Apparatus and methods for forming and securing gastrointestinal tissue folds
View Patent ↗Apparatus and methods are provided for forming a gastrointestinal tissue fold by engaging tissue at a first tissue contact point and moving the first tissue contact point from a position initially distal to, or in line with, a second tissue contact point to a position proximal of the second contact point, thereby forming the tissue fold, and extending an anchor assembly through the tissue fold from a vicinity of the second tissue contact point. Adjustable anchor assemblies; as well as anchor delivery systems, shape-lockable guides and methods for endoluminally performing medical procedures, such as gastric reduction, treatment of gastroesophageal reflux disease, resection of lesions, and treatment of bleeding sites; are also provided.
1. An endoscopic apparatus, comprising:
an elongate endoscopic device having a lumen within an overtube;
an end effector at a distal end of the endoscopic device having at least one opening connecting into the lumen, whereby when a suction source is coupled to the endoscopic device a suction is created in the opening to draw a portion of tissue wall into the opening;
a needle slidable within the endoscopic device by pushing or pulling on a proximal end of the needle for moving the needle from a retracted position in which a distal end of the needle is withdrawn from the opening, to an extended position in which the distal end of the needle extends at least partway across the opening, whereby the needle can be extended into the portion of tissue wall drawn into the opening; and
an anchor assembly comprising a distal anchor, a proximal anchor, and a connector, with at least one of the proximal anchor and the distal anchor having a through-passage of a size to accommodate the needle such that the at least one of the proximal anchor and the distal anchor is disposed substantially concentrically on an exterior surface of the needle.
2. The apparatus of claim 1 wherein the lumen extends from a proximal end of the endoscopic device to the distal end of the end of the endoscopic device, and the needle is slidably positioned within the lumen.
3. The apparatus of claim 1 further comprising an endoscope slidably disposed in the lumen.
4. The apparatus of claim 1 further comprising an endoscopic visualization device slidably disposed in the lumen.
5. The apparatus of claim 1 , wherein at least one of the proximal anchor and the distal anchor comprises a T-type anchor.
6. The apparatus of claim 1 , wherein the connector comprises suture and the proximal and distal anchors are both fixed in place on the suture.
7. The apparatus of claim 1 , wherein the connector has a length that is adjustable.
8. Apparatus for endoscopically reconfiguring tissue, comprising:
a flexible overtube having an elongated body with a proximal end and a distal end, with a lumen within the overtube, and an aperture located at or near the distal end of the overtube and providing access from the exterior of the overtube to the lumen;
a piercing element having a sharp distal tip, the piercing element being slidably disposed in the overtube and having a retracted position in which a distal end of the piercing element is located substantially proximal of the aperture and an extended position in which the distal end of the piercing element is located substantially distal of the aperture and remains within the lumen; and
an anchor assembly comprising a distal anchor, a proximal anchor, and a connector, with at least one of the proximal anchor and the distal anchor having a through-passage of a size to accommodate the piercing element such that the at least one of the proximal anchor and the distal anchor is disposed substantially concentrically on an exterior surface of the piercing element.
9. The apparatus of claim 8 , wherein at least one of the proximal anchor and the distal anchor comprises a T-type anchor.
10. The apparatus of claim 8 , wherein the connector comprises suture and the proximal and distal anchors are both fixed in place on the suture.
11. The apparatus of claim 8 , wherein the connector has a length that is adjustable.
12. The apparatus of claim 8 further comprising an endoscope slidably disposed within the lumen.
13. The apparatus of claim 12 , wherein the piercing element is slidably disposed within a working channel of the endoscope.
14. The apparatus of claim 8 , wherein the aperture is located on the side of the overtube at or near the distal end of the overtube.
15. The apparatus of claim 8 , wherein the aperture is located at the distal end of the overtube.
16. The apparatus of claim 8 , wherein the lumen extends from the proximal end of the overtube to the distal end of the overtube.