Methods for the endoluminal treatment of gastroesophageal reflux disease (GERD)

• US 20020078967A1
• Filed: 12/06/2001
• Published: 06/27/2002
• Est. Priority Date: 12/06/2000
• Status: Active Grant

• Current Assignee: Ethicon Endo-Surgery, Inc. (Johnson & Johnson)
• Original Assignee: Ethicon Endo-Surgery, Inc. (Johnson & Johnson)
• Inventors: Kortenbach, Juergen A., McBrayer, Michael Sean, Slater, Charles R., Sixto, Robert Jr., Smith, Kevin W.
• Granted Patent: US 7,727,246 B2
• Time in Patent Office: Days
• US Class Current: 128/898
• CPC Class Codes: A61B 1/00073 with externally grooved shaft
• CPC Class Codes: A61B 1/00087 Tools A61B17/00234 takes precedence
• CPC Class Codes: A61B 1/0014 Fastening element for attaching accessories to the outside of an endoscope, e.g. clips, clamps or bands
• CPC Class Codes: A61B 1/018 for receiving instruments
• CPC Class Codes: A61B 10/06 Biopsy forceps , e.g. with cup-shaped jaws
• CPC Class Codes: A61B 17/00234 for minimally invasive surgery A61B17/0218, A61B17/0469, A61B17/12013, A61B17/1285, A61B17/29, A61B17/320016 take precedence
• CPC Class Codes: A61B 17/0218 for minimally invasive surgery A61B17/0281, A61B17/0469, A61B17/12013, A61B17/1285, A61B17/29, A61B17/320016 take precedence
• CPC Class Codes: A61B 17/122 Clamps or clips , e.g. for the umbilical cord for the vas deferens A61F6/206
• CPC Class Codes: A61B 17/1227 Spring clips
• CPC Class Codes: A61B 17/1285 for minimally invasive surgery
• CPC Class Codes: A61B 18/1445 at the distal end of a shaft, e.g. forceps or scissors at the end of a rigid rod
• CPC Class Codes: A61B 2017/00292 mounted on or guided by flexible, e.g. catheter-like, means
• CPC Class Codes: A61B 2017/00296 mounted on an endoscope
• CPC Class Codes: A61B 2017/00464 for use with different instruments with hole for different instruments A61B2017/22072
• CPC Class Codes: A61B 2017/2936 Pins in guiding slots
• CPC Class Codes: A61B 2017/320064 with tissue or sample retaining means
• CPC Class Codes: A61B 2018/00577 Ablation
• CPC Class Codes: A61B 2018/00982 combined with or comprising means for visual or photographic inspections inside the body, e.g. endoscopes
• CPC Class Codes: A61B 2018/1253 monopolar
• CPC Class Codes: A61B 2018/126 bipolar
• CPC Class Codes: A61B 2090/306 : using optical fibres
• CPC Class Codes: A61B 2090/3614 : using optical fibre
• CPC Class Codes: A61B 90/50 : Supports for surgical instruments, e.g. articulated arms

Abstract

Methods of the invention include delivering a grasper, a clip applier, and an endoscope transorally to the site of fundoplication; grasping the fundus with the grasper (or similar device, e.g. corkscrew) and pulling it into the jaws of the clip applier; closing the jaws of the clip applier over the fundus and applying a clip to the fundus.

Claims

1. A medical method, comprising:

a) sliding a clip over body tissue, said clip having two arms and a bridge coupling the two arms, such that said body tissue is located between said two arms and such that said clip applies force to said body tissue; and

b) bending at least one of said two arms through more than one half a thickness of said body tissue.

2. A method according to claim 1, wherein:

said bending comprises bending said at least one of said two arms completely through said body tissue.

3. A method according to claim 2, wherein:

said bending comprises bending said at least one of said two arms into contact with the other of said two arms.

4. A method according to claim 2, wherein:

said bending comprises bending both of said arms completely through said body tissue.

5. A method according to claim 1, wherein:

said tissue comprises tissue which is folded on itself to from a first portion of a fold and a second portion of the fold, and said bending comprises bending said at least one of said two arms through said first portion of the fold and at least partially through said second portion of the fold.

6. A method according to claim 1, further comprising:

prior to said sliding, manipulating said tissue so that said tissue is folded on itself.

7. A method according to claim 6, wherein:

said tissue is an invaginated fundus of a stomach and the fold includes several layers of said fundus folded on itself.

8. A method according to claim 7, wherein:

said manipulating is done by grabbing the fundus of the stomach with a grasping instrument and pulling on the fundus to cause invagination of the stomach.

9. A method according to claim 6, further comprising:

c) compressing and clamping first and second portions of a fold in said tissue into contact with each other prior to said sliding.

10. A method according to claim 9, wherein:

said sliding, said clamping, and said bending are accomplished by using a single clip applier.

11. A method according to claim 1, wherein:

said sliding and said bending are accomplished by using a single clip applier.

12. A method according to claim 1, wherein:

said tissue comprises two separate pieces of tissue.

14. A method according to claim 13, further comprising:

c) manipulating said body tissue to create said fold prior to said sliding.

15. A method according to claim 14, wherein:

said fold of body tissue is an invaginated fundus of a stomach.

16. A method according to claim 15, wherein:

said manipulating is done by grabbing the fundus of the stomach with a grasping instrument and pulling on the fundus to cause invagination of the stomach.

17. A method according to claim 16, further comprising:

prior to said sliding, compressing and clamping said first and second portions of said fold into contact with each other.

18. A method according to claim 15, wherein:

said sliding, said clamping, and said bending are accomplished by using a single instrument.

20. A method according to claim 19, wherein:

said inserting a grasping device comprises inserting the grasping device through a lumen of the endoscope.

21. A method according to claim 20, further comprising:

f) attaching a sheath to an exterior of the endoscope, wherein

said inserting a surgical clip applier comprises inserting the clip applier through the sheath.

22. A method according to claim 19, wherein:

said inserting a surgical clip applier comprises attaching the clip applier to the exterior of the endoscope prior to said inserting the endoscope.

23. A method according to claim 20, wherein:

said inserting a surgical clip applier includes inserting the clip applier through a second lumen of the endoscope.

24. A method according to claim 20, further comprising:

f) attaching a guide to an exterior of the endoscope, wherein

said inserting a surgical clip applier comprises attaching the clip applier to the guide.

25. A method according to claim 19, wherein:

said inserting a surgical clip applier comprises attaching the clip applier to the exterior of the endoscope after said inserting the endoscope.

13. A medical method, comprising:

a) sliding two substantially straight unconnected arms over a fold of body tissue such that a first of said two arms contacts a first portion of said fold and a second of said two arms contacts a second portion of said fold; and

b) bending each of said two arms completely through said fold such that both of said two arms compress said first and second portions of said fold into contact with each other.

19. A medical method, comprising:

a) inserting an endoscope transorally through the esophagus to the stomach;

b) inserting a grasping device transorally through the esophagus to the stomach;

c) inserting a surgical clip applier having at least one clip transorally through the esophagus to the stomach;

d) invaginating the fundus of the stomach with the grasping device;

e) using the clip applier to first slide the clip over the invaginated fundus and then to apply force to bend at least one end of the clip to pass through the invaginated fundus in order to plicate the fundus.