Abstract:
Several embodiments disclosed herein relate to apparatus and methods for treating a diverticulum. In some examples, disclosed is a clip placement device for diverticulum inversion. The clip placement device can include a tubular body, a clip attachment structure, and a pusher structure. In some examples, the clip attachment structure has a distal end that is attachable to a clip and wherein the clip attachment structure is configured to engage with the distal end of the tubular body. In some examples, the pusher structure is configured to removeably connect to the clip attachment structure.

Description:
BACKGROUND 
       [0001]    An outpouching of the colon or other body lumen, called a diverticulum, can become the site for inflammation known as diverticulitis, microperforation and/or bleeding. Current treatments may involve the surgical removal of segments of the body lumen. For extreme cases of diverticulitis, treatment can involve colon resection and placement of a colostomy. This approach results in significant healthcare costs and substantial pain for patients. 
       SUMMARY 
       [0002]    Disclosed is a device for inverting a diverticulum. In some embodiments, disclosed is a clip placement device for diverticulum inversion including a tubular body, a clip attachment structure, and a pusher structure. In some examples, clip attachment structure has a distal end that is attachable to a clip. In some examples, the clip attachment structure is further configured to engage with the distal end of the tubular body. In some examples, the pusher structure is coaxially disposed within the tubular body. In some examples, the pusher structure is configured to removeably connect to the clip attachment structure. 
         [0003]    In some embodiments, disclosed is a method of clip placement for diverticulum inversion. In some examples, the method can include positioning a distal end of a clip placement device along an outer wall of a colon at a diverticulum. In some examples, the method can further include inverting the diverticulum into the lumen of the colon with the distal end of the clip placement device, wherein the clip placement device comprises a tubular body and a pusher structure that is coaxially disposed within the tubular body, and wherein the pusher structure is configured to attach to a clip attachment structure. In some examples, the method can include attaching the clip attachment structure to the pusher structure, wherein the clip attachment structure has a distal end that is attached to a clip. In some examples, the method can further include advancing the pusher structure and the attached clip attachment structure along the tubular body until the clip protrudes from the distal end of the tubular body. 
         [0004]    In other embodiments, the method can further include withdrawing the pusher structure with the attached clip attachment structure such that the pusher structure is withdrawn from the tubular body. In some examples, the method can further include removing the attached clip attachment structure from the pusher structure. In some examples, the method can further include attaching a second clip attachment structure to the pusher structure, wherein the second clip attachment structure has a distal end that is attached to a second clip. In some examples, the method can include advancing the pusher structure and the attached second clip attachment structure along the tubular body until the second clip protrudes from the distal end of the tubular body. 
         [0005]    In other embodiments, the method can include a clip attachment structure that is configured to engage with the distal end of the tubular body. 
         [0006]    In some embodiments, disclosed is a system for clip placement and diverticulum inversion that includes a clip placement device. In some examples, the clip placement device can include a tubular body, a clip attachment structure, and a pusher structure. In some examples the clip attachment structure can have a distal end that is attached to a clip, and wherein the clip attachment structure is configured to engage with the distal end of the tubular body. In some examples, the pusher structure is coaxially disposed within the tubular body, wherein the pusher structure is configured to removeably connect to the clip attachment structure. In some examples, the system for clip placement and diverticulum inversion further includes a second clip attachment structure, wherein the second clip attachment structure has a distal end that is attached to a second clip, and wherein the second clip attachment structure is configured to engage with the distal end of the tubular body and is configured to removeably connect to the pusher structure. 
         [0007]    The foregoing summary is illustrative only and is not intended to be in any way limiting. In addition to the illustrative aspects, embodiments, and features described above, further aspects, embodiments, and features will become apparent by reference to the drawings and the following detailed description. 
     
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
         [0008]    The foregoing and other features of the present disclosure will become more fully apparent from the following description and appended claims, taken in conjunction with the accompanying drawings. Understanding that these drawings depict only several embodiments in accordance with the disclosure and are not to be considered limiting of its scope, the disclosure will be described with additional specificity and detail through use of the accompanying drawings. 
           [0009]      FIG. 1A  illustrates a side view of an embodiment of a device for inverting diverticulum with all of the components of the device exposed. 
           [0010]      FIG. 1B  illustrates a side view of the device illustrated in  FIG. 1A  with a few of the components retracted. 
           [0011]      FIGS. 1C-K  illustrate a plurality of views of a method for treating diverticulum disease using the device of  FIG. 1A . 
           [0012]      FIG. 1L  illustrates a flowchart of an embodiment of the method for treating diverticulum disease illustrated in  FIGS. 1C-K . 
           [0013]      FIG. 2A  illustrates a side view of another embodiment of a device for inverting diverticulum. 
           [0014]      FIGS. 2B-H  illustrate a plurality of views of a method for treating diverticulum disease using the device of  FIG. 2A . 
           [0015]      FIG. 3A  illustrates a side view of another embodiment of a device for inverting diverticulum. 
           [0016]      FIG. 3B  illustrates a top view of an embodiment of a closure clip in a relaxed configuration wherein the closure clip can be used with the devices illustrated in  FIGS. 1A, 2A, and 3A . 
           [0017]      FIG. 3C  illustrates a side view of the closure clip of  FIG. 3B  when it is loaded on any of the devices illustrated in  FIGS. 1A, 2A, and 3A . 
           [0018]      FIG. 3D  illustrates a side view of the closure clip of  FIG. 3B  as it is delivered to a target site. 
           [0019]      FIG. 3E  illustrates a side view of an embodiment of a clip tube of the device of  FIG. 3A . 
           [0020]      FIG. 3F  illustrates the clip tube of  FIG. 3E  that is loaded with the closure clip illustrated in  FIG. 3D . 
           [0021]      FIGS. 3G-I  illustrate a plurality of views of the distal end of an embodiment of a push rod of the device of  FIG. 3A . 
           [0022]      FIG. 3J  illustrates a side view of the clip tube of  FIG. 3E  and push rod of  FIGS. 3G-I  that is loaded with the closure clip illustrated in  FIG. 3D . 
           [0023]      FIG. 3K  illustrates a side view of the apparatus of  3 J where the closure clip is configured for delivery as illustrated in  FIG. 3E . 
           [0024]      FIG. 3L  illustrates an embodiment of a sheath of the device of  FIG. 3A . 
           [0025]      FIGS. 3M-S  illustrate a plurality of views of a method for treating diverticulum using the device of  FIG. 3A . 
           [0026]      FIG. 4  illustrates an exploded view of an embodiment of a device with swappable cartridges for inverting diverticulum. 
           [0027]      FIG. 5A  illustrates a side view of an embodiment of a device with swappable cartridges for inverting diverticulum. 
           [0028]      FIGS. 5B-D  illustrate a plurality of views of the handle of the device of  FIG. 5A . 
       
    
    
     DETAILED DESCRIPTION 
       [0029]    In the following detailed description, reference is made to the accompanying drawings, which form a part hereof. In the drawings, similar symbols typically identify similar components, unless context dictates otherwise. The illustrative embodiments described in the detailed description, drawings, and claims are not meant to be limiting. Other embodiments may be used, and other changes may be made, without departing from the spirit or scope of the subject matter presented here. It will be readily understood that the aspects of the present disclosure, as generally described herein, and illustrated in the Figures, can be arranged, substituted, combined, and designed in a wide variety of different configurations, all of which are explicitly contemplated and make part of this disclosure. 
         [0030]      FIGS. 1A-G ,  2 A-H, and  3 A-R illustrate a plurality of views of a device for inverting diverticulum in a method for treating diverticulum disease.  FIGS. 1A-G  illustrate a plurality of views of embodiments of a device for inverting diverticulum  115  in an embodiment of a method for inverting diverticula  100 .  FIGS. 2A-H  illustrate a plurality of views of another embodiment of a device for inverting diverticulum  215  in some embodiments of a method of inverting diverticula. Finally,  FIGS. 3A-R  illustrate a plurality of view of another embodiment of a device for inverting diverticulum  315  in some embodiments of a method of inverting diverticula. 
         [0031]    Turning first to the embodiment of a device for inverting diverticulum  115  illustrated in  FIG. 1A , in some embodiments the device for inverting diverticulum  115  is composed of a plurality of components that are disposed coaxially about each other. As will be illustrated in the method of inverting diverticula  100 , each of the components of the device for inverting diverticulum  115  are configured to be moveable relative to each other. 
         [0032]    In some embodiments the device for inverting diverticulum  115  can include a closer  120 , a basket shaft  122 , a sheath  126 , a clip tube  128 , a tube stop  132 , and a push rod  136 . In some embodiments, the basket shaft  122  can further include a basket  124  at the distal end. As well, in some examples, the clip tube  128  can include a section including locking structures  130  at the distal end. As will be discussed, the locking structures  130  of the clip tube  128  can help to retain a closure clip  140 . In some embodiments, the push rod  136  can further include an atraumatic tip  138  at the distal end. Each of the tubular components of the device for inverting diverticulum  115  can be composed of hardened steel. 
         [0033]    As seen in  FIG. 1A , the push rod  136  is located at the center of the device for inverting diverticulum  115 . In some embodiments, the push rod  136  includes an atraumatic tip  138  at the distal end. As will be discussed below, the atraumatic tip  138  of the push rod  136  can serve to invert a target diverticulum during the method of inverting diverticula  100 . 
         [0034]    In some examples, a tube stop  132  is disposed coaxially about the push rod  136 . In some variants, a flange  134  is located at the distal end of the tube stop  132  such that the flange  134  forms a wider diameter than the distal opening of the tube stop  132 . The push rod  136  and the tube stop  132  can move relative to each other such that the push rod  136  can be withdrawn into the tube stop  132 . In some examples, the atraumatic tip  138  has a sufficiently wide diameter such that it prevents the push rod  136  from being withdrawn entirely into the tube stop  132 . As will be discussed in more detail below, the tube stop  132 —in particular the flange  134  of the tube stop  132 —can help to adjust the angle on which the closure clip  140  is retained on the clip tube  128  as well as adjust the angle that the closure clip  140  penetrates into the target diverticulum. 
         [0035]    In some variants, a clip tube  128  is disposed about the tube stop  132 . As noted above, in some examples, the clip tube  128  includes a plurality of locking structures  130  that are located at the distal end of the clip tube  128 . The locking structures  130  can be configured to retain a closure clip  140  on the distal end of the device for inverting diverticulum  115 . The clip tube  128  is configured such that it is moveable relative to the tube stop  132 . In some examples, the locking structures  130  of the clip tube  128  can extend past the flange  134  of the tube stop  132 . As will be discussed below, the locking structures  130  can help to retain the closure clip  140  on the device for inverting diverticulum  115 . In some variants, along with the flange  134 , the locking structures  130  can adjust the angle of the closure clip  140  on the distal end of the device for inverting diverticulum  115  to better allow the closure clip  140  to engage with the tissue of the target inverted diverticulum. As well, the interaction of the flange  134  and the locking structures  130  can also allow the closure clip  140  to be deployed into the inverted diverticulum. 
         [0036]    In some embodiments, a sheath  126  can be disposed about the clip tube  128 . In some examples, the diameter of the sheath  126  should be wide enough such that it can accommodate the clip tube  128  and the attached closure clip  140 . In some examples, the purpose of the sheath  126  is to prevent the closure clip  140  or the locking structures  130  of the clip tube  128  from catching onto anything prior to deployment or placed into the inverted diverticulum. 
         [0037]    In some examples, the device for inverting diverticulum  115  can further include a basket shaft  122 . As illustrated in  FIG. 1A , in some variants, the basket shaft  122  can include a basket  124  located at the distal end of the basket shaft  122 . As the basket shaft  122  is configured to be moveable relative to the sheath  126 , the basket shaft  122  can be extended or withdrawn proximal and/or distal to the other components of the device for inverting diverticulum  115 . As will be described in more detail below, the basket  124  is configured to retain the tissue about the ostium of the inverted diverticulum. This can help to better deploy the closure clip  140  into the target tissue. 
         [0038]    Lastly, in some embodiments, the device for inverting diverticulum  115  can further include a closer  120 . In some examples, the closer  120  is configured to be disposed about the internal components of the device for inverting diverticulum  115 . As the closer  120  is moveable relative to the basket shaft  122 , the closer  120  can extend distally to cover and retain the basket  124  of the basket shaft  122 . In some examples this can help to maintain the minimal profile of the device for inverting diverticulum  115  prior to use of the device in the method of inverting diverticula  100 . 
         [0039]    As noted above, the various components of the device for inverting diverticulum  115  can be moveable relative to each other. As well, in order to maintain a minimal profile of the device for inverting diverticulum  115  prior to use of the device for inverting diverticulum  115  in the method of inverting diverticula  100 , the closer  120  can be used to retain the basket  124  of the basket shaft  122 . Similarly, to prevent the inadvertent deployment or interaction of the closure clip  140  with the surrounding environment, the sheath  126  can be disposed about the clip tube  128 , tube stop  132 , and the closure clip  140  retained in between.  FIG. 1B  illustrates the initial configuration of the device for inverting diverticulum  115  after the basket  124  is released from the closer  120 . As described, the sheath  126  is disposed about the clip tube  128 , tube stop  132 , and the closure clip  140 . 
         [0040]    Once the device for inverting diverticulum  115  has been inserted into the body, the device can be used to treat a diverticulum.  FIG. 1L  illustrates a flow chart of the method of inverting diverticula  100 . Each of the steps of the method of inverting diverticula  100  are illustrated in  FIGS. 1C-K . In the method of inverting diverticula  100 , the device for inverting diverticulum  115  is used to treat a diverticulum  110  that is located on the surface of the outer wall of colon  116   
         [0041]      FIG. 1C  illustrates step  101  in the method of inverting diverticula  100 . As illustrated, the outer wall of colon  116  includes a diverticulum  110  that protrudes from the diverticulum  110 . In some embodiments, in step  101 , the atraumatic tip  138  of the push rod  136  is extended to contact the top surface of the diverticulum  110 . In some examples, the atraumatic tip  138  enters substantially perpendicular to the colon surface. Initial contact adjustments may be necessary in order to evenly contact the diverticulum  110 . 
         [0042]    Next, as illustrated in  FIG. 1D , the diverticulum  110  is inverted at step  102 . In some embodiments, as can be seen, the push rod  136  can extend distally such that the atraumatic tip  138  compresses the diverticulum  110  to force it to invert. As the diverticulum  110  inverts, the outer lip of the tissue of the diverticulum  110  can form an ostium that can provide the closure clip  140  with tissue to engage with. 
         [0043]    Once the diverticulum  110  has been inverted, as illustrated in  FIG. 1E , step  103  involves fully forming the inverted diverticulum  112  and preparing the basket  124  to engage with the surrounding tissue of the ostium  114 . As can be seen, after the diverticulum  110  is inverted with the atraumatic tip  138  of the push rod  136 , the sheath  126  with the retained clip tube  128 , tube stop  132 , and closure clip  140  can be further advanced into the inverted diverticulum  112 . The advancing of the device into the inverted diverticulum  112  better allows the tines of the basket  124  to engage with the ostium tissue  114  in tension (not pictured in  FIG. 1E ). In some examples, prior to the basket  124  touching the tissue of the ostium  114 , the diameter of the basket  124  can be adjusted to 2-3 mm greater than the ostium  114 . In some embodiments, once the basket  124  engages with the ostium  114  tissue, the outer wall of colon  116  is depressed by approximately 1 inch. 
         [0044]    Next,  FIG. 1F  illustrates step  104  which describes tissue acquisition by the basket  124  once the device for inverting diverticulum  115  is in position. As illustrated, while the tissue of the inverted diverticulum  112  and ostium  114  are still under tension by the inserted distal end of the device for inverting diverticulum  115 , the basket  124  is closed about the ostium  114  to draw up the tissue evenly. In some embodiments, this is accomplished by advancing the closer  120  distally past the tines of the basket  124 . As the closer  120  is advanced, the tines of the basket  124  are drawn together to capture the tissue of the ostium  114 . In some embodiments, if the tines of the basket  124  slip or the creases of the captured tissue are largely asymmetrical, the basket  124  can be opened and step  104  can be repeated. 
         [0045]    Once the tissue of the ostium  114  has been captured by the basket  124 , step  105  as illustrated in  FIGS. 1G-H  disclose deploying and engaging of the closure clip  140  with the tissue of the ostium  114  while located in the inverted diverticulum  112 . As illustrated in  FIG. 1G , the inverted diverticulum  112  can be expanded (e.g. with gas) to allow the closure clip  140  to expand. As described above, the attached closure clip  140  can be expanded to allow the clip tines  142  to flare outwards by withdrawing the sheath  126  in a proximal direction. In some embodiments, the withdrawn sheath  126  allows the clip tines  142  of the closure clip  140  to flare outwards. In some embodiments, as illustrated in  FIG. 1H , the clip tube  128  and the tube stop  132  are withdrawn proximally to engage with the tissue of the inverted diverticulum  112  and ostium  114 . As discussed, in some examples, because the inverted diverticulum  112  is expanded with gas, this prevents the inverted diverticulum  112  tissue from bunching up over the tines. As illustrated, the clip tines  142  of the closure clip  140  are targeted to penetrate into the outer wall of colon  116 . 
         [0046]    In some examples, once the closure clip  140  has penetrated into the tissue, the method of inverting diverticula  100  can further include step  106  which illustrates the releasing of the closure clip  140  into the tissue. As illustrated in  FIG. 1I , the inverted diverticulum  112  is longer inflated (e.g. the gas can be stopped). To release the closure clip  140  into the target tissue, the clip tube  128  can first be withdrawn proximally. In some examples, the proximal withdrawing of the locking structures  130  releases the closure clip  140  from the angle on the clip tube  128  and allows the closure clip  140  to begin to rotate into its final position. The tube stop  132  is not withdrawn so as to maintain the closure clip  140  on the device. Next, as illustrated in  FIG. 1J , after the clip has rotated into its final position (e.g. planar position), the tube stop  132  is withdrawn in a proximal direction. In some examples, the tube stop  132  and the flange  134  slips through the center of the inserted closure clip  140 . As well, as illustrated in  FIG. 1J , the basket  124  can be opened to release the tissue of the ostium  114 . In some embodiments (not pictured), the closure clip  140  can be sprung to the clip tube  128  such that the withdrawal of the tube stop  132  and flange  134  can be self-driven. 
         [0047]    Finally, the device for inverting diverticulum  115  can be removed from the inverted diverticulum  112  in step  107  as illustrated in  FIG. 1K . To remove the device for inverting diverticulum  115  from the inverted diverticulum  112 , the push rod  136  and atraumatic tip  138  can be withdrawn gently to pull it past the implanted closure clip  140 . As seen in  FIG. 1K , once the push rod  136  and atraumatic tip  138  are removed from the inverted diverticulum  112 , the closure clip  140  is allowed to rotate such that it is fully flattened. In some examples, as the closure clip  140  flattens, the clip tines  142  of the closure clip  140  capture the tissue of the ostium  114  so as to flatten and secure the inverted diverticulum  112  closed on the outer wall of colon  116 . 
         [0048]      FIGS. 2A-H  illustrates another embodiment of the device for inverting diverticulum  215 .  FIG. 2A  illustrates a side perspective of the distal end of the device for inverting diverticulum  215 . 
         [0049]    Turning now to another embodiment of a device for inverting diverticulum  215 , in some embodiments the device for inverting diverticulum  215  is composed of a plurality of components that are disposed coaxially about each other. Similar to the method of inverting diverticula  100 , in the method of inverting diverticula  200  as illustrated in  FIGS. 2B-H , each of the components of the device for inverting diverticulum  215  are configured to be moveable relative to each other. 
         [0050]    In some embodiments, the device for inverting diverticulum  215  can include a closer  220 , a basket shaft  222 , a ramp tube  244 , and a push rod  236 . As can be seen, the device for inverting diverticulum  215  is largely similar to the device for inverting diverticulum  115  with a few adjustments. For example, in some embodiments, the device for inverting diverticulum  215  includes a ramp tube  244  that can further include a ramped portion  246  at the distal end of ramp tube  244 . Unlike the closure clip  140  in the device for inverting diverticulum  115  that is attached to the locking structures  130  of the clip tube  128 , the closure clip  240  is disposed about the push rod  236 . In some embodiments, the atraumatic tip  238  of the device for inverting diverticulum  215  can further include an inner opening  237 . Each of the tubular components of the device for inverting diverticulum  115  can be composed of hardened steel. 
         [0051]    As illustrated in  FIG. 2A , the push rod  236  is located at the center of the device for inverting diverticulum  215 . In some embodiments, the push rod  236  includes an atraumatic tip  238  at the distal end. In some examples, at the connection point between the push rod  236  and the atraumatic tip  238 , the outer surface of the push rod  236  and the inner surface of the atraumatic tip  238  can form an inner opening  237 . In some examples, the inner opening  237  can be configured to accommodate a portion of the closure clip  240  to adjust the angle that the closure clip  240  is located on the push rod  236 . In other embodiments, the inner opening  237  of the atraumatic tip  238  can help to keep the closure clip  240  in a “safe” position prior to delivery. As will be discussed below, when it is ready to deliver the closure clip  240 , the atraumatic tip  238  can be withdrawn to guide the closure clip  240  into the ramped position. 
         [0052]    In some examples, the ramp tube  244  is disposed coaxially about the push rod  236 . In some variants, the ramp tube  244  includes a ramped portion  246  that is located at the distal end of the ramped portion  246 . The ramp tube  244  can be moveable relative to the push rod  236 . In some examples, the ramped portion  246  of the ramp tube  244  can move an attached closure clip  240  into the inner opening  237  of the atraumatic tip  238  to alter the angle of the closure clip  240 . The ramped portion  246  can help to adjust the angle on which the closure clip  240  is retained on the push rod  236  as well as to adjust the angle that the closure clip  240  penetrates into the target diverticulum. The ramped portion  246  can flare the clip into delivery position. 
         [0053]    In some variants, the basket shaft  222  can be disposed about the ramp tube  244 . In some examples, the basket shaft  222  can include a basket  224  located at the distal end of the basket shaft  222 . As the basket shaft  222  is configured to be moveable relative to the ramp tube  244 , the basket shaft  222  can be extended or withdrawn proximal and/or distal to the other components of the device for inverting the diverticulum  215 . As will be described in more detail below, the basket  224  can be configured to retain the tissue about the ostium of the inverted diverticulum. This can help to better deploy the closure clip  240  into the target tissue. 
         [0054]    In some embodiments, the device for inverting diverticulum  215  can further include a closer  220 . In some examples, the closer  220  is configured to be disposed about the internal components of the device for inverting diverticulum  215 . As the closer  220  is moveable relative to the basket shaft  222 , the closer  220  can extend distally to cover and retain the basket  224  of the basket shaft  222 . In some examples, this can help to maintain the minimal profile of the device for inverting diverticulum  215  prior to use of the device in the method of inverting diverticula. 
         [0055]    The device for inverting diverticulum  215  can be used to treat a diverticulum.  FIGS. 2B-H  illustrate one embodiment of the method of inverting diverticula. The method of inverting diverticula is generally similar to the method of inverting diverticula  100 . 
         [0056]      FIG. 2B  illustrates step  201  in the method of inverting diverticula. As illustrated, in some embodiments, after the device for inverting diverticulum  215  is inserted through the trocar, the closer  220  can be withdrawn in a proximal direction to release the  22  and the basket  224 . The device for inverting diverticulum  215  can then be advanced until the basket  224  is centered on the target diverticulum  210 . 
         [0057]    Next, at  FIG. 2C , the method of inverting diverticula can include step  202  wherein the atraumatic tip  238  on the push rod  236  can be advanced in a distal direction to invert the diverticulum  210 . In some embodiments, the distal end of the atraumatic tip  238  can be spring loaded to prevent excessive force from being placed on the diverticulum  210  and in order to accommodate diverticulum  210  of different sizes. In some examples, at step  202 , the closure clip  240  is retracted into the inner opening  237  of the atraumatic tip  238 . In this configuration, the clip tines  242  is in a “safe” position, such that the clip tines  242  do not interfere with any tissue as it is inserted into the inverted diverticulum  112 . In some examples, the inverted diverticulum  212  can be inflated (e.g. with gas) to allow better presentation of the ostium  214  to the closure clip  240 . 
         [0058]    In some embodiments, the method of inverting diverticula can include step  203  illustrated in  FIG. 2D . Here, the basket  224  of the basket shaft  222  is closed around the tissue of the ostium  214  formed from the inverted diverticulum  212  on the outer wall of colon  216 . In some examples, the basket  224  can grab the tissue by advancing the closer  220  in a distal direction until it completely covers the length of the basket  224 . This can allow the basket  224  to pull and secure the healthy tissue of the ostium  214  around the ramp tube  244 . 
         [0059]    As illustrated in  FIG. 2E , the method of inverting diverticula can include step  204  wherein the closure clip  240  is ramped into a “deploy” position. In some examples, at step  204 , the push rod  236  is withdrawn in a distal direction with respect to the ramp tube  244 . The ramped portion  246  of the ramp tube  244  can guide the closure clip  240  into the “deploy” position. In some examples, in the “deploy” position, the clip tines  242  of the closure clip  240  are flared outwards and engage with the gathered tissue at the ostium  214  of the inverted diverticulum  212 . In some embodiments (not illustrated) the closure clip  240  can be released by continuing to withdraw the atraumatic tip  238  in a proximal direction. While the inner ledge  237  holds the clip in place, the movement of the atraumatic tip  238  is under the clip and ejects the closure clip  240  into the tissue as the closure clip  240  is moved along the ramped portion  246  of the ramp tube  244 . Once the closure clip  240  is free of the inner ledge  237 , it can begin to expand outwardly to return to its original planar shape. 
         [0060]    Once the clip tines  242  of the closure clip  240  has been inserted into the tissue of the ostium  214 , the method of inverting diverticula can proceed to step  205 . As illustrated in  FIG. 2F , the closer  220  can be withdrawn in a distal direction. As the closer  220  is withdrawn, the basket  224  can be opened—thereby releasing the gathered tissue of the ostium  214  around the neck of the inverted diverticulum  212 . 
         [0061]    In some embodiments, the method of inverting diverticula can then include step  206  as illustrated in  FIG. 2G . Once the clip tines  242  of the closure clip  240  are secured in the tissue of the ostium  214 , the push rod  136  can be advanced in a distal direction. In doing so, the closure clip  240  is released from the inner opening  237  of the atraumatic tip  238 . This can allow the closure clip  240  to rotate with the clip tines  242  in gripping tissue around the ramp tube  244 . 
         [0062]    Once the closure clip  240  has been released from the inner opening  237  of the atraumatic tip  238 , the method of inverting diverticula can proceed to step  207  where the device for inverting diverticulum  215  is retracted from the inverted diverticulum  112 . In some embodiments, once the closure clip  240  has been released, the ramp tube  244 , the ramped portion  246  of the ramp tube  244 , the push rod  236 , and the atraumatic tip  238  of the push rod  236  can be retracted through the ostium  214  of the inverted diverticulum  112 . In some examples, once the distal end of the device for inverting diverticulum  215  has been fully retracted, the closure clip  240  can closed to its natural flat shape and grip the healthy tissue of the ostium  214  together with the clip tines  242 . 
         [0063]    Finally,  FIGS. 3A-S  illustrate another embodiment of the device for inverting diverticulum  315 .  FIG. 3A  illustrates a side perspective of the distal end of the device for inverting diverticulum  315 .  FIGS. 3B-L  illustrate a plurality of views of the components in the device for inverting diverticulum  315 . Many of the illustrations of the components of the device for inverting diverticulum  315  can be similarly applicable to the device for inverting diverticulum  115  and device for inverting diverticulum  215  discussed above. 
         [0064]    The device for inverting diverticulum  315  has elements that resemble or are similar to the device for inverting diverticulum  115  and device for inverting diverticulum  215  described above. Accordingly, numerals used to identify features of the device for inverting diverticulum  115  and device for inverting diverticulum  215  are incremented by a factor of one hundred to identify like features of the device for inverting diverticulum  315 . This numbering conventional generally applies to the remainder of the figures. Any component or step disclosed in any embodiment in this specification can be used in other embodiments. 
         [0065]    In some embodiments, the device for inverting diverticulum  315  (as illustrated in  FIG. 3A ), can be composed of a plurality of components that are disposed coaxially about each other. As will be illustrated in the method of inverting diverticula, each of the components of the device for inverting diverticulum  315  are configured to be moveable relative to each other. Unlike the previous two embodiments, in some examples, the device for inverting diverticulum  315  does not include a basket for securing the ostium of the inverted diverticulum. As discussed above, in some embodiments, each of the tubular components of the device for inverting diverticulum  115  can be composed of hardened steel. 
         [0066]    As seen in  FIG. 3A , the push rod  336  is located at the center of the device for inverting diverticulum  315 . As can be seen, in some embodiments, the closure clip  340  is disposed about the push rod  336  of the device. In some embodiments, the push rod  336  can include an atraumatic tip  338  at the distal end. 
         [0067]      FIGS. 3B-D  illustrate a plurality of views of the closure clip  340 . Each of these illustrations can be applicable to any discussion of the closure clip provided above.  FIG. 3B  illustrates a top view of an embodiment of the closure clip  340  in its relaxed state. In its relaxed state, the closure clip  340  is flat with the clip tines  342  pointing inward. In some embodiments, this is the form the closure clip  340  will take after it has been delivered inside of the inverted diverticulum  112 . In some embodiments, the closure clip  340  can have tines that are 1.88 mm.  FIG. 3C  illustrates the closure clip  340  as it is loaded on the locking structures  330  of the clip tube  328 . In this loaded state, the closure clip  340  is in a semi-flared shape. Lastly,  FIG. 3D  illustrates the closure clip  340  as it is flared even more for delivery to capture the tissue in the ostium  314 . As was discussed, and will be discussed below, in the various embodiments of the method of inverting diverticula, the flaring of the clip tines  342  provide the closure clip  340  with a broader reach to engage the surrounding tissue of the ostium  314 . 
         [0068]    In some examples, at the connection point between the push rod  336  and the atraumatic tip  338 , the outer surface of the push rod  336  and the inner surface of the atraumatic tip  338  can form an inner opening  337 . In some examples, the inner opening  337  can be configured to accommodate a portion of the closure clip  340  to adjust the angle that the closure clip  340  is located on the push rod  336 .  FIGS. 3G-I  illustrate a side, top, and cross-sectional view of the atraumatic tip  338 . As is illustrated, the inner opening  337  provided between the outer surface of the push rod  336  and the inner surface of the atraumatic tip  338  provides an opening to accommodate a portion of the closure clip  340 . As well, as illustrated in  FIG. 3H , in some embodiments, the inner opening  337  can include a ledge that is adjacent the outer surface of the push rod  336 . 
         [0069]    In some examples, a clip tube  328  can be disposed about the push rod  336 . In some embodiments, the clip tube  328  includes locking structures  330  at the distal end of the clip tube  328 . As will be discussed in more detail below, the locking structures  330  can engage with the closure clip  340  that is disposed about the push rod  336  to secure the closure clip  340  on the distal end of the device for inverting diverticulum  315 . As noted above, because the clip tube  328  and the push rod  336  are moveable relative to each other, withdrawing or advancing the clip tube  328  can cause the locking structures  330  to interact with the closure clip  340  to alter the angle in which the clip tines  342  are flared on the distal end of the device. 
         [0070]      FIGS. 3E-F  illustrate the clip tube  328  and a bottom perspective view of the clip tube  328  with closure clip  340  engaged. As illustrated in  FIG. 3E , the locking structures  330  can include a plurality of equally spaced structures.  FIG. 3F  illustrate the closure clip  340  as it is engaged with the locking structures  330 . As seen, each apex of the closure clip  340  is linked around the locking structures  330  to create the loaded flare shape—wherein the clip tines  342  are flared outwards and pointed in a proximal direction. 
         [0071]      FIGS. 3J-K  provide an illustration of the interaction between the locking structures  330  of the clip tube  328 , the closure clip  340 , and the atraumatic tip  338  of the push rod  336 .  FIG. 3J  illustrates the closure clip  340  as it is loaded on the clip tube  328 . In some examples, as the atraumatic tip  338  is moved up towards the clip tube  328 , the ledge in the inner opening  337  can bump the apices of the closure clip  340 . This can push them upward to cause a larger flare.  FIG. 3K  illustrates the distal end of the device for inverting diverticulum  315  and the configuration of the closure clip  340  during delivery. The structure of the inner opening  337  and atraumatic tip  338  allows the closure clip  340  to be pulled into the tissue without being inverted due to the force. 
         [0072]    Lastly, in some embodiments, the device for inverting diverticulum  315  can further include a sheath  326  that can be disposed about the clip tube  328 . In some examples, as seen in  FIG. 3L , the sheath  326  can be wide enough such that it can accommodate the clip tube  328  and the attached closure clip  340 . In some examples, the purpose of the sheath  326  is to prevent the closure clip  340  or the locking structures  330  of the clip tube  328  from unintentionally interacting with any tissue prior to deployments of the closure clip  340 . The sheath  326  therefore protects the surrounding tissue as the device for inverting diverticulum  315  is inserted. As will be seen, the sheath  326  can be removed prior to deployment. 
         [0073]    As discussed above, the device for inverting diverticulum  315  can be used to treat a diverticulum.  FIGS. 3M-S  illustrate another embodiment of the method of inverting diverticula. However, as will be discussed below, unlike the method of inverting diverticula discussed above, the device for inverting diverticulum  315  in the method of inverting diverticula does not include a basket for capturing the tissue of an inverted diverticula. 
         [0074]      FIG. 3M  can illustrate step  301  in the method of inverting diverticula. As is illustrated, the outer wall of colon  316  can include a diverticulum  310  that protrudes from the surface of the colon. In some embodiments, the atraumatic tip  338  located at the distal end of the device for inverting diverticulum  315  can be used to manually invert the diverticulum  310 . 
         [0075]      FIG. 3N  next illustrates step  302  which shows the distal end of the device for inverting diverticulum  315  located in the inverted diverticulum  312 . The distal end of the atraumatic tip  338  can further push into the inverted diverticulum  312  such that the ostium  314  is disposed snugly about the sheath  326 . 
         [0076]    The method of inverting diverticula can then include step  303  as illustrated in  FIG. 3O . In some embodiments, at step  303 , the sheath  326  is withdrawn in a proximal direction such that the closure clip  340  is exposed within the inverted diverticulum  312 . As discussed above, the closure clip  340  at this stage is in the configuration illustrated in  FIG. 3C , wherein the closure clip  340  is in a semi-flared state. In some examples, the inverted diverticulum  312  can be inflated (e.g. with gas) to allow better presentation of the ostium  214  to the closure clip  340 . 
         [0077]    In some examples, as illustrated in  FIG. 3P , the method of inverting diverticula can include step  304  wherein the push rod  336  and the atraumatic tip  338  is retracted in a distal direction. As the push rod  336  is retracted, the ledge located within the atraumatic tip  338  (not pictured) can pull the closure clip  340  in a proximal direction, causing the closure clip  340  to flare to a larger diameter. In some examples, the closure clip  340  can be in the configuration illustrated in  FIG. 3D  wherein the flaring of the clip tines  342  can provide the closure clip  340  with a broader reach in order to engage the surrounding tissue of the ostium  314 . 
         [0078]    Once the closure clip  340  is flared outwards, the method of inverting diverticula can then include step  305  wherein the entirety of the device for inverting diverticulum  315  is retracted in a proximal direction. In some embodiments, as illustrated in  FIG. 3Q , the device for inverting diverticulum  315  can be retracted in a proximal direction, this can serve to seat the clip tines  342  of the closure clip  340  into the surrounding tissue of the ostium  314 . In some examples, once the clip tines  342  are in the surrounding tissue of the ostium  314 , the closure clip  340  is ready to be released. 
         [0079]    In some examples, the method of inverting diverticula can then include step  306  in order to begin the step of releasing the closure clip  340  into the tissue of the ostium  314 . As illustrated in  FIG. 3R , the atraumatic tip  338  of the push rod  336  is advanced in a distal direction. This can relax the closure clip  340  from the flared configuration to a semi-flared configuration. In some examples, the advancing of the atraumatic tip  338  in the inverted diverticulum  112  can allow the closure clip  340  to be released from the locking structures  330  of the clip tube  328 . In some embodiments, (not illustrated) the push rod  336  can include a ramped portion. The closure clip  340  can be released by continuing to withdraw the atraumatic tip  338  in a proximal direction to cause the closure clip  340  to be ejected from the push rod  336 . 
         [0080]    Once the closure clip  340  has been released from the locking structures  330  of the clip tube  328 , the distal end of the device for inverting diverticulum  315  can be retracted from the inverted diverticulum  112 . As illustrated in  FIG. 3S , in some embodiments, the configuration of the closure clip  340  can allow the atraumatic tip  338  to be pulled through the center of the closure clip  340 . As the distal end of the device for inverting diverticulum  315  is pulled from the ostium  314  of the inverted diverticulum  312 , the closure clip  340  can close around the captured tissue of the ostium  314 . In some examples, the closure clip  340  can take the form of the closure clip  340  illustrated in  FIG. 3B . 
         [0081]    As described above, in some embodiments, the above steps described for the method of inverting diverticula  100 , can be used to successfully invert a diverticulum  110 ,  210 ,  310  and place a closure clip  140 ,  240 ,  340  in the inverted diverticulum  112 ,  212 ,  312 . In some examples, the device for inverting diverticulum  115 ,  215 ,  315  can be configured such that the user can use a different closure clip  140 ,  240 ,  340 , than initially inserted. 
         [0082]    For example, after the healthy tissue on the ostium  114 ,  214 ,  314 , has been gathered, the user can determine that the size of the closure clip  140 ,  240   340  required is a different size (e.g. smaller or larger) than initially presumed. This would therefore require that the clip be removed from the device and steps in the method would need to be repeated as the device with an appropriately sized clip is reinserted. Described below is an example of a device for inverting diverticulum  415  that enables the user to swap out the closure clip  440  (or even delay introduction of the closure clip  440 ) until the target tissue has been gathered and an assessment of the closure clip  440  requirements has been made. This same feature can allow for a significant increase in the speed in the speed of a procedure involving treating a plurality of diverticulum. In some examples, it could obviate the need for repeated removal and re-introduction of new devices containing integrated closure clips  440 . In other examples, this could enable a single device for inverting diverticulum  415  to be used for treating multiple diverticulum and delivering a plurality of closure clip  440  which could produce a reduction of cost in performing the procedure. 
         [0083]      FIGS. 4 and 5A -D illustrate an example of a device for inverting diverticulum  415  that includes a swappable cartridge.  FIG. 4  illustrates an exploded view of a device for inverting diverticulum  415  with swappable cartridge.  FIG. 5A  illustrates a side view of the device for inverting diverticulum  415  with swappable cartridge.  FIGS. 5B-D  illustrates a plurality of views of the handle of the device for inverting diverticulum  415  of  FIG. 5A . 
         [0084]      FIG. 4  illustrates an embodiment of a device for inverting diverticulum  415 . In some examples, the device for inverting diverticulum  415  can include a handle  452 . In some variants, the handle  452  can be attached to a plurality of components. As illustrated, the device for inverting diverticulum  415  can include a tissue tube  448 , a basket shaft  422 , a closer  420 , a push rod  436 , and a cartridge  454 . Each of the components can be configured to be moveable relative to each other. As well, in some examples, each of the components can be coaxially disposed about each other. 
         [0085]    In some examples, the device for inverting diverticulum  415  can include a tissue tube  448 . During use, the tissue tube  448  can be located coaxially between the clip tube  428  and the basket shaft  422 . The purpose of the tissue tube  448  is to support the tissue of the ostium of the inverted diverticulum when the clip tube  428  has not been inserted into the device for inverting diverticulum  415 . In some examples, the tissue tube  448  can include castellated structures  450  at the distal end. As was discussed above, the purpose of the castellated structures  450  is to engage the closure clip  440  of the device for inverting diverticulum  415  and to provide the closure clip  440  with access to the tissue during treatment. 
         [0086]    As with the other devices described above, the device for inverting diverticulum  415  can include a basket shaft  422 . In some embodiments, the basket shaft  422  can be coaxially disposed about the tissue tube  448  such that the tissue tube  448  can be advanced or withdrawn relative to the tissue tube  448 . In some examples, the basket shaft  422  can include a basket  424  located at the distal end of the basket shaft  422 . The basket  424  of the basket shaft  422  can serve the same purpose as the baskets described above for the device for inverting diverticulum  115 ,  215 ,  315 . As noted previously, the basket  424  can be used to gather the tissue of the ostium of the inverted diverticulum prior to clip placement. 
         [0087]    In some embodiments, the device for inverting diverticulum  415  can include a closer  420  that is a tube that can be coaxially disposed about the basket shaft  422 . In some examples, as described above for the device for inverting diverticulum  115 ,  215 ,  315 , the closer  420  can be configured to advance distally about the proximal end of the basket  424 . This can narrow the basket  424  as it is gathering the tissue of the ostium of the inverted diverticulum. 
         [0088]    In some examples, the device for inverting diverticulum  415  can include a push rod  436  that can be advanced coaxially with the tissue tube  448 , such that the tissue tube  448  is disposed about the push rod  436 . In some embodiments, the push rod  436  can have an atraumatic tip  438  located on the distal end of the push rod  436 . As discussed above, in some examples, the atraumatic tip  438  can be used to invert a diverticulum during treatment. In some examples, the push rod  436  can include a cartridge  454  that is configured to attach to a portion of the push rod  436 . The cartridge  454  can be introduced into the handle  452  and can be advanced to the distal end of the device. 
         [0089]    In order to provide a swappable closure clip  440 , the device for inverting diverticulum  415  can be configured to include a clip tube  428  with a closure clip  440  attached to the distal end. In some embodiments, the cartridge  454  can be loaded with the closure clip  440  (and/or the clip tube  428 ) such that the closure clip  440  can be inserted into the device for inverting diverticulum  415  after the device for inverting diverticulum  415  has gathered the ostium tissue with the basket  424 . As discussed above, this can provide the benefit of inserting a closure clip  440  after the size and/or shape of the ostium of the inverted diverticulum has been determined. As well, in some embodiments, the attachment of the closure clip  440  to the swappable cartridge  454  enables the user to deploy a plurality of closure clips  440  in the treatment of a plurality of diverticulum. 
         [0090]      FIG. 5A  illustrates a side view of the device for inverting diverticulum  415  with a cross-sectional view of the handle  452 . As illustrated, the device for inverting diverticulum  415  can include a handle  452  on the proximal end  458  of the device for inverting diverticulum  415 . The handle  452  can include a plurality of components that provide control of the distal end  457  of the device for inverting diverticulum  415  which engages and treats a diverticulum. 
         [0091]      FIG. 5B-D  illustrates a plurality of views of a handle  452  on a device for inverting diverticulum  415 . In some embodiments, the  425  can include an actuator  456 , a rotary cam drive  453 , and an opening on the distal end  457  of the handle  452  that allows the insertion of the cartridge  454 . 
         [0092]    As illustrated, the cartridge  454  can be inserted into the distal end  457  of the handle  452 . The cartridge  454  can include a rotary engagement  455  that is located on a surface of the cartridge  454 . As the cartridge  454  is inserted, the rotary engagement  455  of the cartridge  454  can engage with a pathway located on a surface of the rotary cam drive  453 . In some examples, the actuator  456  on the handle  452  can turn the rotary cam drive  453  when actuated. As the rotary cam drive  453  turns, it rotates the pathway located on the surface of the rotary cam drive  453  and advances the cartridge  454  in a distal direction. Once introduced, the cartridge  454  can engage with the handle  452  and enable continuation of an integrated closure clip  440  delivery process starting from the moment of introduction. 
         [0093]    While the description generally refers to colonoscopies and treatments within a colon, the devices and methods described herein are not limited to applications within a colon. They can be used to invert and/or treat outpocketings (e.g., diverticula, aneurisms, etc.) in any body lumen. Any reference to a colonoscope should be understood to be applicable to endoscopes generally, and similarly, any reference to a colon should be understood to be applicable to any body lumen. 
         [0094]    With respect to the use of substantially any plural and/or singular terms herein, those having skill in the art can translate from the plural to the singular and/or from the singular to the plural as is appropriate to the context and/or application. The various singular/plural permutations may be expressly set forth herein for sake of clarity. 
         [0095]    It will be understood by those within the art that, in general, terms used herein, and especially in the appended claims (e.g., bodies of the appended claims) are generally intended as “open” terms (e.g., the term “including” should be interpreted as “including but not limited to,” the term “having” should be interpreted as “having at least,” the term “includes” should be interpreted as “includes but is not limited to,” etc.). It will be further understood by those within the art that if a specific number of an introduced claim recitation is intended, such an intent will be explicitly recited in the claim, and in the absence of such recitation no such intent is present. For example, as an aid to understanding, the following appended claims may contain usage of the introductory phrases “at least one” and “one or more” to introduce claim recitations. However, the use of such phrases should not be construed to imply that the introduction of a claim recitation by the indefinite articles “a” or “an” limits any particular claim containing such introduced claim recitation to embodiments containing only one such recitation, even when the same claim includes the introductory phrases “one or more” or “at least one” and indefinite articles such as “a” or “an” (e.g., “a” and/or “an” should be interpreted to mean “at least one” or “one or more”); the same holds true for the use of definite articles used to introduce claim recitations. In addition, even if a specific number of an introduced claim recitation is explicitly recited, those skilled in the art will recognize that such recitation should be interpreted to mean at least the recited number (e.g., the bare recitation of “two recitations,” without other modifiers, means at least two recitations, or two or more recitations). Furthermore, in those instances where a convention analogous to “at least one of A, B, and C, etc.” is used, in general such a construction is intended in the sense one having skill in the art would understand the convention (e.g., “a system having at least one of A, B, and C” would include but not be limited to systems that have A alone, B alone, C alone, A and B together, A and C together, B and C together, and/or A, B, and C together, etc.). In those instances where a convention analogous to “at least one of A, B, or C, etc.” is used, in general such a construction is intended in the sense one having skill in the art would understand the convention (e.g., “a system having at least one of A, B, or C” would include but not be limited to systems that have A alone, B alone, C alone, A and B together, A and C together, B and C together, and/or A, B, and C together, etc.). It will be further understood by those within the art that virtually any disjunctive word and/or phrase presenting two or more alternative terms, whether in the description, claims, or drawings, should be understood to contemplate the possibilities of including one of the terms, either of the terms, or both terms. For example, the phrase “A or B” will be understood to include the possibilities of “A” or “B” or “A and B.” 
         [0096]    In addition, where features or aspects of the disclosure are described in terms of Markush groups, those skilled in the art will recognize that the disclosure is also thereby described in terms of any individual member or subgroup of members of the Markush group. 
         [0097]    As will be understood by one skilled in the art, for any and all purposes, such as in terms of providing a written description, all ranges disclosed herein also encompass any and all possible sub-ranges and combinations of sub-ranges thereof. Any listed range can be easily recognized as sufficiently describing and enabling the same range being broken down into at least equal halves, thirds, quarters, fifths, tenths, etc. As a non-limiting example, each range discussed herein can be readily broken down into a lower third, middle third and upper third, etc. As will also be understood by one skilled in the art all language such as “up to,” “at least,” “greater than,” “less than,” and the like include the number recited and refer to ranges which can be subsequently broken down into sub-ranges as discussed above. Finally, as will be understood by one skilled in the art, a range includes each individual member. Thus, for example, a group having 1-3 articles refers to groups having 1, 2, or 3 articles. Similarly, a group having 1-5 articles refers to groups having 1, 2, 3, 4, or 5 articles, and so forth. 
         [0098]    While various aspects and embodiments have been disclosed herein, other aspects and embodiments will be apparent to those skilled in the art. The various aspects and embodiments disclosed herein are for purposes of illustration and are not intended to be limiting, with the true scope and spirit being indicated by the following claims.