Apparatus and method for concurrently forming a gastroesophageal valve and tightening the lower esophageal sphincter
View Patent ↗An apparatus enables concurrent restoration of a gastroesophageal valve and tightening of the lower esophageal sphincter. The apparatus comprises a longitudinal member having a distal end arranged to be received within a stomach, a tissue shaper at the distal end of the longitudinal member that forms a gastroesophageal valve from stomach tissue, and a tissue gatherer that gathers fundus tissue at or aboral to the gastroesophageal junction to reduce an esophageal opening into the stomach and tighten the lower esophageal sphincter. A fastener deployer then deploys at least one fastener pair to maintain both the restored gastroesophageal valve and the tightened lower esophageal sphincter.
1. A method of treating a stomach disorder involving a patient's stomach, esophagus, and esophageal opening into the stomach, comprising:
placing a medical instrument having a longitudinal member into the stomach, and wherein forming a gastroesophageal valve comprises folding stomach tissue with the medical instrument so that serosa tissue contacts serosa tissue to form a flap of stomach tissue layers;
advancing the longitudinal member transorally into the stomach, the longitudinal member having a chassis and a bail at a distal end of the longitudinal member, and positioning the chassis and the bail in the stomach;
extending a helical coil on a cable out of a guide tube in the bail and inserting the helical coil into stomach tissue;
forming a gastroesophageal valve from stomach tissue by gathering stomach tissue at or aboral of a gastroesophageal junction by pulling the cable and helical coil, and hence the stomach tissue, into a mold formed by the chassis and bail; and
deploying at least one fastener to maintain both the formed gastroesophageal valve and stomach tissue fold;
wherein the stomach tissue layers comprise an inner tissue layer and an outer tissue layer, and gathering stomach tissue comprises gathering the inner tissue layer at a gathering point and displacing the inner tissue layer into the esophageal opening with the medical instrument; and
wherein deploying comprises deploying a fastener with the instrument through the tissue layers on opposite sides of the gathering point.
2. The method of claim 1 , wherein gathering stomach tissue comprises displacing the stomach tissue into the esophageal opening.
3. The method of claim 1 , wherein gathering stomach tissue comprises gripping the stomach tissue by screwing the helical coil into the stomach tissue.
4. The method of claim 1 , wherein gathering stomach tissue includes gathering the stomach tissue at a gathering point and wherein deploying at least one fastener comprises deploying a fastener on opposite sides of the gathering point.
5. The method of claim 1 , wherein deploying at least one fastener comprises deploying at least a pair of fasteners spaced apart and wherein gathering stomach tissue comprises providing the fasteners with converging trajectories during deployment.
6. The method of claim 1 , wherein gathering stomach tissue comprises inserting the helical coil into the inner tissue layer.
7. The method of claim 1 , wherein the stomach tissue layers comprise an inner tissue layer and an outer tissue layer, wherein deploying stomach tissue comprises driving at least a pair of fasteners spaced apart and from the inner tissue layer to and through the outer tissue layer and wherein deploying stomach tissue comprises providing the fasteners with converging trajectories while being driven.