Incisionless Endoluminal Gastric Tissue Approximation for the Treatment Of Obesity

Abstract

An incisionless fully endoscopic method of reducing the capacity of the stomach is provided to surgically treat obesity. The method is directed to endoluminal tissue approximation of a portion of the stomach, including at least a portion of the greater curvature thereof. The method includes a pattern of stitching in which a portion of the stomach is closed off. One stitching pattern causes the lateral portion of the stomach to be drawn to reduce the usable volume of the stomach while maintaining a pathway from the esophagus to the pylorus. As the stitching pattern advances, the fundus is automatically drawn downward so that it may be endoscopically approached for stitching in a facilitated manner. According to another aspect of the invention, another stitching pattern extends from the antrum to the fundus between the anterior and posterior portions of the stomach.

What is claimed is: 
     
         1 . A method of treating obesity in a patient, the patient having a stomach having an antrum, a central body, and a fundus, the stomach having a stomach wall with anterior, posterior, lateral and medial sides, the method comprising:
 a) endoluminally passing a first tissue securing element through the esophagus and into the stomach;   b) from within the stomach, first attaching the first tissue securing element through the anterior, posterior and lateral portions of the stomach wall at first locations;   c) from within the stomach, first approximating the anterior, posterior and lateral portions of the stomach wall together with the first tissue securing element to reduce a volume of the stomach; and   d) from within the stomach, first securing the first tissue securing element relative to the stomach wall.   
     
     
         2 . The method of  claim 1 , wherein:
 said method is incisionless.   
     
     
         3 . The method of  claim 1 , wherein:
 the first tissue securing element is at least one suture.   
     
     
         4 . The method of  claim 3 , wherein:
 said first securing includes applying a cinch to the first tissue securing element.   
     
     
         5 . The method of  claim 1 , wherein:
 said first attaching includes helically extending the first tissue securing element through the anterior, posterior and lateral portions at vertical displaced locations on the stomach wall, and   said first approximating includes applying tension to the first tissue securing element to draw the anterior, posterior and lateral portions together.   
     
     
         6 . The method of  claim 1 , further comprising:
 from within the stomach, second attaching a second tissue securing element through the anterior, posterior and lateral portions of the stomach wall at second locations vertically displaced from said first locations,
 wherein said second attaching is performed after said first attaching, said first approximating, and said first securing; 
   from within the stomach, second approximating the anterior, posterior and lateral portions of the stomach wall together with the second tissue securing element to reduce a volume of the stomach; and   from within the stomach, second securing the second tissue securing element relative to the stomach wall.   
     
     
         7 . The method of  claim 6 , wherein:
 said first attaching, said first approximating, and said first locations are located below the fundus, and said second locations are located within said fundus.   
     
     
         8 . The method of  claim 6 , further comprising:
 after said second securing, approximating and securing the stomach wall together in the anterior-posterior direction from a lower end of the stomach to an upper end of the stomach.   
     
     
         9 . The method of  claim 8 , wherein:
 said approximating and securing the stomach wall together in the anterior-posterior direction includes placing a vertically displaced suture pattern between the anterior and posterior sides of the stomach wall, cinching the suture, and then securing the suture to the stomach wall.   
     
     
         10 . The method of  claim 6 , wherein:
 said second securing includes applying a cinch to the second tissue securing element.   
     
     
         11 . The method of  claim 1 , further comprising:
 providing an endoscope having a proximal end, a distal end, and at least one working channel extending between said proximal and distal ends, and a tissue suturing system coupled to adjacent the distal end,
 wherein the first tissue securing element is passed through the at least one working channel to the tissue suturing system for said first attaching. 
   
     
     
         12 . The method of  claim 11 , wherein:
 said endoscope is a steerable endoscope, and said endoscope is steered toward said anterior, posterior and lateral portions of the stomach wall.   
     
     
         13 . The method of  claim 1 , wherein:
 in advance of said first attaching, marking a guideline along at least one interior surface of the stomach wall.   
     
     
         14 . The method of  claim 13 , wherein:
 a guideline is marked on each of the anterior and posterior interior surfaces of the stomach wall.   
     
     
         15 . The method of  claim 13 , wherein:
 the guideline is marked with a laser coagulator.   
     
     
         16 . A method of treating obesity in a patient, the patient having a stomach having an antrum, a central body, and a fundus, the stomach having a stomach wall with anterior, posterior, lateral and medial sides, the method comprising:
 a) endoluminally first securing approximation of the anterior, posterior and lateral sides of a stomach wall below the fundus; and then   b) endoluminally second securing approximation of the anterior, posterior and lateral sides of the stomach wall within the fundus.   
     
     
         17 . The method of  claim 16 , wherein:
 said method is incisionless.   
     
     
         18 . The method of  claim 16 , further comprising:
 providing an endoscope having a proximal end, a distal end, and at least one working channel extending between said proximal and distal ends, and a tissue suturing system coupled to adjacent the distal end,
 wherein said first securing includes using the tissue suturing system to suture a first suture through the anterior, posterior and lateral sides of the stomach wall below the fundus, and 
 said second securing includes using the tissue suturing system to suture a second suture through the anterior, posterior and lateral sides of the stomach wall within the fundus. 
   
     
     
         19 . The method of  claim 16 , wherein:
 said first securing includes inserting suture through the stomach wall, and said second securing includes inserting suture through the stomach wall.   
     
     
         20 . The method of  claim 19 , wherein:
 first securing and said second securing utilize different sutures.   
     
     
         21 . The method of  claim 19 , wherein:
 said first securing includes applying a cinch to the suture.   
     
     
         22 . The method of  claim 16 , wherein:
 said first securing draws the fundus downward toward the body of the stomach.   
     
     
         23 . The method of  claim 16 , further comprising:
 b) after said second securing, endoluminally third securing approximation of the anterior and posterior sides of the stomach at vertically displaced locations medial of said first and second securing.   
     
     
         24 . The method of  claim 23 , wherein:
 said third securing includes providing a running stitch between the anterior and posterior sides of the stomach from a lower end of the stomach to an upper end of the stomach.   
     
     
         25 . The method of  claim 23 , wherein:
 said third securing defines a passage from the upper end of the stomach to the lower end of the stomach that exclude the secured approximation of the anterior, posterior, and lateral sides at the first and second locations.   
     
     
         26 . The method of  claim 16 , further comprising:
 in advance of said first securing, marking a guideline along at least one interior surface of the stomach wall.   
     
     
         27 . The method of  claim 26 , wherein:
 a guideline is marked on each of the anterior and posterior interior surface of the stomach wall.   
     
     
         28 . The method of  claim 26 , wherein:
 the guideline is marked with a laser coagulator.   
     
     
         29 . A method of treating obesity in a patient, the patient having a stomach having an antrum, a central body, and a fundus, the stomach having a stomach wall with anterior, posterior, lateral and medial sides, the method comprising:
 a) providing an endoscopic tissue suturing system;   b) endoluminally passing the endoscopic tissue suturing system through a natural orifice into the stomach;   c) using the endoscopic tissue suturing system to advance a first suture through the anterior, posterior and lateral sides of the stomach wall at first locations below the fundus;   d) cinching the first suture to draw inward into approximation the anterior, posterior and lateral sides at the first locations;   e) using the endoscopic tissue suturing system to advance a second suture through the anterior, posterior and lateral sides of the stomach wall at second locations vertically displaced above the first locations, wherein the second locations are located within the fundus; and   f) cinching the second suture to draw inward into approximation the anterior, posterior and lateral sides at the second locations.   
     
     
         30 . The method of  claim 29 , wherein:
 the first suture is advanced in a helical pattern about the stomach wall.   
     
     
         31 . The method of  claim 30 , wherein:
 the second suture is advanced in a helical pattern about the stomach wall.   
     
     
         32 . The method of  claim 29 , wherein:
 said cinching the first suture includes applying a first cinch to the first suture to secure the first suture in a cinched configuration relative to the stomach wall, and   said cinching the second suture includes applying a second cinch to the second suture to secure the second suture in a cinched configuration relative to the stomach wall.   
     
     
         33 . The method of  claim 29 , further comprising:
 using the endoscopic tissue suturing system to advance a third suture between the anterior and posterior sides of the stomach in an alternating pattern at vertical displaced locations;   cinching said third suture to form a passage within the stomach that exclude the approximation of the anterior, posterior, and lateral sides at the first and second locations.   
     
     
         34 . The method of  claim 29 , further comprising:
 before advancing the first suture through the anterior, posterior and lateral sides of the stomach wall, marking a guideline along the stomach wall.   
     
     
         35 . The method of  claim 34 , wherein:
 a separate guideline is marked on each of the anterior and posterior sides of the interior stomach wall.   
     
     
         36 . The method of  claim 34 , wherein:
 the guideline is marked with a laser coagulator.   
     
     
         37 . A method of reshaping the stomach of a patient, the stomach having a stomach wall with anterior, posterior, lateral and medial sides, the method comprising:
 a) endoscopically marking the anterior and posterior sides of the stomach along a greater curvature of the stomach to create guidelines; and   b) endoscopically securing from inside the stomach the anterior and posterior sides of the stomach together at multiple locations to reduce a usable volume of the stomach.   
     
     
         38 . The method of  claim 37 , wherein:
 the endoscopically securing proceeds relative to the guidelines.   
     
     
         39 . The method of  claim 37 , wherein:
 the marking is made with a laser coagulator.   
     
     
         40 . The method of  claim 37 , wherein:
 the endoscopically securing also secures the lateral side of the stomach with the anterior and posterior sides.