Incisionless endoluminal gastric tissue approximation for the treatment of obesity
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.
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) 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 first locations through the anterior, posterior, and lateral sides of the stomach wall below the fundus;
d) first cinching the first suture to draw inward into approximation the anterior, posterior, and lateral sides at the first locations;
e) then using the endoscopic tissue suturing system to advance a second suture through second locations through the anterior, posterior, and lateral sides of the stomach wall vertically displaced above the first locations, wherein the second locations are located within the fundus; and
f) second cinching the second suture to draw inward into approximation the anterior, posterior, and lateral sides at the second locations.
2. The method of claim 1 , wherein the first suture is advanced in a helical pattern about the stomach wall.
3. The method of claim 2 , wherein the second suture is advanced in a helical pattern about the stomach wall.
4. The method of claim 1 , wherein:
said first 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 below the fundus; and
said second 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.
5. The method of claim 1 , 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; and
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.
6. The method of claim 1 , 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.
7. The method of claim 6 , wherein a separate guideline is marked on each of the anterior and posterior sides of the interior stomach wall.
8. The method of claim 6 , wherein the guideline is marked with a laser coagulator.
9. The method of claim 1 , wherein the first cinching draws the anterior, posterior, and lateral sides into contact at the first locations.
10. The method of claim 9 , wherein the second cinching draws the anterior, posterior, and lateral sides into contact at the second locations.
11. The method of claim 1 , wherein the first cinching comprises causing the fundus to be drawn downward to effectively shorten the length of the fundus.