System for treating gastroesophageal reflux disease

• US 20050251176A1
• Filed: 04/07/2005
• Published: 11/10/2005
• Est. Priority Date: 05/07/2004
• Status: Abandoned Application

• Current Assignee: USGI Medical, Inc.
• Original Assignee: USGI Medical, Inc.
• Inventors: Saadat, Vahid, Chen, Eugene, Cox, John A., Swanstrom, Lee L.
• Application Number:
  US11/102,571
• Publication Number:
  US 20050251176A1
• Time in Patent Office: Days
• US Class Current: 606/153
• 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 17/00234 for minimally invasive surgery A61B17/0218, A61B17/0469, A61B17/12013, A61B17/1285, A61B17/29, A61B17/320016 take precedence
• CPC Class Codes: A61B 17/0401 Suture anchors, buttons or pledgets, i.e. means for attaching sutures to bone, cartilage or soft tissue; Instruments for applying or removing suture anchors A61B17/0642 takes precedence; fixation devices for tendons or ligaments A61F2/0811
• CPC Class Codes: A61B 17/0469 Suturing instruments for use in minimally invasive surgery, e.g. endoscopic surgery
• CPC Class Codes: A61B 17/06066 Needles, e.g. needle tip configurations making needles B21G1/00
• CPC Class Codes: A61B 17/1114 of the digestive tract, e.g. bowels or oesophagus
• CPC Class Codes: A61B 17/29 Forceps for use in minimally invasive surgery
• CPC Class Codes: A61B 17/295 combined with cutting implements
• CPC Class Codes: A61B 2017/003 Steerable
• CPC Class Codes: A61B 2017/00349 Needle-like instruments having hook or barb-like gripping means, e.g. for grasping suture or tissue A61B17/06066 takes precedence
• CPC Class Codes: A61B 2017/00827 Treatment of gastro-esophageal reflux
• CPC Class Codes: A61B 2017/00867 shape memory effect for prostheses A61F2210/0014
• CPC Class Codes: A61B 2017/00876 magnetic
• CPC Class Codes: A61B 2017/0409 Instruments for applying suture anchors for applying suture clamps, clips or locks A61B2017/0488
• CPC Class Codes: A61B 2017/0417 T-fasteners
• CPC Class Codes: A61B 2017/0419 H-fasteners
• CPC Class Codes: A61B 2017/0464 for soft tissue
• CPC Class Codes: A61B 2017/0496 for tensioning sutures
• CPC Class Codes: A61B 2017/06052 Needle-suture combinations in which a suture is extending inside a hollow tubular needle, e.g. over the entire length of the needle hollow suture needles A61B2017/061
• CPC Class Codes: A61B 2017/06076 helically or spirally coiled for sutures A61B2017/06171
• CPC Class Codes: A61B 2017/3488 : Fixation to inner organ or inner body tissue
• CPC Class Codes: A61B 2090/037 : with a frangible part, e.g. by reduced diameter

Abstract

A system for treating gastroesophageal reflux disease (GERD) is disclosed herein. A variety of tools, such as a shape-lockable endoscopic device, can be advanced trans-esophageally and into the stomach or through the stomach wall to access regions of the tissue in and around the gastroesophageal junction. Utilizing expandable tissue anchors, the angle of Hiss can be reconfigured by deploying the anchors within the esophagus and fundus and approximating the two. Alternatively, the esophagus can be lengthened by approximating tissue from within the stomach to follow the lesser curve of the stomach. Alternatively, one or more tissue folds can be formed within or adjacent to the GEJ to form a barrier to refluxing stomach contents.

Claims

1. A method for treating gastroesophageal reflux disease, comprising:

advancing trans-esophageally an endoscopic body adapted to shape-lock a selected configuration; and

modifying tissue in or around a gastroesophageal junction with at least one tool disposed at a distal end of the endoscopic body.

2. The method of claim 1 further comprising locking the selected configuration of the endoscopic body within the esophagus after advancing trans-esophageally.

3. The method of claim 1 wherein advancing trans-esophageally comprises advancing the endoscopic body in a flexible state.

4. The method of claim 1 wherein advancing trans-esophageally comprises advancing the distal end of the endoscopic body within a proximity of the gastroesophageal junction.

5. The method of claim 4 wherein advancing the distal end of the endoscopic body comprises advancing the distal end to a position superior to the gastroesophageal junction.

6. The method of claim 4 wherein advancing the distal end of the endoscopic body comprises advancing the distal end to a position adjacent to the gastroesophageal junction such that a distal portion of the endoscopic body is retroflexed within a stomach.

7. The method of claim 1 wherein advancing trans-esophageally comprises securing a distal end of the endoscopic body to an opening in a stomach wall.

8. The method of claim 7 further comprising advancing an endoscope through the endoscopic body into a peritoneal or thoracic cavity within a patient.

9. The method of claim 1 wherein modifying tissue comprises distally advancing a needle assembly from the endoscopic body into the tissue in or around the gastroesophageal junction.

10. The method of claim 9 further comprising deploying at least two expandable anchors slidingly interconnected via suture from the needle assembly against the tissue.

11. The method of claim 10 further comprising approximating the at least two expandable anchors over the suture such that an outer surface of esophageal tissue is secured against an outer surface of stomach tissue.

12. The method of claim 10 wherein deploying at least two expandable anchors comprises deploying the anchors within the esophagus adjacent to one another such that the suture forms a U-stitch relative to the gastroesophageal junction.

13. The method of claim 10 wherein deploying at least two expandable anchors comprises deploying the anchors within a stomach adjacent to one another such that the suture forms a U-stitch relative to the gastroesophageal junction.

14. The method of claim 1 further comprising adhering the tissue in or around the gastroesophageal junction to a region of the endoscopic body and advancing the adhered tissue distally past a diaphragm of a patient prior to modifying tissue.

15. The method of claim 14 further comprising securing the tissue below the diaphragm of the patient.

16. The method of claim 14 wherein adhering the tissue comprises adhering the tissue via a vacuum force.

17. The method of claim 14 wherein adhering the tissue comprises adhering the tissue via one or more retractable hooks or barbs projecting from a surface of the endoscopic body.

18. A method for treating gastroesophageal reflux disease, comprising:

advancing trans-esophageally an endoscopic body adapted to shape-lock a selected configuration into a stomach;

positioning the endoscopic body adjacent a tissue region of interest within the stomach;

locking the selected configuration of the endoscopic body; and

approximating tissue from the tissue region of interest such that at least one tissue fold is formed within the stomach.

19. The method of claim 18 wherein advancing trans-esophageally comprises advancing the endoscopic body in a flexible state.

20. The method of claim 18 wherein approximating tissue comprises approximating tissue from an anterior region and a posterior region of the stomach such that a tissue pouch is formed.

21. The method of claim 20 wherein the tissue pouch extends from a gastroesophageal junction into the stomach.

22. The method of claim 18 further comprising securing the approximated tissue.

23. The method of claim 22 wherein securing comprises deploying at least one pair of expandable anchors.

24. The method of claim 18 wherein advancing trans-esophageally comprises adhering stomach tissue located superior to a hiatus opening to a region of the endoscopic body and advancing the adhered tissue distally past the hiatus opening.

25. The method of claim 24 wherein adhering stomach tissue comprises adhering the tissue via a vacuum force.

26. The method of claim 24 wherein adhering stomach tissue comprises adhering the tissue via one or more retractable hooks or barbs projecting from a surface of the endoscopic body.

27. A method for treating gastroesophageal reflux disease, comprising:

advancing trans-esophageally an endoscopic body adapted to shape-lock a selected configuration; and

forming at least one tissue fold in or around a gastroesophageal junction with at least one tool disposed at a distal end of the endoscopic body.

28. The method of claim 27 further comprising locking the selected configuration of the endoscopic body within the esophagus after advancing trans-esophageally.

29. The method of claim 27 wherein advancing trans-esophageally comprises advancing the endoscopic body in a flexible state.

30. The method of claim 27 wherein forming at least one tissue fold comprises deploying at least one pair of expandable tissue anchors within or against the tissue fold.

31. The method of claim 27 wherein forming at least one tissue fold comprises forming the at least one tissue fold such that a cross-sectional area of the esophagus is reduced.

32. The method of claim 27 wherein forming at least one tissue fold comprises forming at least one additional adjacent tissue fold.

33. The method of claim 32 wherein forming at least one additional adjacent tissue fold comprises forming the additional tissue fold such that both tissue folds are connected to one another via suture.

34. The method of claim 27 wherein advancing trans-esophageally comprises adhering stomach tissue located superior to a hiatus opening to a region of the endoscopic body and advancing the adhered tissue distally past the hiatus opening.