Methods of treatment using a bariatric sleeve
Method and apparatus for limiting absorption of food products in specific parts of the digestive system is presented. A gastrointestinal implant device is anchored in the stomach and extends beyond the ligament of Treitz. All food exiting the stomach is funneled through the device. The gastrointestinal device includes an anchor for anchoring the device to the stomach and a flexible sleeve to limit absorption of nutrients in the duodenum. The anchor is collapsible for endoscopic delivery and removal.
1. A method of treatment comprising the steps of:
anchoring a stent within the digestive system, the stent comprising a network of struts and coupled to a proximal portion of a flexible, floppy sleeve, open at both ends, the stent comprising barbs that are inserted into muscle as the sleeve anchor expands to anchor the proximal portion of the sleeve; and
extending the flexible, floppy sleeve within the intestine, a distal portion of the flexible, floppy sleeve extending beyond the stent and being unsupported;
wherein the flexible sleeve is anchored distal to or within the pylorus; and
wherein the sleeve is thin and conformable so that it collapses in the intestine to a small volume.
2. The method of treatment of claim 1 , wherein the flexible sleeve is anchored distal to the pylorus.
3. The method of treatment of claim 1 , wherein the anchoring step comprises anchoring the stent within the pyloric orifice.
4. The method of treatment of claim 1 , wherein the stent is collapsible.
5. The method of treatment of claim 1 , wherein the stent is covered by a proximal portion of the sleeve.
6. The method of treatment of claim 5 , wherein the stent is sandwiched between a first inner layer of the sleeve and a second outer layer of the sleeve.
7. The method of treatment of claim 1 , wherein the sleeve is of a length that chyme exiting the stomach funneled through the proximal end of the sleeve exits the sleeve through the distal end below the ligament of Treitz.
8. The method of treatment of claim 1 , wherein the sleeve is formed of a fluoropolymer.
9. The method of treatment of claim 1 , wherein the sleeve is formed of expanded polytetrafluoroethylene.
10. The method of treatment of claim 9 , wherein the sleeve is coated with a coat of silicone.
11. The method of treatment of claim 9 , wherein the sleeve is coated with a coat of polyurethane.
12. The method of treatment of claim 1 , wherein the sleeve is formed of polyethylene.
13. The method of treatment of claim 1 , wherein the distal end of the sleeve is directionally textured.
14. The treatment of claim 1 , further comprising anchoring the proximal portion of the sleeve with barbs extending from the exterior surface of the stent into tissue.
15. The method of treatment of claim 14 , wherein the barbs comprise pairs of barbs that are outwardly directed and in opposite, axial directions.
16. The method of treatment of claim 15 , wherein the barbs anchor the flexible sleeve to the pyloric muscle in the stomach.
17. The method of claim 15 , wherein the barbs are at a proximal end of the stent.
18. The method of treatment of claim 14 , wherein a first plurality of barbs are oriented in a proximal direction and a second plurality of barbs are oriented in a distal direction.
19. The method of treatment of claim 1 , further comprising coupling an anti-buckling device to the sleeve to reduce buckling of the sleeve.
20. The method of claim 19 , wherein the anti-buckling device extends from below the stent to the distal end of the flexible sleeve.
21. The method of claim 19 , wherein the anti-buckling device reduces twisting of the sleeve.
22. The method of treatment of claim 1 , further comprising causing enzymes secreted in the duodenum to pass through the duodenum outside of the extended sleeve.
23. The method of treatment of claim 1 , wherein the flexible sleeve and stent are delivered to the intestine using an esophageal catheter.
24. The method of treatment of claim 1 , wherein the flexible sleeve and stent are removed through the esophagus.
25. The method of treatment of claim 1 , wherein the flexible sleeve extends into the duodenum.
26. The method of treatment of claim 1 , wherein the sleeve has a coefficient of friction of less than 0.2.
27. The method of treatment of claim 1 , wherein the anchoring step further comprises:
placing the stent within the pyloric orifice; and
holding the pylorus open using the stent.
28. The method of treatment of claim 27 , further comprising coupling an anti-buckling device to the sleeve to reduce buckling of the sleeve.
29. The method of treatment of claim 28 , wherein the anti-buckling device extends from below the sleeve anchor to the distal end of the flexible sleeve.
30. The method of claim 28 , wherein the anti-buckling device reduces twisting of the sleeve.
31. The method of claim 1 , wherein the sleeve is at least one foot in length.
32. A method of treatment comprising the steps of:
anchoring within the digestive system a proximal portion of a flexible, floppy, sleeve, open at both ends, and coupled to a collapsible sleeve anchor, the sleeve anchor comprising barbs that are inserted into muscle as the sleeve anchor expands to anchor the proximal portion of the sleeve; and
extending the flexible, floppy sleeve within the intestine, a distal portion of the flexible floppy sleeve extending beyond the sleeve anchor and being unsupported;
wherein the sleeve anchor is a stent;
wherein the sleeve is anchored distal to or within the pylorus; and
the sleeve is thin and conformable so that it collapses in the intestine to a small volume.
33. The method of treatment of claim 32 , wherein the flexible sleeve is anchored distal to the pylorus.
34. The method of treatment of claim 32 , wherein the anchoring step further comprises:
placing the collapsible sleeve anchor within the pyloric orifice; and
holding the pylorus open using the collapsible sleeve anchor.
35. The method of treatment of claim 32 , wherein the sleeve anchor is covered by a proximal portion of the sleeve.
36. The method of treatment of claim 35 , wherein the sleeve anchor is sandwiched between a first inner layer of the sleeve and a second outer layer of the sleeve.
37. The method of treatment of claim 32 , wherein the sleeve is of a length that chyme exiting the stomach funneled through the proximal end of the sleeve exits the sleeve through the distal end below the ligament of Treitz.
38. The method of treatment of claim 32 , wherein the sleeve material has a coefficient of friction of less than 0.2.
39. The method of treatment of claim 32 , wherein the sleeve is formed of a fluoropolymer.
40. The method of treatment of claim 32 , wherein the sleeve is formed of expanded polytetrafluoroethylene.
41. The method of treatment of claim 40 , wherein the sleeve is coated with a coat of silicone.
42. The method of treatment of claim 40 , wherein the sleeve is coated with a coat of polyurethane.
43. The method of treatment of claim 32 , wherein the sleeve is formed of polyethylene.
44. The method of treatment of claim 32 , wherein the distal end of the sleeve is directionally textured.
45. The method of treatment of claim 32 , wherein the barbs anchor the flexible sleeve to the pyloric muscle in the stomach.
46. The method of treatment of claim 32 , wherein the barbs comprise pairs of barbs that are outwardly directed and in opposite, axial directions.
47. The method of claim 46 , wherein the barbs are at a proximal end of the anchor.
48. The method of treatment of claim 32 , wherein a first plurality of barbs are oriented in a proximal direction and a second plurality of barbs are oriented in a distal direction.
49. The method of treatment of claim 32 , wherein the sleeve causes enzymes secreted in the duodenum to pass through the duodenum outside the sleeve.
50. The method of treatment of claim 32 , wherein the flexible sleeve and sleeve anchor are delivered to the intestine using an esophageal catheter.
51. The method of treatment of claim 32 , wherein the flexible sleeve and sleeve anchor are removed through the esophagus.
52. The method of treatment of claim 32 , wherein the flexible sleeve extends into the duodenum.
53. The method of claim 32 , wherein the sleeve is at least one foot in length.
54. A method of treatment comprising the steps of:
anchoring with an anchoring mechanism within the gastrointestinal tract a flexible, floppy, sleeve, open at both ends, the anchoring mechanism being a stent and the stent comprising barbs that are inserted into muscle as the stent expands to anchor a proximal portion of the sleeve; and
extending the flexible, floppy sleeve into the intestine, the sleeve having a coefficient of friction of less than about 0.2, a distal portion of the flexible floppy sleeve extending beyond the anchoring mechanism and being unsupported;
wherein the sleeve is anchored distal to or within the pylorus; and
the sleeve is thin and conformable so that it collapses in the intestine to a small volume.
55. The method of claim 54 , wherein the extended sleeve limits absorption of nutrients in the duodenum.
56. The method of treatment of claim 54 , wherein the stent comprises a network of struts that is anchored within the pyloric orifice.
57. The method of treatment of claim 54 , wherein the sleeve is formed of a fluoropolymer.
58. The method of treatment of claim 54 , wherein the fluoropolymer is expanded polytetrafluoroethylene.
59. The method of claim 58 wherein the sleeve is anchored distal to the pylorus.
60. The method of claim 54 , wherein the sleeve is at least one foot in length.
61. The method of claim 54 wherein the sleeve is anchored distal to the pylorus.