Method and device for use in endoscopic organ procedures

Abstract

Methods and devices for use in tissue approximation and fixation are described herein. The present invention provides, in part, methods and devices for acquiring tissue folds in a circumferential configuration within a hollow body organ, e.g., a stomach, positioning the tissue folds for affixing within a fixation zone of the stomach, preferably to create a pouch or partition below the esophagus, and fastening the tissue folds such that a tissue ring, or stomas, forms excluding the pouch from the greater stomach cavity. The present invention further provides for a liner or bypass conduit which is affixed at a proximal end either to the tissue ring or through some other fastening mechanism. The distal end of the conduit is left either unanchored or anchored within the intestinal tract. This bypass conduit also includes a fluid bypass conduit which allows the stomach and a portion of the intestinal tract to communicate.

1 . A surgical method, comprising:
 transorally advancing a proximal end of a tubular member through an esophagus of a patient to position the proximal end of the tubular member adjacent an attachment site near a gastroesophageal junction;   transorally advancing a distal end of the tubular member through the esophagus and through a stomach of the patient to position the distal end adjacent an intestine of the patient; and   attaching the proximal end of the tubular member at the attachment site such that the tubular member is configured to channel food from the esophagus directly into the intestine by allowing the food to pass from the esophagus into an inner lumen of the tubular member through the proximal end of the tubular member and exit the inner lumen of the tubular member into the intestine through the distal end of the tubular member.   
     
     
         2 . The method of  claim 1 , further comprising anchoring the distal end of the tubular member to the intestine. 
     
     
         3 . The method of  claim 1 , further comprising anchoring the distal end of the tubular member in a pylorus of the patient. 
     
     
         4 . The method of  claim 1 , further comprising implanting the tubular member within the patient without anchoring the distal end of the tubular member to tissue such that the distal end of the tubular member is allowed to freely move within the patient. 
     
     
         5 . The method of  claim 1 , wherein attaching the proximal end of the tubular member at the attachment site comprises attaching the proximal end of the tubular member distal of the esophagus. 
     
     
         6 . The method of  claim 1 , further comprising transorally advancing an endoscopic device through the esophagus, wherein transorally advancing the proximal and distal ends of the tubular member through the esophagus comprises advancing the tubular member over the endoscopic device with the endoscopic device passing through the inner lumen of the tubular member. 
     
     
         7 . The method of  claim 1 , wherein attaching the proximal end of the tubular member at the attachment site comprises attaching the proximal end of the tubular member at the attachment site using at least one fastening element. 
     
     
         8 . The method of  claim 1 , wherein attaching the proximal end of the tubular member at the attachment site comprises attaching the proximal end of the tubular member at the attachment site using at least one fastening element without creating a tissue fold. 
     
     
         9 . The method of  claim 1 , further comprising forming a tissue fold at the attachment site, wherein attaching the proximal end of the tubular member at the attachment site comprises attaching the proximal end of the tubular member to the tissue fold. 
     
     
         10 . The method of  claim 9 , wherein the tissue fold is formed at the attachment site simultaneously with attachment of the proximal end of the tubular member at the attachment site. 
     
     
         11 . The method of  claim 9 , wherein the proximal end of the tubular member is attached at the attachment site after the tissue fold is formed. 
     
     
         12 . The method of  claim 9 , further comprising transorally advancing an endoscopic device through the esophagus, wherein the tissue fold is formed using the endoscopic device, and transorally advancing the proximal and distal ends of the tubular member through the esophagus comprises advancing the tubular member over the endoscopic device with the endoscopic device passing through the inner lumen of the tubular member. 
     
     
         13 . The method of  claim 9 , wherein forming the tissue fold comprises forming a tissue ring from tissue adjacent the gastroesophageal junction, and attaching the proximal end of the tubular member at the attachment site comprises attaching the proximal end of the tubular member to a proximal side of the tissue ring such that the tubular member passes through an inner opening defined by a perimeter of the tissue ring. 
     
     
         14 . The method of  claim 9 , wherein forming the tissue fold comprises forming a circumferential tissue fold around a partial circumference of the esophagus from tissue adjacent the gastroesophageal junction, and attaching the proximal end of the tubular member at the attachment site comprises attaching the proximal end of the tubular member to the tissue fold. 
     
     
         15 . The method of  claim 1 , wherein the tubular member is formed from a flexible material that allows the tubular member to move within the intestine due to peristalsis of a wall of the intestine. 
     
     
         16 . The method of  claim 1 , wherein the inner lumen of the tubular member is free of obstructions such that the food is allowed to freely pass through the inner lumen of the tubular member. 
     
     
         17 . A surgical method, comprising:
 transorally advancing into a patient a conduit having an unobstructed inner lumen extending between proximal and distal ends thereof;   positioning the proximal end of the conduit adjacent a gastroesophageal junction of the patient;   positioning the distal end of the conduit within an intestine of the patient such that an intermediate portion of the conduit extending between the proximal and distal ends thereof is positioned within the stomach; and   attaching the proximal end of the conduit adjacent the gastroesophageal junction using at least one fastening element such that food can pass directly from the esophagus into the inner lumen of the conduit through the proximal end of the conduit, advance through the inner lumen of the conduit, and exit the inner lumen through the distal end of the conduit to pass directly into the intestine.