device and method
US8038720B2 (en) * 2005-10-18 2011-10-18 Wallace Jeffrey M Methods and devices for intragastrointestinal prostheses
US8556934B2 (en) * 2006-05-19 2013-10-15 Norman Godin Article, system, and method for securing medical devices to treat obesity, gastro-esophageal reflux disease (GERD) and irritable bowel syndrome (IBS) reversibly
US7819836B2 (en) * 2006-06-23 2010-10-26 Gi Dynamics, Inc. Resistive anti-obesity devices
US10350099B2 (en) 2006-09-01 2019-07-16 Ethicon Endo-Surgery, Inc. Devices and methods for anchoring an endoluminal sleeve in the GI tract
EP2572673B1 (en) 2006-09-02 2015-08-19 Boston Scientific Scimed, Inc. Intestinal sleeves and associated deployment systems and methods
US20090125040A1 (en) * 2006-09-13 2009-05-14 Hambly Pablo R Tissue acquisition devices and methods
US9314361B2 (en) * 2006-09-15 2016-04-19 Boston Scientific Scimed, Inc. System and method for anchoring stomach implant
US7862502B2 (en) 2006-10-20 2011-01-04 Ellipse Technologies, Inc. Method and apparatus for adjusting a gastrointestinal restriction device
US8529431B2 (en) 2007-02-14 2013-09-10 Bfkw, Llc Bariatric device and method
WO2008100984A2 (en) * 2007-02-14 2008-08-21 Sentinel Group, Llc Mucosal capture fixation of medical device
US8801647B2 (en) * 2007-02-22 2014-08-12 Gi Dynamics, Inc. Use of a gastrointestinal sleeve to treat bariatric surgery fistulas and leaks
AU2008251300B2 (en) * 2007-05-12 2014-05-29 Boston Scientific Scimed, Inc. Devices and methods for stomach partitioning
US20090012542A1 (en) * 2007-07-03 2009-01-08 Synecor, Llc Satiation devices and methods for controlling obesity
WO2009005634A1 (en) * 2007-07-03 2009-01-08 Synecor, Llc Devices for treating gastroesophageal reflux disease and hiatal hernia, and methods of treating gastroesophageal reflux disease and hiatal hernia using same
CA2696993C (en) 2007-07-18 2017-01-03 Samuel T. Crews Endoscopic implant system and method
US20090024138A1 (en) * 2007-07-18 2009-01-22 Rafic Saleh Surgical retrieval device radially deployable from collapsed position to a snare or cauterization loop
US20090030284A1 (en) 2007-07-18 2009-01-29 David Cole Overtube introducer for use in endoscopic bariatric surgery
US20110245854A1 (en) * 2007-10-10 2011-10-06 Hourglass Technologies, Inc. Devices and methods to deliver, retain and remove a separating device in an intussuscepted hollow organ
CA2702044C (en) * 2007-10-12 2013-09-10 Edward Jordan Stoll, Jr. Toggle bolt suture anchor kit
US20090171383A1 (en) * 2007-12-31 2009-07-02 David Cole Gastric space occupier systems and methods of use
EP2240140B8 (en) * 2008-01-29 2022-05-18 Implantica Patent Ltd. An apparatus for treating gerd
US8020741B2 (en) * 2008-03-18 2011-09-20 Barosense, Inc. Endoscopic stapling devices and methods
US11202707B2 (en) 2008-03-25 2021-12-21 Nuvasive Specialized Orthopedics, Inc. Adjustable implant system
US20090259246A1 (en) * 2008-04-14 2009-10-15 Sherif Eskaros Intragastric Volume-Occupying Device
US7934631B2 (en) 2008-11-10 2011-05-03 Barosense, Inc. Multi-fire stapling systems and methods for delivering arrays of staples
US8382756B2 (en) 2008-11-10 2013-02-26 Ellipse Technologies, Inc. External adjustment device for distraction device
US9622792B2 (en) 2009-04-29 2017-04-18 Nuvasive Specialized Orthopedics, Inc. Interspinous process device and method
US20100276469A1 (en) * 2009-05-01 2010-11-04 Barosense, Inc. Plication tagging device and method
US8961539B2 (en) * 2009-05-04 2015-02-24 Boston Scientific Scimed, Inc. Endoscopic implant system and method
WO2011049651A1 (en) 2009-10-21 2011-04-28 Innovelle, Llc Bariatric device and method for weight loss
US20110295299A1 (en) * 2010-03-03 2011-12-01 Gavin Braithwaite Gastric volume filling construct
PL2547286T3 (en) 2010-03-15 2015-07-31 Apollo Endosurgery Inc Bariatric device and method for weight loss
WO2011146853A2 (en) * 2010-05-21 2011-11-24 Barosense, Inc. Tissue-acquisition and fastening devices and methods
US10420665B2 (en) 2010-06-13 2019-09-24 W. L. Gore & Associates, Inc. Intragastric device for treating obesity
US8628554B2 (en) 2010-06-13 2014-01-14 Virender K. Sharma Intragastric device for treating obesity
US10010439B2 (en) 2010-06-13 2018-07-03 Synerz Medical, Inc. Intragastric device for treating obesity
US9526648B2 (en) 2010-06-13 2016-12-27 Synerz Medical, Inc. Intragastric device for treating obesity
US9248043B2 (en) 2010-06-30 2016-02-02 Ellipse Technologies, Inc. External adjustment device for distraction device
EP2595693B1 (en) 2010-07-22 2015-03-04 Endobetix Ltd Pancreatiobiliary diversion device
MX2013002953A (en) * 2010-09-17 2013-10-28 Tomas E Menzel Internal gastric bander for obesity.
EP2629714B1 (en) 2010-10-18 2015-12-30 Apollo Endosurgery, Inc. Intragastric implants with duodenal anchors
WO2012054519A2 (en) 2010-10-18 2012-04-26 Allergan, Inc. Reactive intragastric implant devices
US9233016B2 (en) 2010-10-18 2016-01-12 Apollo Endosurgery, Inc. Elevating stomach stimulation device
US8870966B2 (en) 2010-10-18 2014-10-28 Apollo Endosurgery, Inc. Intragastric balloon for treating obesity
US9463107B2 (en) 2010-10-18 2016-10-11 Apollo Endosurgery, Inc. Variable size intragastric implant devices
US9198790B2 (en) 2010-10-19 2015-12-01 Apollo Endosurgery, Inc. Upper stomach gastric implants
US9095405B2 (en) 2010-10-19 2015-08-04 Apollo Endosurgery, Inc. Space-filling intragastric implants with fluid flow
US20120095483A1 (en) 2010-10-19 2012-04-19 Allergan, Inc. Anchored non-piercing duodenal sleeve and delivery systems
US8920447B2 (en) 2010-10-19 2014-12-30 Apollo Endosurgery, Inc. Articulated gastric implant clip
US9498365B2 (en) 2010-10-19 2016-11-22 Apollo Endosurgery, Inc. Intragastric implants with multiple fluid chambers
US9398969B2 (en) 2010-10-19 2016-07-26 Apollo Endosurgery, Inc. Upper stomach gastric implants
US8864840B2 (en) 2010-10-19 2014-10-21 Apollo Endosurgery, Inc. Intragastric implants with collapsible frames
US9713463B2 (en) 2011-01-13 2017-07-25 Howmedica Osteonics Corp Toggle bolt assembly and method of assembly
US8715282B2 (en) 2011-02-14 2014-05-06 Ellipse Technologies, Inc. System and method for altering rotational alignment of bone sections
JP6162690B2 (en) 2011-05-20 2017-07-12 ビーエフケイダブリュ・リミテッド・ライアビリティ・カンパニーBfkw, Llc Intraluminal device with increased anti-migration and intraluminal methods
US10743794B2 (en) 2011-10-04 2020-08-18 Nuvasive Specialized Orthopedics, Inc. Devices and methods for non-invasive implant length sensing
CA2851145C (en) 2011-10-05 2019-04-16 Boston Scientific Scimed, Inc. Profile reduction seal for prosthetic heart valve
WO2013066946A1 (en) 2011-11-01 2013-05-10 Ellipse Technologies, Inc. Adjustable magnetic devices and methods of using same
WO2013134227A1 (en) 2012-03-06 2013-09-12 Bfkw, Llc Intraluminal device delivery technique
WO2013134412A1 (en) 2012-03-07 2013-09-12 Boston Scientific Neuromodulation Corporation System and method for securing an implant to tissue
US9456916B2 (en) 2013-03-12 2016-10-04 Medibotics Llc Device for selectively reducing absorption of unhealthy food
US9636065B2 (en) 2012-09-29 2017-05-02 Empire Technology Development Llc Detecting leakage from an internal surgical site
CA2889769A1 (en) 2012-10-29 2014-05-08 Ellipse Technologies, Inc. Adjustable devices for treating arthritis of the knee
WO2014137999A1 (en) 2013-03-07 2014-09-12 Cook Medical Technologies Llc Tissue ingrowth intestinal bypass sleeve and method of deployment
US9067070B2 (en) 2013-03-12 2015-06-30 Medibotics Llc Dysgeusia-inducing neurostimulation for modifying consumption of a selected nutrient type
US9011365B2 (en) 2013-03-12 2015-04-21 Medibotics Llc Adjustable gastrointestinal bifurcation (AGB) for reduced absorption of unhealthy food
US9517334B2 (en) 2013-08-19 2016-12-13 Boston Scientific Neuromodulation Corporation Lead anchors and systems and methods employing the lead anchors
US9456917B2 (en) 2013-08-28 2016-10-04 Ethicon Endo-Surgery, Inc. Endoscopic transoral duodenal sleeve applier
US20150088016A1 (en) 2013-09-25 2015-03-26 Zoll Medical Corporation Mobile Device Control
US10751094B2 (en) 2013-10-10 2020-08-25 Nuvasive Specialized Orthopedics, Inc. Adjustable spinal implant
CA2943182A1 (en) 2014-03-21 2015-09-24 University Of Pittsburgh - Of The Commonwealth System Of Higher Education Methods for preparation of a terminally sterilized hydrogel derived from extracellular matrix
JP6626458B2 (en) 2014-04-28 2019-12-25 ニューヴェイジヴ スペシャライズド オーソペディクス,インコーポレイテッド System for information magnetic feedback in adjustable implants
US9803922B2 (en) * 2014-05-09 2017-10-31 Altek L.L.C. System and method for melting light gauge scrap
US10172611B2 (en) * 2014-06-10 2019-01-08 Ethicon Llc Adjunct materials and methods of using same in surgical methods for tissue sealing
US9579186B2 (en) 2014-06-26 2017-02-28 Boston Scientific Scimed, Inc. Medical devices and methods to prevent bile reflux after bariatric procedures
US9707116B2 (en) * 2014-08-28 2017-07-18 Elwha Llc Gastrointestinal device with associated microbe-promoting agents
JP6542877B2 (en) 2014-09-18 2019-07-10 ボストン サイエンティフィック サイムド,インコーポレイテッドBoston Scientific Scimed,Inc. A device that allows the normal function of the pyloric sphincter for a stent for the treatment of obesity
JP6847341B2 (en) 2014-12-26 2021-03-24 ニューベイシブ スペシャライズド オーソペディックス,インコーポレイテッド Systems and methods for extension
AU2015374326B2 (en) 2014-12-29 2020-05-21 Bfkw, Llc Fixation of intraluminal device
US11013629B2 (en) 2014-12-29 2021-05-25 Bfkw, Llc Fixation of intraluminal device
US11020213B2 (en) 2014-12-29 2021-06-01 Bfkw, Llc Fixation of intraluminal device
WO2016134326A2 (en) 2015-02-19 2016-08-25 Nuvasive, Inc. Systems and methods for vertebral adjustment
US10697245B2 (en) * 2015-03-24 2020-06-30 Cameron International Corporation Seabed drilling system
US20160313958A1 (en) * 2015-04-27 2016-10-27 Microsoft Technology Licensing, Llc Cross-platform command extensibility
WO2016182283A1 (en) * 2015-05-11 2016-11-17 주식회사 엘지화학 Organic light-emitting display device
US9636498B2 (en) 2015-08-03 2017-05-02 Boston Scientific Neuromodulation Corporation Lead anchor with a wedge and systems using the lead anchor
US10327892B2 (en) 2015-08-11 2019-06-25 Boston Scientific Scimed Inc. Integrated adaptive seal for prosthetic heart valves
US10492790B2 (en) 2015-09-24 2019-12-03 Ethicon Llc Apparatus and method for cinching a straight staple line
EP4218609A1 (en) 2015-10-16 2023-08-02 NuVasive Specialized Orthopedics, Inc. Adjustable devices for treating arthritis of the knee
US10653409B2 (en) 2015-12-04 2020-05-19 Crossroads Extremity Systems, Llc Devices and methods for anchoring tissue
KR20180093988A (en) 2015-12-10 2018-08-22 누베이시브 스페셜라이즈드 오소페딕스, 인크. External adjustment device for distraction device
US11406736B2 (en) 2016-01-13 2022-08-09 University of Pittsburgh—Of the Commonwealth Systems of Higher Education Vascular extracellular matrix hydrogel
BR112018015504A2 (en) 2016-01-28 2018-12-18 Nuvasive Specialized Orthopedics, Inc. bone transport systems
US10071242B2 (en) 2016-02-29 2018-09-11 Boston Scientific Neuromodulation Corporation Lead anchor for an electrical stimulation system
US10779980B2 (en) 2016-04-27 2020-09-22 Synerz Medical, Inc. Intragastric device for treating obesity
US10369354B2 (en) 2016-05-17 2019-08-06 Boston Scientific Neuromodulation Corporation Systems and method for anchoring a lead for neurostimulation of a target anatomy
US10709886B2 (en) 2017-02-28 2020-07-14 Boston Scientific Neuromodulation Corporation Electrical stimulation leads and systems with elongate anchoring elements and methods of making and using
US10835739B2 (en) 2017-03-24 2020-11-17 Boston Scientific Neuromodulation Corporation Electrical stimulation leads and systems with elongate anchoring elements and methods of making and using
US10857351B2 (en) 2017-04-28 2020-12-08 Boston Scientific Neuromodulation Corporation Lead anchors for electrical stimulation leads and systems and methods of making and using
CN111315440A (en) * 2017-07-21 2020-06-19 Gi动力公司 Segmented gastrointestinal device and method of use
WO2019165394A1 (en) 2018-02-26 2019-08-29 Boston Scientific Scimed, Inc. Embedded radiopaque marker in adaptive seal
US11051931B2 (en) * 2018-10-31 2021-07-06 Cilag Gmbh International Active sphincter implant to re-route flow through gastrointestinal tract
US11439504B2 (en) 2019-05-10 2022-09-13 Boston Scientific Scimed, Inc. Replacement heart valve with improved cusp washout and reduced loading

Citations (84)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US3589356A (en) * 1969-09-04 1971-06-29 Daniel Silverman Method for everting and extraverting flexible tubing into a body cavity
US4006747A (en) * 1975-04-23 1977-02-08 Ethicon, Inc. Surgical method
US4134405A (en) * 1977-01-10 1979-01-16 Smit Julie A Catheter and intestine tube and method of using the same
US4252131A (en) * 1978-04-17 1981-02-24 American Home Products Corporation Catheter for measuring intrauterine pressure
US4271839A (en) * 1979-07-25 1981-06-09 Thomas J. Fogarty Dilation catheter method and apparatus
US4315509A (en) * 1977-01-10 1982-02-16 Smit Julie A Insertion and removal catheters and intestinal tubes for restricting absorption
US4329995A (en) * 1980-08-29 1982-05-18 Board Of Regents, The University Of Texas System Catheter for nasotracheal aspiration of uncontaminated sputum specimens
US4493711A (en) * 1982-06-25 1985-01-15 Thomas J. Fogarty Tubular extrusion catheter
US4501264A (en) * 1978-06-02 1985-02-26 Rockey Arthur G Medical sleeve
US5085661A (en) * 1990-10-29 1992-02-04 Gerald Moss Surgical fastener implantation device
US5306300A (en) * 1992-09-22 1994-04-26 Berry H Lee Tubular digestive screen
US5314473A (en) * 1989-07-20 1994-05-24 Godin Norman J Prosthesis for preventing gastric reflux into the esophagus
US5861035A (en) * 1997-05-23 1999-01-19 Griffith; Donald P. Modular prosthetic conduit
US5887594A (en) * 1997-09-22 1999-03-30 Beth Israel Deaconess Medical Center Inc. Methods and devices for gastroesophageal reflux reduction
US6193733B1 (en) * 1997-06-20 2001-02-27 Boston Scientific Corporation Hemostatic clips
US6338345B1 (en) * 1999-04-07 2002-01-15 Endonetics, Inc. Submucosal prosthesis delivery device
US20020016607A1 (en) * 1998-12-01 2002-02-07 Atropos Limited Medical device comprising an evertable sleeve
US20020026214A1 (en) * 1997-06-30 2002-02-28 Tanner Howard M. Surgical fastener
US20020035370A1 (en) * 1997-11-03 2002-03-21 Symbiosis Corporation End errector for use with a flexible endoscopic surgical instrument for invagination and fundoplication
US20020040226A1 (en) * 1999-06-22 2002-04-04 Laufer Michael D. Tissue reconfiguration
US6387104B1 (en) * 1999-11-12 2002-05-14 Scimed Life Systems, Inc. Method and apparatus for endoscopic repair of the lower esophageal sphincter
US20020058960A1 (en) * 1998-04-08 2002-05-16 Hudson John Overton Hemostatic system for body cavities
US20020062621A1 (en) * 2000-11-30 2002-05-30 Goettl George M. Batten elements for securing tiles to a roof and method of making the battens
US6409656B1 (en) * 1997-10-15 2002-06-25 Patrick Sangouard Artificial sphincter with magnetic control
US20030018358A1 (en) * 1999-06-25 2003-01-23 Vahid Saadat Apparatus and methods for treating tissue
US20030040808A1 (en) * 2001-08-27 2003-02-27 Stack Richard S. Satiation devices and methods
US20030040804A1 (en) * 2001-08-27 2003-02-27 Stack Richard S. Satiation devices and methods
US6535764B2 (en) * 2001-05-01 2003-03-18 Intrapace, Inc. Gastric treatment and diagnosis device and method
US20030055442A1 (en) * 1999-06-22 2003-03-20 Laufer Michael D. Method and devices for tissue reconfiguration
US20030055313A1 (en) * 2001-08-31 2003-03-20 Anderson Kimberly A. Surgical articles for placing an implant about a tubular tissue structure and methods
US20030065359A1 (en) * 2001-05-30 2003-04-03 Gary Weller Overtube apparatus for insertion into a body
US20030065340A1 (en) * 2000-05-10 2003-04-03 Scimed Life Systems, Inc. Devices and related methods for securing a tissue fold
US6544291B2 (en) * 1997-12-09 2003-04-08 Thomas V. Taylor Sutureless gastroesophageal anti-reflux valve prosthesis and tool for peroral implantation thereof
US6558400B2 (en) * 2001-05-30 2003-05-06 Satiety, Inc. Obesity treatment tools and methods
US20030093117A1 (en) * 1999-06-25 2003-05-15 Vahid Saadat Implantable artificial partition and methods of use
US20030109931A1 (en) * 2001-11-09 2003-06-12 Boston Scientific Corporation Intragastric stent for duodenum bypass
US20030120285A1 (en) * 1997-11-03 2003-06-26 Symbiosis Corporation Surgical instrument for invagination and fundoplication
US20040002734A1 (en) * 2002-06-26 2004-01-01 Stryker Endoscopy, Inc. Soft tissue repair system
US20040039452A1 (en) * 2002-08-26 2004-02-26 Marc Bessler Endoscopic gastric bypass
US20040044364A1 (en) * 2002-08-29 2004-03-04 Devries Robert Tissue fasteners and related deployment systems and methods
US6702735B2 (en) * 2000-10-17 2004-03-09 Charlotte Margaret Kelly Device for movement along a passage
US20040059354A1 (en) * 2002-09-20 2004-03-25 Smith Kevin W. Surgical fastener particularly for the treatment of gastroesophageal reflux disease (GERD)
US20040059349A1 (en) * 2002-09-20 2004-03-25 Robert Sixto Instrument for applying a surgical fastener particularly for the transoral treatment of gastroesophageal reflux disease (GERD)
US20040067976A1 (en) * 2001-09-26 2004-04-08 Priestley Eldon Scott Compounds useful for treating Hepatitis C virus
US20040082963A1 (en) * 2002-10-23 2004-04-29 Jamy Gannoe Method and device for use in endoscopic organ procedures
US20040087977A1 (en) * 2000-03-06 2004-05-06 United States Surgical Apparatus and method for performing a bypass procedure in a digestive system
US20040092974A1 (en) * 2002-10-23 2004-05-13 Jamy Gannoe Method and device for use in endoscopic organ procedures
US20040092892A1 (en) * 2002-11-01 2004-05-13 Jonathan Kagan Apparatus and methods for treatment of morbid obesity
US20040089313A1 (en) * 1998-02-19 2004-05-13 Curon Medical, Inc. Systems and methods for treating obesity and other gastrointestinal conditions
US6736828B1 (en) * 2000-09-29 2004-05-18 Scimed Life Systems, Inc. Method for performing endoluminal fundoplication and apparatus for use in the method
US20040097986A1 (en) * 1998-05-26 2004-05-20 Scimed Life Systems Inc. Implantable tissue fastener and system for treating gastroesophageal reflux disease
US20040097987A1 (en) * 2001-08-23 2004-05-20 Pugsley Charles H. Impermanent biocompatible fastener
US20040102855A1 (en) * 2002-11-21 2004-05-27 Scimed Life Systems, Inc. Anti-reflux stent
US20040107004A1 (en) * 2002-12-02 2004-06-03 Seedling Enterprises, Llc Bariatric sleeve
US20050033240A1 (en) * 2001-10-03 2005-02-10 Hideto Oishi Esophagus stoma button
US20050033332A1 (en) * 2003-07-28 2005-02-10 Burnett Daniel R. Pyloric valve corking device and method
US20050033331A1 (en) * 2003-07-28 2005-02-10 Polymorfix, Inc., C/O Medventure Associates Pyloric valve obstructing devices and methods
US20050049718A1 (en) * 2002-11-01 2005-03-03 Valentx, Inc. Gastrointestinal sleeve device and methods for treatment of morbid obesity
US20050065401A1 (en) * 2003-01-15 2005-03-24 Usgi Medical Inc. Endoluminal tool deployment system
US20050075654A1 (en) * 2003-10-06 2005-04-07 Brian Kelleher Methods and devices for soft tissue securement
US20050080444A1 (en) * 2003-10-14 2005-04-14 Kraemer Stefan J.M. Transesophageal gastric reduction device, system and method
US20050085900A1 (en) * 2003-07-31 2005-04-21 Case Brian C. Prosthetic valve for implantation in a body vessel
US20050085787A1 (en) * 2003-10-17 2005-04-21 Laufer Michael D. Minimally invasive gastrointestinal bypass
US20050085923A1 (en) * 2002-12-02 2005-04-21 Gi Dynamics, Inc. Anti-obesity devices
US20050096673A1 (en) * 2003-10-10 2005-05-05 Stack Richard S. Devices and methods for retaining a gastro-esophageal implant
US20060015125A1 (en) * 2004-05-07 2006-01-19 Paul Swain Devices and methods for gastric surgery
US20060020278A1 (en) * 2003-07-28 2006-01-26 Polymorfix, Inc. Gastric retaining devices and methods
US20060020247A1 (en) * 2002-11-01 2006-01-26 Jonathan Kagan Devices and methods for attaching an endolumenal gastrointestinal implant
US20060020164A1 (en) * 2002-08-06 2006-01-26 Atropos Limited Evertable insertion tube for colonoscope
US20060020254A1 (en) * 2004-05-10 2006-01-26 Hoffmann Gerard V Suction assisted tissue plication device and method of use
US20060020277A1 (en) * 2004-07-20 2006-01-26 Gostout Christopher J Gastric reshaping devices and methods
US20060025819A1 (en) * 2004-05-14 2006-02-02 Nobis Rudolph H T-type suture anchoring devices and methods of using same
US20060047289A1 (en) * 2004-08-27 2006-03-02 Roberto Fogel Endoscopic tissue apposition device and method of use
US20060064120A1 (en) * 2004-09-17 2006-03-23 Levine Andy H Atraumatic gastrointestinal anchor
US7037344B2 (en) * 2002-11-01 2006-05-02 Valentx, Inc. Apparatus and methods for treatment of morbid obesity
US20070010866A1 (en) * 2002-11-01 2007-01-11 Mitchell Dann Attachment cuff for gastrointestinal implant
US20070016244A1 (en) * 2005-07-06 2007-01-18 Percutaneous Systems, Inc. Methods and apparatus for deploying ureteral stents
USRE39533E1 (en) * 1987-04-30 2007-03-27 Biofertec Ltd. Process for intra-uterine fertilization in mammals and device for implementation thereof
US20070106233A1 (en) * 2005-10-20 2007-05-10 Percutaneous Systems, Inc. Systems and methods for dilating and accessing body lumens
US20080058887A1 (en) * 2006-04-25 2008-03-06 Bobby Griffin Methods and devices for gastrointestinal stimulation
US20090012541A1 (en) * 2007-06-11 2009-01-08 Valentx, Inc. Expandable fastener system with flower petal-shaped retention elements
US7509175B2 (en) * 2006-08-03 2009-03-24 Intrapace, Inc. Method and devices for stimulation of an organ with the use of a transectionally placed guide wire
US7520884B2 (en) * 2004-05-07 2009-04-21 Usgi Medical Inc. Methods for performing gastroplasty
US7666180B2 (en) * 2005-05-20 2010-02-23 Tyco Healthcare Group Lp Gastric restrictor assembly and method of use

Family Cites Families (142)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US3357432A (en) * 1965-02-09 1967-12-12 Edwards Lab Inc Anastomotic coupling
DE2462537C3 (en) 1974-05-02 1979-05-03 Byk Gulden Lomberg Chemische Fabrik Gmbh, 7750 Konstanz Catheter device
US3982544A (en) 1974-11-18 1976-09-28 Johnson & Johnson Device for everting a probe into a body cavity
US4109659A (en) 1976-07-19 1978-08-29 Mallinckrodt, Inc. Evagination catheters
US4235238A (en) 1978-05-11 1980-11-25 Olympus Optical Co., Ltd. Apparatus for suturing coeliac tissues
US4217664A (en) 1979-02-02 1980-08-19 Faso Joseph M Prosthesis and method for creating a stoma
US4630609A (en) 1981-05-14 1986-12-23 Thomas J. Fogarty Dilatation catheter method and apparatus
US4606347A (en) 1983-03-25 1986-08-19 Thomas J. Fogarty Inverted balloon catheter having sealed through lumen
US4532926A (en) 1983-06-20 1985-08-06 Ethicon, Inc. Two-piece tissue fastener with ratchet leg staple and sealable latching receiver
US4905693A (en) * 1983-10-03 1990-03-06 Biagio Ravo Surgical method for using an intraintestinal bypass graft
US4719916A (en) * 1983-10-03 1988-01-19 Biagio Ravo Intraintestinal bypass tube
US4763653A (en) 1985-02-19 1988-08-16 Rockey Arthur G Medical sleeve
USRE34021E (en) 1985-11-18 1992-08-04 Abbott Laboratories Percutaneous fixation of hollow organs
US4863440A (en) 1985-12-23 1989-09-05 Thomas J. Fogarty Pressurized manual advancement dilatation catheter
US4846836A (en) 1988-10-03 1989-07-11 Reich Jonathan D Artificial lower gastrointestinal valve
US4946440A (en) 1988-10-05 1990-08-07 Hall John E Evertible membrane catheter and method of use
US5236423A (en) 1988-12-13 1993-08-17 Endomed Corporation Facilitating endoscopy
CH680263A5 (en) 1989-07-20 1992-07-31 Norman Godin
US5171305A (en) 1991-10-17 1992-12-15 Imagyn Medical, Inc. Linear eversion catheter with reinforced inner body extension
US5197649A (en) * 1991-10-29 1993-03-30 The Trustees Of Columbia University In The City Of New York Gastrointestinal endoscoptic stapler
US5458573A (en) 1992-05-01 1995-10-17 American Biomed, Inc. Everting toposcopic dilation catheter
US5431666A (en) 1994-02-24 1995-07-11 Lasersurge, Inc. Surgical suture instrument
US5470337A (en) 1994-05-17 1995-11-28 Moss; Gerald Surgical fastener
US5582616A (en) 1994-08-05 1996-12-10 Origin Medsystems, Inc. Surgical helical fastener with applicator
US5972023A (en) 1994-08-15 1999-10-26 Eva Corporation Implantation device for an aortic graft method of treating aortic aneurysm
AU3783195A (en) 1994-11-15 1996-05-23 Advanced Cardiovascular Systems Inc. Intraluminal stent for attaching a graft
US5676688A (en) 1995-02-06 1997-10-14 Rtc, Inc. Variably inflatable medical device
US5904697A (en) 1995-02-24 1999-05-18 Heartport, Inc. Devices and methods for performing a vascular anastomosis
CH688174A5 (en) 1995-03-28 1997-06-13 Norman Godin Prosthesis to oppose the gastric reflux into the esophagus.
US5785684A (en) 1996-02-06 1998-07-28 Zimmon Science Corporation Apparatus and method for the deployment of an esophagastric balloon tamponade device
US5645568A (en) 1995-11-20 1997-07-08 Medicinelodge, Inc. Expandable body suture
WO1998056440A1 (en) 1997-06-13 1998-12-17 Percusurge, Inc. Syringe and method for inflating low volume catheter balloons
US5957940A (en) 1997-06-30 1999-09-28 Eva Corporation Fasteners for use in the surgical repair of aneurysms
US5944750A (en) 1997-06-30 1999-08-31 Eva Corporation Method and apparatus for the surgical repair of aneurysms
US5997556A (en) 1997-06-30 1999-12-07 Eva Corporation Surgical fastener
US5820584A (en) 1997-08-28 1998-10-13 Crabb; Jerry A. Duodenal insert and method of use
US6626919B1 (en) 1997-12-29 2003-09-30 Lee L. Swanstrom Method and apparatus for attaching or locking an implant to an anatomic vessel or hollow organ wall
AU6131499A (en) 1998-08-27 2000-03-21 Endonetics, Inc. Lower esophageal bulking device
US6264700B1 (en) 1998-08-27 2001-07-24 Endonetics, Inc. Prosthetic gastroesophageal valve
ATE254889T1 (en) * 1998-08-31 2003-12-15 Wilson Cook Medical Inc ANTI-BACKFLOW ESPIROUS PROSTHESIS
US6746489B2 (en) 1998-08-31 2004-06-08 Wilson-Cook Medical Incorporated Prosthesis having a sleeve valve
JP3463736B2 (en) * 1998-09-25 2003-11-05 株式会社村田製作所 Semiconductor light emitting device and method of adjusting light emission intensity thereof
EP2055244B1 (en) 1998-12-31 2012-02-01 Kensey Nash Corporation Tissue fastening devices
AU4335700A (en) 1999-04-07 2000-10-23 Endonetics, Inc. Implantable monitoring probe
US6285897B1 (en) 1999-04-07 2001-09-04 Endonetics, Inc. Remote physiological monitoring system
US6623494B1 (en) 1999-04-16 2003-09-23 Integrated Vascular Interventional Technologies, L.C. (Ivit, Lc) Methods and systems for intraluminally directed vascular anastomosis
US7846180B2 (en) 1999-06-22 2010-12-07 Ethicon Endo-Surgery, Inc. Tissue fixation devices and methods of fixing tissue
US6494888B1 (en) 1999-06-22 2002-12-17 Ndo Surgical, Inc. Tissue reconfiguration
US7416554B2 (en) 2002-12-11 2008-08-26 Usgi Medical Inc Apparatus and methods for forming and securing gastrointestinal tissue folds
US20050192629A1 (en) 1999-06-25 2005-09-01 Usgi Medical Inc. Methods and apparatus for creating and regulating a gastric stoma
US8574243B2 (en) 1999-06-25 2013-11-05 Usgi Medical, Inc. Apparatus and methods for forming and securing gastrointestinal tissue folds
US20040122456A1 (en) 2002-12-11 2004-06-24 Saadat Vahid C. Methods and apparatus for gastric reduction
US7618426B2 (en) 2002-12-11 2009-11-17 Usgi Medical, Inc. Apparatus and methods for forming gastrointestinal tissue approximations
DE19938403C2 (en) * 1999-08-13 2002-03-14 Micronas Gmbh circuit
EP1108400A1 (en) 1999-12-13 2001-06-20 Biomedix S.A. Removable fixation apparatus for a prosthesis in a body vessel
WO2001066018A1 (en) 2000-03-03 2001-09-13 C. R. Bard, Inc. Endoscopic tissue apposition device with multiple suction ports
AU3952501A (en) 2000-03-16 2001-09-24 Medigus Ltd Fundoplication apparatus and method
AU4599001A (en) 2000-03-27 2001-10-08 Wilson Cook Medical Inc Apparatus for measuring esophageal sphincter compliance
JP4939717B2 (en) * 2000-05-02 2012-05-30 ウィルソン−クック メディカル インコーポレイテッド Catheter with reversible sleeve O.D. T.A. Introducing device for L
US6921361B2 (en) 2000-07-24 2005-07-26 Olympus Corporation Endoscopic instrument for forming an artificial valve
US20020082621A1 (en) 2000-09-22 2002-06-27 Schurr Marc O. Methods and devices for folding and securing tissue
US7338522B2 (en) * 2001-02-13 2008-03-04 Second Sight Medical Products, Inc. Implantable retinal electrode array configuration for minimal retinal damage and method of reducing retinal stress
US6595911B2 (en) 2001-04-03 2003-07-22 Lovuolo Michael Method and device for anchor implantation and support of bodily structures
US7747322B2 (en) * 2001-05-01 2010-06-29 Intrapace, Inc. Digestive organ retention device
US7020531B1 (en) * 2001-05-01 2006-03-28 Intrapace, Inc. Gastric device and suction assisted method for implanting a device on a stomach wall
US20050143784A1 (en) 2001-05-01 2005-06-30 Imran Mir A. Gastrointestinal anchor with optimal surface area
WO2002094108A2 (en) 2001-05-18 2002-11-28 University College London A flexible device for transfixing and joining tissue
US6916332B2 (en) 2001-05-23 2005-07-12 Scimed Life Systems, Inc. Endoluminal fundoplication device and related method for installing tissue fastener
US20020188354A1 (en) 2001-06-12 2002-12-12 Peghini Paolo Lino Device to treat obesity by obstructing gastric outlet
US7097665B2 (en) 2003-01-16 2006-08-29 Synecor, Llc Positioning tools and methods for implanting medical devices
CN101810521B (en) 2001-08-27 2015-05-13 辛尼科有限责任公司 Satiation devices and methods
US20040117031A1 (en) 2001-08-27 2004-06-17 Stack Richard S. Satiation devices and methods
US6790237B2 (en) 2001-10-09 2004-09-14 Scimed Life Systems, Inc. Medical stent with a valve and related methods of manufacturing
US8142448B2 (en) 2001-11-26 2012-03-27 Olympus Corporation Endoscopic instruments for suturing tissues in a body cavity
JP2005514145A (en) 2002-01-09 2005-05-19 ネオガイド システムズ, インコーポレイテッド Apparatus and method for endoscopic colectomy
US6699263B2 (en) 2002-04-05 2004-03-02 Cook Incorporated Sliding suture anchor
AU2003213058A1 (en) 2002-04-08 2003-10-27 Barosense, Inc. Satiation devices and methods
US7146984B2 (en) 2002-04-08 2006-12-12 Synecor, Llc Method and apparatus for modifying the exit orifice of a satiation pouch
US20050197715A1 (en) 2002-04-26 2005-09-08 Torax Medical, Inc. Methods and apparatus for implanting devices into non-sterile body lumens or organs
CA2485249A1 (en) 2002-05-09 2003-11-20 Thomas D. Egan Gastric bypass prosthesis
US20040133219A1 (en) 2002-07-29 2004-07-08 Peter Forsell Multi-material constriction device for forming stoma opening
US6746460B2 (en) 2002-08-07 2004-06-08 Satiety, Inc. Intra-gastric fastening devices
JP2004077789A (en) * 2002-08-19 2004-03-11 Konica Minolta Holdings Inc Light-shielding flange member
US7083630B2 (en) 2002-08-29 2006-08-01 Scimed Life Systems, Inc. Devices and methods for fastening tissue layers
WO2004021894A1 (en) 2002-09-09 2004-03-18 Brian Kelleher Device and method for endoluminal therapy
US8066724B2 (en) * 2002-09-12 2011-11-29 Medtronic, Inc. Anastomosis apparatus and methods
GB0222106D0 (en) 2002-09-24 2002-10-30 Univ Dundee Body cavity inspection
US20090149871A9 (en) 2002-11-01 2009-06-11 Jonathan Kagan Devices and methods for treating morbid obesity
US20040133147A1 (en) 2002-11-06 2004-07-08 Woo Sang Hoon Intestinal bypass device to treat obesity
US8282678B2 (en) 2002-11-13 2012-10-09 Allium Medical Solutions Ltd. Endoluminal lining
WO2004050971A2 (en) 2002-11-29 2004-06-17 Liddicoat John R Apparatus and method for manipulating tissue
US20070032879A1 (en) * 2002-12-02 2007-02-08 Levine Andy H Anti-buckling sleeve
US7678068B2 (en) 2002-12-02 2010-03-16 Gi Dynamics, Inc. Atraumatic delivery devices
US7766973B2 (en) 2005-01-19 2010-08-03 Gi Dynamics, Inc. Eversion resistant sleeves
US7608114B2 (en) 2002-12-02 2009-10-27 Gi Dynamics, Inc. Bariatric sleeve
US7695446B2 (en) 2002-12-02 2010-04-13 Gi Dynamics, Inc. Methods of treatment using a bariatric sleeve
US7942884B2 (en) 2002-12-11 2011-05-17 Usgi Medical, Inc. Methods for reduction of a gastric lumen
US7942898B2 (en) 2002-12-11 2011-05-17 Usgi Medical, Inc. Delivery systems and methods for gastric reduction
US20040249367A1 (en) 2003-01-15 2004-12-09 Usgi Medical Corp. Endoluminal tool deployment system
US20040143342A1 (en) 2003-01-16 2004-07-22 Stack Richard S. Satiation pouches and methods of use
US20040181242A1 (en) 2003-03-12 2004-09-16 Stack Richard S. Articulated suturing system
EP1610719B1 (en) 2003-03-28 2010-01-13 GI Dynamics, Inc. Sleeve for delayed introduction of enzymes into the intestine
US20040220682A1 (en) 2003-03-28 2004-11-04 Gi Dynamics, Inc. Anti-obesity devices
EP1615319B1 (en) 2003-03-31 2013-04-10 Yamaha Hatsudoki Kabushiki Kaisha Rotating electric machine and electric vehicle
GB0307715D0 (en) * 2003-04-03 2003-05-07 Ethicon Endo Surgery Inc Guide wire structure for insertion into an internal space
GB0307826D0 (en) 2003-04-04 2003-05-07 Univ London A device for transfixing and joining tissue
US20070225555A1 (en) 2003-05-16 2007-09-27 David Stefanchik Method for deploying a medical device
JP2007511247A (en) 2003-05-19 2007-05-10 ユーエスジーアイ メディカル, インコーポレイテッド Lumen tool deployment system
WO2004105643A1 (en) 2003-05-20 2004-12-09 Biomedix S.A. Device for securing to wall of internal lumen
US7731757B2 (en) 2003-06-01 2010-06-08 Reflux Corporation Obesity treatment
US7314489B2 (en) * 2003-08-20 2008-01-01 Ethicon Endo-Surgery, Inc. Method and apparatus to facilitate nutritional malabsorption
EP1663065A1 (en) * 2003-09-02 2006-06-07 Biomedix SA Gastrointestinal anti-reflux prosthesis apparatus and method
EP1708655A1 (en) 2003-12-09 2006-10-11 GI Dynamics, Inc. Apparatus to be anchored within the gastrointestinal tract and anchoring method
US8828025B2 (en) 2004-02-13 2014-09-09 Ethicon Endo-Surgery, Inc. Methods and devices for reducing hollow organ volume
US7632287B2 (en) 2004-02-20 2009-12-15 Endogastric Solutions, Inc. Tissue fixation devices and assemblies for deploying the same
US8585771B2 (en) 2004-02-26 2013-11-19 Endosphere, Inc. Methods and devices to curb appetite and/or to reduce food intake
US20050197714A1 (en) 2004-03-02 2005-09-08 Sayet Peter H. System, system devices, and methods for regulating nutrient absorption and caloric intake
US8628547B2 (en) 2004-03-09 2014-01-14 Ethicon Endo-Surgery, Inc. Devices and methods for placement of partitions within a hollow body organ
AU2005231323B2 (en) 2004-03-26 2011-03-31 Ethicon Endo-Surgery, Inc Systems and methods for treating obesity
US20050228413A1 (en) 2004-04-12 2005-10-13 Binmoeller Kenneth F Automated transluminal tissue targeting and anchoring devices and methods
WO2005105003A1 (en) 2004-04-26 2005-11-10 Synecor, Llc Restrictive and/or obstructive implant for inducing weight loss
WO2005107641A2 (en) 2004-05-03 2005-11-17 Fulfillium, Inc. Method and system for gastric volume control
WO2006016894A1 (en) 2004-07-09 2006-02-16 Gi Dynamics, Inc. Methods and devices for placing a gastrointestinal sleeve
US7244270B2 (en) 2004-09-16 2007-07-17 Evera Medical Systems and devices for soft tissue augmentation
US20060155375A1 (en) 2004-09-27 2006-07-13 Jonathan Kagan Devices and methods for attachment of a gastrointestinal sleeve
JP4856082B2 (en) 2004-10-15 2012-01-18 ビーエフケイダブリュ・エルエルシー Obesity device
US7771382B2 (en) 2005-01-19 2010-08-10 Gi Dynamics, Inc. Resistive anti-obesity devices
US7699863B2 (en) 2005-03-01 2010-04-20 Tulip Medical Ltd. Bioerodible self-deployable intragastric implants
US20060235446A1 (en) 2005-04-14 2006-10-19 Norman Godin Article, system, and method for securing medical device to tissue or organ
US8932208B2 (en) 2005-05-26 2015-01-13 Maquet Cardiovascular Llc Apparatus and methods for performing minimally-invasive surgical procedures
US7976488B2 (en) * 2005-06-08 2011-07-12 Gi Dynamics, Inc. Gastrointestinal anchor compliance
US7470621B2 (en) 2005-07-11 2008-12-30 Semiconductor Energy Laboratory Co., Ltd. Method for manufacturing semiconductor device
US20080249533A1 (en) 2005-09-09 2008-10-09 Biomedix, S.A. Medical Device and Method For Controlling Obesity
US9055942B2 (en) 2005-10-03 2015-06-16 Boston Scienctific Scimed, Inc. Endoscopic plication devices and methods
US20080221597A1 (en) 2005-10-12 2008-09-11 Wallace Jeffrey M Methods and devices for intragastrointestinal fixation
US20070100367A1 (en) * 2005-10-31 2007-05-03 Quijano Rodolfo C Intragastric space filler
US20070100368A1 (en) * 2005-10-31 2007-05-03 Quijano Rodolfo C Intragastric space filler
US20080167610A1 (en) 2006-09-25 2008-07-10 Valentx, Inc. Toposcopic methods and devices for delivering a sleeve having axially compressed and elongate configurations
US8226602B2 (en) 2007-03-30 2012-07-24 Reshape Medical, Inc. Intragastric balloon system and therapeutic processes and products
WO2008154450A1 (en) 2007-06-08 2008-12-18 Valentx, Inc. Methods and devices for intragastric support of functional or prosthetic gastrointestinal devices
US20090012544A1 (en) 2007-06-08 2009-01-08 Valen Tx, Inc. Gastrointestinal bypass sleeve as an adjunct to bariatric surgery
CA2696993C (en) * 2007-07-18 2017-01-03 Samuel T. Crews Endoscopic implant system and method

Patent Citations (98)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US3589356A (en) * 1969-09-04 1971-06-29 Daniel Silverman Method for everting and extraverting flexible tubing into a body cavity
US4006747A (en) * 1975-04-23 1977-02-08 Ethicon, Inc. Surgical method
US4134405A (en) * 1977-01-10 1979-01-16 Smit Julie A Catheter and intestine tube and method of using the same
US4315509A (en) * 1977-01-10 1982-02-16 Smit Julie A Insertion and removal catheters and intestinal tubes for restricting absorption
US4252131A (en) * 1978-04-17 1981-02-24 American Home Products Corporation Catheter for measuring intrauterine pressure
US4501264A (en) * 1978-06-02 1985-02-26 Rockey Arthur G Medical sleeve
US4641653A (en) * 1978-06-02 1987-02-10 Rockey Arthur G Medical sleeve
US4271839A (en) * 1979-07-25 1981-06-09 Thomas J. Fogarty Dilation catheter method and apparatus
US4329995A (en) * 1980-08-29 1982-05-18 Board Of Regents, The University Of Texas System Catheter for nasotracheal aspiration of uncontaminated sputum specimens
US4493711A (en) * 1982-06-25 1985-01-15 Thomas J. Fogarty Tubular extrusion catheter
USRE39533E1 (en) * 1987-04-30 2007-03-27 Biofertec Ltd. Process for intra-uterine fertilization in mammals and device for implementation thereof
US5314473A (en) * 1989-07-20 1994-05-24 Godin Norman J Prosthesis for preventing gastric reflux into the esophagus
US5085661A (en) * 1990-10-29 1992-02-04 Gerald Moss Surgical fastener implantation device
US5306300A (en) * 1992-09-22 1994-04-26 Berry H Lee Tubular digestive screen
US5861035A (en) * 1997-05-23 1999-01-19 Griffith; Donald P. Modular prosthetic conduit
US6193733B1 (en) * 1997-06-20 2001-02-27 Boston Scientific Corporation Hemostatic clips
US20020026214A1 (en) * 1997-06-30 2002-02-28 Tanner Howard M. Surgical fastener
US6520974B2 (en) * 1997-06-30 2003-02-18 Eva Corporation Surgical fastener
US5887594A (en) * 1997-09-22 1999-03-30 Beth Israel Deaconess Medical Center Inc. Methods and devices for gastroesophageal reflux reduction
US6409656B1 (en) * 1997-10-15 2002-06-25 Patrick Sangouard Artificial sphincter with magnetic control
US20020035370A1 (en) * 1997-11-03 2002-03-21 Symbiosis Corporation End errector for use with a flexible endoscopic surgical instrument for invagination and fundoplication
US20030120285A1 (en) * 1997-11-03 2003-06-26 Symbiosis Corporation Surgical instrument for invagination and fundoplication
US6558429B2 (en) * 1997-12-09 2003-05-06 Reflux Corporation Perorally insertable gastroesophageal anti-reflux valve prosthesis and tool for implantation thereof
US6544291B2 (en) * 1997-12-09 2003-04-08 Thomas V. Taylor Sutureless gastroesophageal anti-reflux valve prosthesis and tool for peroral implantation thereof
US20040089313A1 (en) * 1998-02-19 2004-05-13 Curon Medical, Inc. Systems and methods for treating obesity and other gastrointestinal conditions
US20020058960A1 (en) * 1998-04-08 2002-05-16 Hudson John Overton Hemostatic system for body cavities
US20040097986A1 (en) * 1998-05-26 2004-05-20 Scimed Life Systems Inc. Implantable tissue fastener and system for treating gastroesophageal reflux disease
US20020016607A1 (en) * 1998-12-01 2002-02-07 Atropos Limited Medical device comprising an evertable sleeve
US6338345B1 (en) * 1999-04-07 2002-01-15 Endonetics, Inc. Submucosal prosthesis delivery device
US20030055442A1 (en) * 1999-06-22 2003-03-20 Laufer Michael D. Method and devices for tissue reconfiguration
US20020040226A1 (en) * 1999-06-22 2002-04-04 Laufer Michael D. Tissue reconfiguration
US20030093117A1 (en) * 1999-06-25 2003-05-15 Vahid Saadat Implantable artificial partition and methods of use
US20030018358A1 (en) * 1999-06-25 2003-01-23 Vahid Saadat Apparatus and methods for treating tissue
US6387104B1 (en) * 1999-11-12 2002-05-14 Scimed Life Systems, Inc. Method and apparatus for endoscopic repair of the lower esophageal sphincter
US20040087977A1 (en) * 2000-03-06 2004-05-06 United States Surgical Apparatus and method for performing a bypass procedure in a digestive system
US20030065340A1 (en) * 2000-05-10 2003-04-03 Scimed Life Systems, Inc. Devices and related methods for securing a tissue fold
US6736828B1 (en) * 2000-09-29 2004-05-18 Scimed Life Systems, Inc. Method for performing endoluminal fundoplication and apparatus for use in the method
US6702735B2 (en) * 2000-10-17 2004-03-09 Charlotte Margaret Kelly Device for movement along a passage
US20020062621A1 (en) * 2000-11-30 2002-05-30 Goettl George M. Batten elements for securing tiles to a roof and method of making the battens
US6535764B2 (en) * 2001-05-01 2003-03-18 Intrapace, Inc. Gastric treatment and diagnosis device and method
US20040024427A1 (en) * 2001-05-01 2004-02-05 Imran Mir A. Gastric anchor and method
US7483754B2 (en) * 2001-05-01 2009-01-27 Intrapace, Inc. Endoscopic instrument system for implanting a device in the stomach
US20030109892A1 (en) * 2001-05-30 2003-06-12 Deem Mark E. Obesity treatment tools and methods
US6558400B2 (en) * 2001-05-30 2003-05-06 Satiety, Inc. Obesity treatment tools and methods
US20030065359A1 (en) * 2001-05-30 2003-04-03 Gary Weller Overtube apparatus for insertion into a body
US20040097987A1 (en) * 2001-08-23 2004-05-20 Pugsley Charles H. Impermanent biocompatible fastener
US20030040808A1 (en) * 2001-08-27 2003-02-27 Stack Richard S. Satiation devices and methods
US6675809B2 (en) * 2001-08-27 2004-01-13 Richard S. Stack Satiation devices and methods
US20030040804A1 (en) * 2001-08-27 2003-02-27 Stack Richard S. Satiation devices and methods
US6845776B2 (en) * 2001-08-27 2005-01-25 Richard S. Stack Satiation devices and methods
US20030055313A1 (en) * 2001-08-31 2003-03-20 Anderson Kimberly A. Surgical articles for placing an implant about a tubular tissue structure and methods
US20040067976A1 (en) * 2001-09-26 2004-04-08 Priestley Eldon Scott Compounds useful for treating Hepatitis C virus
US20050033240A1 (en) * 2001-10-03 2005-02-10 Hideto Oishi Esophagus stoma button
US20030109931A1 (en) * 2001-11-09 2003-06-12 Boston Scientific Corporation Intragastric stent for duodenum bypass
US6740121B2 (en) * 2001-11-09 2004-05-25 Boston Scientific Corporation Intragastric stent for duodenum bypass
US20040002734A1 (en) * 2002-06-26 2004-01-01 Stryker Endoscopy, Inc. Soft tissue repair system
US20060020164A1 (en) * 2002-08-06 2006-01-26 Atropos Limited Evertable insertion tube for colonoscope
US20040039452A1 (en) * 2002-08-26 2004-02-26 Marc Bessler Endoscopic gastric bypass
US20040044364A1 (en) * 2002-08-29 2004-03-04 Devries Robert Tissue fasteners and related deployment systems and methods
US20040059354A1 (en) * 2002-09-20 2004-03-25 Smith Kevin W. Surgical fastener particularly for the treatment of gastroesophageal reflux disease (GERD)
US20040059349A1 (en) * 2002-09-20 2004-03-25 Robert Sixto Instrument for applying a surgical fastener particularly for the transoral treatment of gastroesophageal reflux disease (GERD)
US20050101977A1 (en) * 2002-10-23 2005-05-12 Jamy Gannoe Method and device for use in endoscopic organ procedures
US20040082963A1 (en) * 2002-10-23 2004-04-29 Jamy Gannoe Method and device for use in endoscopic organ procedures
US20040092974A1 (en) * 2002-10-23 2004-05-13 Jamy Gannoe Method and device for use in endoscopic organ procedures
US20070010864A1 (en) * 2002-11-01 2007-01-11 Mitchell Dann Gastrointestinal implant system
US20060020247A1 (en) * 2002-11-01 2006-01-26 Jonathan Kagan Devices and methods for attaching an endolumenal gastrointestinal implant
US20070010866A1 (en) * 2002-11-01 2007-01-11 Mitchell Dann Attachment cuff for gastrointestinal implant
US20070010794A1 (en) * 2002-11-01 2007-01-11 Mitchell Dann Devices and methods for endolumenal gastrointestinal bypass
US7037344B2 (en) * 2002-11-01 2006-05-02 Valentx, Inc. Apparatus and methods for treatment of morbid obesity
US20040092892A1 (en) * 2002-11-01 2004-05-13 Jonathan Kagan Apparatus and methods for treatment of morbid obesity
US7220284B2 (en) * 2002-11-01 2007-05-22 Valentx, Inc. Gastrointestinal sleeve device and methods for treatment of morbid obesity
US20050049718A1 (en) * 2002-11-01 2005-03-03 Valentx, Inc. Gastrointestinal sleeve device and methods for treatment of morbid obesity
US20050096750A1 (en) * 2002-11-01 2005-05-05 Jonathan Kagan Apparatus and methods for treatment of morbid obesity
US20040102855A1 (en) * 2002-11-21 2004-05-27 Scimed Life Systems, Inc. Anti-reflux stent
US20050085923A1 (en) * 2002-12-02 2005-04-21 Gi Dynamics, Inc. Anti-obesity devices
US20040107004A1 (en) * 2002-12-02 2004-06-03 Seedling Enterprises, Llc Bariatric sleeve
US20050065401A1 (en) * 2003-01-15 2005-03-24 Usgi Medical Inc. Endoluminal tool deployment system
US20050033331A1 (en) * 2003-07-28 2005-02-10 Polymorfix, Inc., C/O Medventure Associates Pyloric valve obstructing devices and methods
US20060020278A1 (en) * 2003-07-28 2006-01-26 Polymorfix, Inc. Gastric retaining devices and methods
US20050033332A1 (en) * 2003-07-28 2005-02-10 Burnett Daniel R. Pyloric valve corking device and method
US20050085900A1 (en) * 2003-07-31 2005-04-21 Case Brian C. Prosthetic valve for implantation in a body vessel
US20050075654A1 (en) * 2003-10-06 2005-04-07 Brian Kelleher Methods and devices for soft tissue securement
US20050096673A1 (en) * 2003-10-10 2005-05-05 Stack Richard S. Devices and methods for retaining a gastro-esophageal implant
US20050080444A1 (en) * 2003-10-14 2005-04-14 Kraemer Stefan J.M. Transesophageal gastric reduction device, system and method
US20050085787A1 (en) * 2003-10-17 2005-04-21 Laufer Michael D. Minimally invasive gastrointestinal bypass
US20060015125A1 (en) * 2004-05-07 2006-01-19 Paul Swain Devices and methods for gastric surgery
US7520884B2 (en) * 2004-05-07 2009-04-21 Usgi Medical Inc. Methods for performing gastroplasty
US20060020254A1 (en) * 2004-05-10 2006-01-26 Hoffmann Gerard V Suction assisted tissue plication device and method of use
US20060025819A1 (en) * 2004-05-14 2006-02-02 Nobis Rudolph H T-type suture anchoring devices and methods of using same
US20060020277A1 (en) * 2004-07-20 2006-01-26 Gostout Christopher J Gastric reshaping devices and methods
US20060047289A1 (en) * 2004-08-27 2006-03-02 Roberto Fogel Endoscopic tissue apposition device and method of use
US20060064120A1 (en) * 2004-09-17 2006-03-23 Levine Andy H Atraumatic gastrointestinal anchor
US7666180B2 (en) * 2005-05-20 2010-02-23 Tyco Healthcare Group Lp Gastric restrictor assembly and method of use
US20070016244A1 (en) * 2005-07-06 2007-01-18 Percutaneous Systems, Inc. Methods and apparatus for deploying ureteral stents
US20070106233A1 (en) * 2005-10-20 2007-05-10 Percutaneous Systems, Inc. Systems and methods for dilating and accessing body lumens
US20080058887A1 (en) * 2006-04-25 2008-03-06 Bobby Griffin Methods and devices for gastrointestinal stimulation
US7509175B2 (en) * 2006-08-03 2009-03-24 Intrapace, Inc. Method and devices for stimulation of an organ with the use of a transectionally placed guide wire
US20090012541A1 (en) * 2007-06-11 2009-01-08 Valentx, Inc. Expandable fastener system with flower petal-shaped retention elements

Cited By (117)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US8182459B2 (en) 2002-11-01 2012-05-22 Valentx, Inc. Devices and methods for endolumenal gastrointestinal bypass
US7892214B2 (en) 2002-11-01 2011-02-22 Valentx, Inc. Attachment system for transmural attachment at the gastroesophageal junction
US9561127B2 (en) 2002-11-01 2017-02-07 Valentx, Inc. Apparatus and methods for treatment of morbid obesity
US9839546B2 (en) 2002-11-01 2017-12-12 Valentx, Inc. Apparatus and methods for treatment of morbid obesity
US20060020247A1 (en) * 2002-11-01 2006-01-26 Jonathan Kagan Devices and methods for attaching an endolumenal gastrointestinal implant
US10350101B2 (en) 2002-11-01 2019-07-16 Valentx, Inc. Devices and methods for endolumenal gastrointestinal bypass
US20060206064A1 (en) * 2002-11-01 2006-09-14 Jonathan Kagan Methods of adjusting therapy in a patient having an endolumenal bypass to treat obesity
US8012135B2 (en) 2002-11-01 2011-09-06 Valentx, Inc. Attachment cuff for gastrointestinal implant
US20060293742A1 (en) * 2002-11-01 2006-12-28 Mitchell Dann Cuff and sleeve system for gastrointestinal bypass
US20070010794A1 (en) * 2002-11-01 2007-01-11 Mitchell Dann Devices and methods for endolumenal gastrointestinal bypass
US20070010864A1 (en) * 2002-11-01 2007-01-11 Mitchell Dann Gastrointestinal implant system
US7837669B2 (en) 2002-11-01 2010-11-23 Valentx, Inc. Devices and methods for endolumenal gastrointestinal bypass
US7846138B2 (en) 2002-11-01 2010-12-07 Valentx, Inc. Cuff and sleeve system for gastrointestinal bypass
US9060844B2 (en) 2002-11-01 2015-06-23 Valentx, Inc. Apparatus and methods for treatment of morbid obesity
US8012140B1 (en) 2002-11-01 2011-09-06 Valentx, Inc. Methods of transmural attachment in the gastrointestinal system
US20090149871A9 (en) * 2002-11-01 2009-06-11 Jonathan Kagan Devices and methods for treating morbid obesity
US7794447B2 (en) 2002-11-01 2010-09-14 Valentx, Inc. Gastrointestinal sleeve device and methods for treatment of morbid obesity
US8070743B2 (en) 2002-11-01 2011-12-06 Valentx, Inc. Devices and methods for attaching an endolumenal gastrointestinal implant
US20040092892A1 (en) * 2002-11-01 2004-05-13 Jonathan Kagan Apparatus and methods for treatment of morbid obesity
US20050177181A1 (en) * 2002-11-01 2005-08-11 Jonathan Kagan Devices and methods for treating morbid obesity
US20070198074A1 (en) * 2002-11-01 2007-08-23 Mitchell Dann Devices and methods for endolumenal gastrointestinal bypass
US20050049718A1 (en) * 2002-11-01 2005-03-03 Valentx, Inc. Gastrointestinal sleeve device and methods for treatment of morbid obesity
US8603186B2 (en) 2004-02-26 2013-12-10 Endosphere, Inc. Methods and devices to curb appetite and/or reduce food intake
US8585771B2 (en) 2004-02-26 2013-11-19 Endosphere, Inc. Methods and devices to curb appetite and/or to reduce food intake
US9352126B2 (en) 2004-02-26 2016-05-31 Endosphere, Inc. Methods and devices to curb appetite and/or reduce food intake
US20070293885A1 (en) * 2004-02-26 2007-12-20 Binmoeller Kenneth F Methods and devices to curb appetite and/or to reduce food intake
US8147561B2 (en) 2004-02-26 2012-04-03 Endosphere, Inc. Methods and devices to curb appetite and/or reduce food intake
US20110190684A1 (en) * 2004-02-26 2011-08-04 Binmoeller Kenneth F Method and apparatus for reducing obesity
US20060178691A1 (en) * 2004-02-26 2006-08-10 Binmoeller Kenneth F Methods and devices to curb appetite and/or reduce food intake
US7931693B2 (en) 2004-02-26 2011-04-26 Endosphere, Inc. Method and apparatus for reducing obesity
US8623095B2 (en) 2004-02-26 2014-01-07 Endosphere, Inc. Method and apparatus for reducing obesity
US20060015125A1 (en) * 2004-05-07 2006-01-19 Paul Swain Devices and methods for gastric surgery
US9072861B2 (en) 2004-11-30 2015-07-07 Endosphere, Inc. Methods and devices for delivering or delaying lipids within a duodenum
US20060282107A1 (en) * 2005-05-09 2006-12-14 Kiyoshi Hashiba Intragastric device for treating obesity
US7967818B2 (en) 2005-06-10 2011-06-28 Cook Medical Technologies Llc Cautery catheter
US8216268B2 (en) 2005-12-22 2012-07-10 Cook Medical Technologies Llc Intragastric bag for treating obesity
US20070276428A1 (en) * 2005-12-22 2007-11-29 Haller Frederick B Intragastric bag for treating obesity
US20070239284A1 (en) * 2005-12-22 2007-10-11 Skerven Gregory J Coiled intragastric member for treating obesity
US20070198039A1 (en) * 2006-01-27 2007-08-23 Wilson-Cook Medical, Inc. Intragastric device for treating obesity
US9277921B2 (en) 2006-03-02 2016-03-08 Michael D. Laufer Gastrointestinal implant and methods for use
US20100191167A1 (en) * 2006-03-02 2010-07-29 Lytn Gastrointestinal implant and methods for use
US8376981B2 (en) 2006-03-02 2013-02-19 Michael D. Laufer Gastrointestinal implant and methods for use
US20080058887A1 (en) * 2006-04-25 2008-03-06 Bobby Griffin Methods and devices for gastrointestinal stimulation
US7881797B2 (en) 2006-04-25 2011-02-01 Valentx, Inc. Methods and devices for gastrointestinal stimulation
US9060835B2 (en) 2006-05-26 2015-06-23 Endosphere, Inc. Conformationally-stabilized intraluminal device for medical applications
US8118774B2 (en) 2006-09-25 2012-02-21 Valentx, Inc. Toposcopic access and delivery devices
US20080167606A1 (en) * 2006-09-25 2008-07-10 Valentx, Inc. Toposcopic access and delivery devices
US20080167610A1 (en) * 2006-09-25 2008-07-10 Valentx, Inc. Toposcopic methods and devices for delivering a sleeve having axially compressed and elongate configurations
US8808270B2 (en) 2006-09-25 2014-08-19 Valentx, Inc. Methods for toposcopic sleeve delivery
US20100099949A1 (en) * 2007-01-30 2010-04-22 Alexander Quillin Tilson Biological navigation device
WO2008095046A3 (en) * 2007-01-30 2008-12-24 Loma Vista Medical Inc Biological navigation device
US20100198016A1 (en) * 2007-01-30 2010-08-05 Alexander Quillin Tilson Biological navigation device
WO2008095046A2 (en) * 2007-01-30 2008-08-07 Loma Vista Medical, Inc., Biological navigation device
US10188273B2 (en) 2007-01-30 2019-01-29 Loma Vista Medical, Inc. Biological navigation device
US8007507B2 (en) 2007-05-10 2011-08-30 Cook Medical Technologies Llc Intragastric bag apparatus and method of delivery for treating obesity
US20080281257A1 (en) * 2007-05-10 2008-11-13 Waller David F Intragastric bag apparatus and method of delivery for treating obesity
US8182441B2 (en) 2007-06-08 2012-05-22 Valentx, Inc. Methods and devices for intragastric support of functional or prosthetic gastrointestinal devices
US20090012553A1 (en) * 2007-06-08 2009-01-08 Valentx, Inc. Methods and devices for intragastric support of functional or prosthetic gastrointestinal devices
US20090012544A1 (en) * 2007-06-08 2009-01-08 Valen Tx, Inc. Gastrointestinal bypass sleeve as an adjunct to bariatric surgery
US20090012356A1 (en) * 2007-06-11 2009-01-08 Valen Tx, Inc. Endoscopic delivery devices and methods
US20110137227A1 (en) * 2007-07-16 2011-06-09 Mckinley James T Methods and devices for delivering or delaying lipids within a duodenum
US20090149879A1 (en) * 2007-12-10 2009-06-11 Dillon Travis E Dynamic volume displacement weight loss device
US20090164028A1 (en) * 2007-12-21 2009-06-25 Wilson-Cook Medical Inc. Method of delivering an intragastric device for treating obesity
US7883524B2 (en) 2007-12-21 2011-02-08 Wilson-Cook Medical Inc. Method of delivering an intragastric device for treating obesity
US8016851B2 (en) 2007-12-27 2011-09-13 Cook Medical Technologies Llc Delivery system and method of delivery for treating obesity
US20090171382A1 (en) * 2007-12-27 2009-07-02 Wilson-Cook Medical Inc. Delivery system and method of delivery for treating obesity
US8100850B2 (en) 2008-04-09 2012-01-24 E2 Llc Pyloric valve devices and methods
US20090259240A1 (en) * 2008-04-09 2009-10-15 Stryker Development Llc Pyloric valve
US20090259238A1 (en) * 2008-04-09 2009-10-15 Stryker Development Llc Pyloric valve devices and methods
US20090259239A1 (en) * 2008-04-09 2009-10-15 Stryker Development Llc Pyloric valve devices and methods
US8517972B2 (en) 2008-04-09 2013-08-27 E2 Llc Pyloric valve
US8579849B2 (en) 2008-04-09 2013-11-12 E2 Llc Pyloric valve devices and methods
US8226593B2 (en) 2008-04-09 2012-07-24 E2 Llc Pyloric valve
US8182442B2 (en) 2008-04-09 2012-05-22 Electrocore Llc Pyloric valve devices and methods
US8142385B2 (en) 2008-04-09 2012-03-27 E2 Llc Pyloric valve devices and methods
US20090259237A1 (en) * 2008-04-09 2009-10-15 Stryker Development Llc Pyloric valve devices and methods
US20100241178A1 (en) * 2008-06-02 2010-09-23 Loma Vista Medical, Inc. Inflatable medical devices
US8708955B2 (en) 2008-06-02 2014-04-29 Loma Vista Medical, Inc. Inflatable medical devices
US9504811B2 (en) 2008-06-02 2016-11-29 Loma Vista Medical, Inc. Inflatable medical devices
US20090301643A1 (en) * 2008-06-02 2009-12-10 Loma Vista Medical, Inc. Inflatable medical devices
US9186488B2 (en) 2008-06-02 2015-11-17 Loma Vista Medical, Inc. Method of making inflatable medical devices
US9271734B2 (en) 2008-07-09 2016-03-01 Covidien Lp Methods and devices for sheath compression
EP2165665A1 (en) * 2008-09-22 2010-03-24 Tyco Healthcare Group, LP Devices for compression of an anastomotic sheath
US9962278B2 (en) 2009-04-03 2018-05-08 Metamodix, Inc. Modular gastrointestinal prostheses
US8211186B2 (en) 2009-04-03 2012-07-03 Metamodix, Inc. Modular gastrointestinal prostheses
US8702641B2 (en) 2009-04-03 2014-04-22 Metamodix, Inc. Gastrointestinal prostheses having partial bypass configurations
US20100256775A1 (en) * 2009-04-03 2010-10-07 Metamodix, Inc. Modular gastrointestinal prostheses
US9173760B2 (en) 2009-04-03 2015-11-03 Metamodix, Inc. Delivery devices and methods for gastrointestinal implants
US10322021B2 (en) 2009-04-03 2019-06-18 Metamodix, Inc. Delivery devices and methods for gastrointestinal implants
US9044300B2 (en) 2009-04-03 2015-06-02 Metamodix, Inc. Gastrointestinal prostheses
US9278019B2 (en) 2009-04-03 2016-03-08 Metamodix, Inc Anchors and methods for intestinal bypass sleeves
US8702642B2 (en) 2009-07-10 2014-04-22 Metamodix, Inc. External anchoring configurations for modular gastrointestinal prostheses
US8282598B2 (en) 2009-07-10 2012-10-09 Metamodix, Inc. External anchoring configurations for modular gastrointestinal prostheses
WO2011006098A3 (en) * 2009-07-10 2011-03-10 Metamodix, Inc. External anchoring configurations for modular gastrointestinal prostheses
US20110009690A1 (en) * 2009-07-10 2011-01-13 Metamodix, Inc. External Anchoring Configurations for Modular Gastrointestinal Prostheses
CN102470038A (en) * 2009-07-10 2012-05-23 美特默迪克斯公司 External anchoring configurations for modular gastrointestinal prostheses
US9592119B2 (en) 2010-07-13 2017-03-14 C.R. Bard, Inc. Inflatable medical devices
US10188436B2 (en) 2010-11-09 2019-01-29 Loma Vista Medical, Inc. Inflatable medical devices
US8956318B2 (en) 2012-05-31 2015-02-17 Valentx, Inc. Devices and methods for gastrointestinal bypass
US9173759B2 (en) 2012-05-31 2015-11-03 Valentx, Inc. Devices and methods for gastrointestinal bypass
US9681975B2 (en) 2012-05-31 2017-06-20 Valentx, Inc. Devices and methods for gastrointestinal bypass
US9675489B2 (en) 2012-05-31 2017-06-13 Valentx, Inc. Devices and methods for gastrointestinal bypass
US9566181B2 (en) 2012-05-31 2017-02-14 Valentx, Inc. Devices and methods for gastrointestinal bypass
US9451960B2 (en) 2012-05-31 2016-09-27 Valentx, Inc. Devices and methods for gastrointestinal bypass
US9039649B2 (en) 2012-05-31 2015-05-26 Valentx, Inc. Devices and methods for gastrointestinal bypass
US9050168B2 (en) 2012-05-31 2015-06-09 Valentx, Inc. Devices and methods for gastrointestinal bypass
US11793839B2 (en) 2013-01-15 2023-10-24 Metamodix, Inc. System and method for affecting intestinal microbial flora
US10159699B2 (en) 2013-01-15 2018-12-25 Metamodix, Inc. System and method for affecting intestinal microbial flora
US9757264B2 (en) 2013-03-13 2017-09-12 Valentx, Inc. Devices and methods for gastrointestinal bypass
US9622897B1 (en) 2016-03-03 2017-04-18 Metamodix, Inc. Pyloric anchors and methods for intestinal bypass sleeves
US10729573B2 (en) 2016-03-03 2020-08-04 Metamodix, Inc. Pyloric anchors and methods for intestinal bypass sleeves
US20170252195A1 (en) 2016-03-03 2017-09-07 Metamodix, Inc. Pyloric anchors and methods for intestinal bypass sleeves
US10751209B2 (en) 2016-05-19 2020-08-25 Metamodix, Inc. Pyloric anchor retrieval tools and methods
US11666470B2 (en) 2016-05-19 2023-06-06 Metamodix, Inc Pyloric anchor retrieval tools and methods
WO2020141023A1 (en) * 2019-01-03 2020-07-09 Butz Alexander Gastrointestinal implant and positioning device for same
EP4241742A3 (en) * 2019-01-03 2023-11-15 Butz, Alexander Gastrointestinal implant and positioning device for same
WO2022128117A1 (en) * 2020-12-18 2022-06-23 Butz Alexander Gastrointestinal implant

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US20070010794A1 (en) 2007-01-11

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