Method of promoting tissue adhesion

Abstract

The present invention provides methods and devices for promoting tissue adhesion, which utilizes the healing process and scar tissue formation to bond two tissue surfaces together. A tissue injury is accomplished by destroying the mucosal layer of tissue. After the injury is initiated, the tissue is preferably held in close contact by a tissue apposition means such as a suture, staple or clip device placed adjacent to the treatment site. The tissue injury may be initiated by electrical/radiofrequency energy; chemical or mechanical means integrated with the tissue apposition device or delivered by a separate instrument such as an electrocautery catheter through an endoscope. As scar tissue created by the injury forms, the tissue surfaces become bonded together in a permanent union.

1 . A method of promoting tissue adhesion between surfaces of tissue, the method comprising:
 collecting a first tissue area into a first fold,   placing a suture through the first fold;   releasing the first tissue area;   collecting a second tissue area, adjacent to the first tissue area, into a second fold;   placing the suture through the second fold;   creating a tissue injury between the first and second tissue folds;   tightening the suture to draw the first and second tissue folds and the injured tissue into contact with each other; and   securing the suture to hold the first and second tissue folds and the injured tissue in contact with each other.   
     
     
         2 . The method as defined in  claim 1 , wherein the tissue is gastric tissue and the injury is applied to the mucosal layer of the gastric tissue. 
     
     
         3 . The method as defined in  claim 2 , wherein the method is performed endoscopically. 
     
     
         4 . A method of promoting tissue adhesion between the surfaces of tissue, the method comprising:
 collecting a first tissue area into a first fold;   placing a tissue fastener through the first fold;   releasing the first tissue area;   collecting a second tissue area, adjacent to the first tissue area, into a second fold;   placing the tissue fastener through the second fold;   releasing the second tissue area;   tightening the tissue fastener to draw the first and second tissue folds together;   inserting a tissue injury device between the first and second tissue folds;   creating a tissue injury between the first and second tissue folds with the tissue injury device; and   securing the tissue fastener to hold the first and second tissue folds together.   
     
     
         5 . The method as defined in  claim 4 , wherein the tissue is gastric tissue and the injury is applied to the mucosal layer of the gastric tissue. 
     
     
         6 . The method as defined in  claim 5 , wherein the method is performed endoscopically. 
     
     
         7 . A method of promoting tissue adhesion surfaces of gastric tissue, the method comprising:
 advancing a first endoscope through the esophagus of a patient to a location adjacent a first area of gastric tissue below the gastroesophageal junction, the first endoscope having an endoscopic suturing device at its distal end;   applying vacuum to the suturing device to capture a first tissue fold;   passing a suture through the first tissue fold with a needle;   withdrawing the needle and releasing the first tissue fold from the suturing device;   moving the endoscopic suturing device to a second area of gastric tissue;   applying vacuum to capture a second tissue fold;   advancing the suture through the second tissue fold with the needle;   withdrawing the needle and releasing the second tissue fold;   withdrawing the first endoscope from the patient;   advancing a second endoscope through the esophagus of the patient to the vicinity of the first and second tissue folds;   advancing an electrocautery catheter through the working channel of the second endoscope and beyond the distal end of the second endoscope;   applying radiofrequency energy to the gastric tissue surface between the locations of the suture placed through the first and second tissue folds to create an injured tissue area;   withdrawing the electrocautery catheter and the second endoscope from the patient;   tightening the suture to draw the first and second tissue folds together and place the injured tissue area in contact; and   securing the suture to maintain the injured tissue area in contact.   
     
     
         8 . A tissue apposition device comprising:
 a cavity for capturing a tissue portion;   a tissue securement device including a needle adapted to deliver a suture along a suture path to penetrate a tissue portion captured in the cavity; and   a tissue abrasion device positioned within the cavity and adapted to produce an area of tissue injury to a captured tissue portion, the tissue abrasion device including one or more RF energy emitting plates configured to create an area of tissue injury to a region of the captured tissue portion that is not penetrated by the needle.   
     
     
         9 . The tissue apposition device as defined in  claim 8 , wherein the cavity captures tissue by application of vacuum. 
     
     
         10 . The tissue apposition device as defined in  claim 8 , wherein the tissue abrasion device includes two or more RF energy emitting plates. 
     
     
         11 . The tissue apposition device as defined in  claim 10 , wherein the RF emitting plates are constructed and arranged with the suture path extending therebetween. 
     
     
         12 . The tissue apposition device as defined in  claim 10 , wherein the RF emitting plates are independently operable. 
     
     
         13 . The tissue apposition device as defined in  claim 10 , wherein each RF energy emitting plate forms a tissue-contacting surface within the cavity. 
     
     
         14 . The tissue apposition device as defined in  claim 8 , wherein the tissue abrasion device further includes a mechanical abrader adapted to abrade tissue. 
     
     
         15 . A method of joining tissue surfaces, the method comprising:
 providing a tissue apposition device having a tissue securement device, a cavity and a tissue abrasion device;   placing the tissue apposition device adjacent a first tissue portion;   capturing the first tissue portion in the cavity;   advancing the tissue securement device through the first tissue portion;   abrading a surface of the first tissue portion with the tissue abrasion device;   releasing the first tissue portion from the cavity;   moving the tissue apposition device to a second tissue potion;   capturing the second tissue portion into the cavity;   advancing the tissue securement device through the second tissue portion;   abrading a surface of the second tissue portion with the tissue abrasion device;   releasing the second tissue portion from the cavity; and   tightening the tissue securement device to draw the first and second tissue portions together and place the abraded surfaces in contact.