Patent Publication Number: US-11642234-B2

Title: Bariatric device and method

Description:
CROSS REFERENCE TO RELATED APPLICATIONS 
     The present invention is a continuation of prior application Ser. No. 15/805,495, filed Nov. 7, 2017, which is a continuation of application Ser. No. 15/211,034 filed Jul. 15, 2016, now U.S. Pat. No. 9,839,545, which is a continuation of U.S. patent application Ser. No. 14/920,403, filed on Oct. 22, 2015, now U.S. Pat. No. 9,414,948, which is a continuation of U.S. patent application Ser. No. 14/314,444, filed on Jun. 25, 2014, now U.S. Pat. No. 9,198,789, which is a continuation of U.S. patent application Ser. No. 14/142,131, filed on Dec. 27, 2013, now U.S. Pat. No. 8,801,599, which is a continuation of U.S. patent application Ser. No. 13/331,425 filed on Dec. 20, 2011, now U.S. Pat. No. 8,672,831, which is a continuation of U.S. patent application Ser. No. 12/915,952, filed on Oct. 29, 2010, now U.S. Pat. No. 8,100,931, which is a continuation of U.S. patent application Ser. No. 11/463,192, filed on Aug. 8, 2006, now U.S. Pat. No. 7,846,174, which is continuation-in-part application of International Application No. PCT/US2005/036991, filed on Oct. 13, 2005, entitled BARIATRIC DEVICE AND METHOD, which claims the benefit of Ser. No. 60/619,308 filed on Oct. 15, 2004; and claims the benefit of Ser. No. 60/632,147 filed on Dec. 1, 2004; and claims the benefit of Ser. No. 60/636,845 filed on Dec. 15, 2004; and claims the benefit of Ser. No. 60/711,310 filed on Aug. 25, 2005, the disclosures of which are incorporated herein in their entirety. 
    
    
     BACKGROUND OF THE INVENTION 
     The present invention is directed to a bariatric device and method of causing at least partial satiety in a patient. In particular, the present invention is directed to a bariatric device and a method of causing at least partial satiety in a patient by a noninvasive or minimally invasive technique. 
     Obesity is a large and increasing problem in the United States and worldwide. In round numbers, from the period encompassing the year 1990 to the period encompassing the year 2000, the prevalence of overweight people (BMI greater than 25) increased from 56 percent of United States adults to 65 percent and the prevalence of obese adults (BMI greater than 30) increased from 23 percent to 30 percent. Likewise, the prevalence of overweight children and adolescents (ages 6-19 years) increased from 11 percent in the period encompassing the year 1990 to 16 percent in the period encompassing the year 2000. The increasing prevalence of overweight among children and adolescents will make the problem even greater when they reach adulthood. The problem is not limited to the United States. Between 10 percent and 20 percent of European men are obese and between 10 percent and 25 percent of European women are obese. Numerous medical conditions are made worse by obesity including Type II diabetes, stroke, gallbladder disease and various forms of cancer. Approximately 500,000 people in North America and Western Europe are estimated to die from obesity-related diseases every year and obesity is estimated to affect more than one billion adults worldwide. Therefore, there is a pressing and unmet need for a solution to the epidemic problem. 
     Various techniques are known for reducing obesity in patients. Known techniques tend to be based upon restricting food movement and/or nutrient absorption. One example is gastric bypass surgery on the patient, which is highly invasive. The goal of such surgery is to form a pouch from a portion of the stomach to reduce the volume of the space in the stomach receiving food. When the patient ingests food, the pouch is filled which stretches the stomach wall and produces satiety. One difficulty with such procedure is that it requires food to fill the pouch to create satiety. As a result, dietary restrictions are required for effective operation of the pouch. Such restrictions include withholding of liquids during meals to avoid washing the food from the pouch. Also, liquids with substantial calories tend to pass through the pouch without creating substantial satiety. Moreover, the opening from the pouch tends to become enlarged over time, thus allowing more food to pass while achieving reduced satiety. Thus, patients undergoing such surgical techniques often experience gradual weight gain over time. 
     Alternative weight loss devices and methods have been proposed. However, such devices and methods may be difficult to place in the patient, have questionable efficacy, and may cause undesirable side effects. 
     SUMMARY OF THE INVENTION 
     The present invention utilizes a new principle of implied satiation. The present invention provides a bariatric device and method of causing satiety in a patient that augments the natural response of the body. This may be accomplished using a non-invasive or minimally invasive procedure with a device that may be removable or absorbable. Moreover, satiety may be caused in a manner that does not interfere with other body functions, such as operation of normal reflux mechanism, bile ducts, taking of medications, and the like. The implied satiation technique of the present invention does not rely on either the restrictive or malabsorptive techniques of the prior art. 
     A bariatric device, according to an aspect of the invention, includes a body having a wall defining a lumen. The wall is configured to generally conform to the shape and size of the proximal cardiac portion of the stomach and to exert pressure on the proximal cardiac portion of the stomach in the absence of food, thereby influencing a neurohormonal feedback mechanism of the patient to cause at least partial satiety by augmenting fullness caused by food and simulating fullness in the absence of food. The lumen is substantially unrestricted. At least one fixation mechanism resists distal migration of the body. 
     The wall may be made from a self-extendable silicone-coated material. The wall may be flared to thereby conform to the cardiac notch of the proximal cardiac portion of the stomach. The body may be generally frusto-conical in shape. The wall may exert a generally consistent radial pressure on the proximal cardiac portion of the stomach. The wall may be at least partially absorbable. 
     The fixation system may include barbs, V-shaped appendages, metallic anchors extending radially from said body, staples and/or sutures. The wall may be compressible for deployment through the esophagus. The wall may be removable. 
     A method of causing at least partial satiety in a recipient, according to an aspect of the invention, includes positioning a body at a proximal cardiac portion of the stomach and fixing the body to the recipient to resist migration of the body. The body has a wall defining a lumen and is configured to the size and shape of the proximal cardiac portion of the stomach. The lumen is substantially unrestricted. Pressure is exerted with the wall on the proximal cardiac portion of the stomach in the absence of food, thereby influencing a neurohormonal feedback mechanism of the patient to cause at least partial satiety by augmenting fullness caused by food and simulating fullness in the absence of food. 
     Anti-nausea medication may be administered to the recipient at least during initial deployment of said body. Nutritional supplements may be administered to the recipient. The body may be generally frusto-conical in shape. A generally consistent radial pressure may be exerted with the wall to the proximal cardiac portion of the stomach. The wall may be at least partially absorbable. 
     The fixation system may include barbs, V-shaped appendages, metallic anchors extending radially from said body, staples and/or sutures. The wall may be compressed and the body deployed through a recipient&#39;s esophagus. The body may be removed after the recipient has experienced sufficient weight loss. 
     Thus, it can be seen that embodiments of the present invention provide an implied satietor and implied satiation method that does not require food to generate the satiety through the neurohormonal mechanism of the body. This advantageously produces at least partial satiety in the patient in the absence of food, as well as augmenting fullness caused by food during the ingestion of the food. Moreover, because satiety is not caused by food, the patient would not necessarily need to be subject to dietary restrictions, such as withholding of liquids during meals or withholding of liquids having substantial calories. 
     Moreover, in contrast to surgical procedures, embodiments of the present invention provide a bariatric device and method of causing at least partial satiety that is minimally invasive and which avoids many of the potential side effects of gastric bypass surgery and other surgical procedures, such as adjustable gastric banding, and the like. Also, because of the placement of the device, there is no interference with operation of gastric functions, such as with the bile ducts, and the like. Further, as previously noted, the bariatric device can be adapted to allow the gastro-esophageal junction to function normally without any significant interference or impediment. Also, embodiments of the invention provide a bariatric device and method of inducing at least partial satiety in the patient that does not operate on the basis of causing flu-like symptoms in the patient in a thwarted effort to attempt to induce the patient to eat less, such as may occur by the placement of devices in the patient&#39;s duodenum, or the like. 
     Additionally, in contrast to pouches formed in gastric bypass surgery, embodiments of the present invention do not include a discharge opening that is subject to enlargement with the passage of time, thereby eliminating at least one source of gradual weight gain in patients undergoing gastric bypass surgery. 
     Moreover, because it is a non-invasive or minimally invasive procedure, embodiments of the present invention may be applied not only to morbidly obese patients, but also to obese patients, overweight patients, adolescents, and potentially even children. 
     Thus, it is seen that the present invention is embodied in a bariatric device and method including a body having an expandable wall, which evokes normal neurohormonal responses associated with fullness or satiety. The body wall does so by acting on one or more portions of the distal esophagus and/or the cardia of the patient. The normal filling sensation of the stomach is augmented and amplified. Further, it has been found that the body appears to have a “satiety continuum” where a person transitions from hungry, which is on one end of the continuum or spectrum where there is a lack of satiety, to lacking hunger or being satisfied after eating and to being full with continued consumption. If the person continues to eat to the point of overeating, the person then becomes nauseous, which represents the other end of the continuum. As the pressure applied to the distal esophagus and/or the cardia of a patient is increased, the further along the patient will be on this “continuum” or spectrum. Ideally, then for an extremely overweight person, the bariatric device of the present invention may be best used if sufficient pressure is applied so that the patient is on the nausea end of the spectrum or just below at a “sub-nausea” point. 
     These and other objects, advantages and features of this invention will become apparent upon review of the following specification in conjunction with the drawings. 
    
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
         FIG.  1    is a diagram of a bariatric device positioned at the abdominal portion of the esophagus, the esophageal-gastric junction and the proximal cardiac portion of the stomach of the patient; 
         FIG.  2    is a bottom view of the bariatric device in  FIG.  1   ; 
         FIG.  3    is a perspective view of an alternative embodiment of the bariatric device in  FIG.  1   ; 
         FIG.  4    is the same view as  FIG.  3    of another alternative embodiment; 
         FIG.  5    is the same view as  FIG.  4    illustrating an alternative control technique; 
         FIG.  6    is the same view as  FIG.  2    of yet another alternative embodiment; 
         FIG.  7    is the same view as  FIG.  6    illustrating adjustment of restriction; 
         FIG.  8    is the same view as  FIG.  2    of yet another alternative embodiment; 
         FIG.  9    is the same view as  FIG.  2    of yet another alternative embodiment; 
         FIG.  10    is the same view as  FIG.  1    of yet another alternative embodiment; 
         FIG.  11    is the same view as  FIG.  1    of yet another alternative embodiment; 
         FIG.  12    is the same view as  FIG.  2    of yet another alternative embodiment; 
         FIG.  13    is the same view as  FIG.  2    of yet another alternative embodiment; 
         FIG.  14    is the same view as  FIG.  2    of yet another alternative embodiment; 
         FIG.  14 A  is a perspective view of an alternate embodiment of the bariatric device of  FIG.  1   ; and 
         FIG.  15    is a block diagram of a technique for selecting the level of pressure exerted by the body wall. 
     
    
    
     DESCRIPTION OF THE PREFERRED EMBODIMENT 
     Referring now specifically to the drawings, and the illustrative embodiments depicted therein, a bariatric device, or implied satietor,  15 , which causes satiety by acting on the abdominal portion of the esophagus, and/or the esophageal-gastric junction and/or the proximal cardiac portion of the stomach, is illustrated in  FIG.  1    being positioned in the patient. Device  15  includes a body  16  having an expandable wall  17  thereby defining a transverse passage, or lumen  18  through the body. Body  16  is designed to conform to the shape and size of the abdominal portion of the esophagus, the esophageal-gastric junction and/or the proximal cardiac portion, or cardia, of the patient&#39;s stomach. The present invention is embodied in various bariatric devices. The devices may be removable, absorbable and/or permanent. The devices may be manufactured from a synthetic or a bioprosthetic material. While the invention is illustrated with a mesh wall, other configurations are possible, such as coil configurations, and the like. Bariatric device  15  may be positioned utilizing various techniques, such as endoscopic placement with fluoroscopic assist. 
     Wall  17  is configured to exert an outward pressure, typically a generally radial outward pressure, at the abdominal portion of the esophagus, the esophageal-gastric junction and/or the cardia of the patient. This may be accomplished, for example, by configuring the wall to have a proximal portion  17   a  to create an interference fit with the abdominal portion of the esophagus and/or a central portion  17   b  configured to create an interference fit with the esophageal-gastric junction and/or a distal portion  17   c  configured to create an interference fit with the patient&#39;s cardia. The pressure exerted by wall portions  17   a ,  17   b  and/or  17   c  influences the neurohormonal feedback mechanism present at the esophagus and/or stomach to cause at least partial satiety. As will be discussed in more detail below, the pressure exerted by the extendable wall may be fixed or adjustable. The force that influences the neurohormonal feedback mechanism present at the abdominal portion of the esophagus, the esophageal-gastric junction and/or the cardiac portion of the stomach is intended to be relatively consistent over as large an area as reasonably possible. The force exerted by the wall of the bariatric device is believed to activate stretch receptors located in the abdominal portion of the esophagus, the esophageal junction and/or the cardia. In contrast to prior proposed devices, which require that the patient ingest food in order to influence neurohormonal feedback mechanisms, bariatric device  15  simulates fullness in the absence of food. It also augments fullness caused by food. 
     This interference fit may be created by a self-extendable, or self-expanding, wall. Alternatively, it may be created by an extendable wall, such as a balloon-extendable wall. The extended wall diameter is chosen so that it is somewhat oversized compared to the diameter of the conduit in which it is positioned, namely, the abdominal portion of the esophagus, the esophageal-gastric junction and/or the cardia. A self-extendable wall may be, by way of example, formed from a material, such as metal, fibers or fibrous materials, including carbon fibers, and may be a wall made from a self-extendable silicone-coated material. For example, the wall may be formed from a metal sheet, such as a Nitinol sheet, formed for example, by laser cutting, or from a coil or lattice structure formed from a metal or carbon fiber, which may be encapsulated or embedded in an insert polymer, such as silicone or the like. Alternatively, the wall may be extended by a balloon or fluid extendable reservoir expanding the wall outwardly, including generally radially outwardly, to a position firmly against the wall of the conduit in which the body is inserted. This inflation may be accomplished endoscopically with a blunt needle or with a control as will be discussed in more detail below. 
     As can be seen in  FIG.  1   , wall  17  is longitudinally non-symmetrical with respect to the central longitudinal axis “L” defined by the direction of movement of the food along the patient&#39;s esophagus and stomach. In particular, as one moves along axis L, the cross-sectional configuration of wall  17  varies proximally to distally. For example, wall portions  17   a  and  17   b  are generally cylindrical in shape and wall portion  17   c  is frusto-conical in shape, flaring outwardly from a distal end of wall portion  17   b . Wall portion  17   c  is angled to conform to the cardiac notch. Wall  17  may also be radially non-symmetrical with respect to this longitudinal axis “L”. In particular, certain portions of wall  17  are at a greater radial distance from axis L than portions of the wall at a different location around axis L. For example, wall portion  17   c  is enlarged at  19  to extend to more of the fundus of the cardia, such as the angle of His. This enlarged portion  19  makes wall  17  radially nonsymmetrical with respect to axis “L”. 
     The narrow portion of lumen  18 , which generally is the portion in the patient&#39;s esophagus, may have a length that is no longer required to provide enough force to produce satiety. In the illustrative embodiment, the narrow portion of lumen  18  is less than 9 cm in length. In certain embodiments, the narrow portion of lumen  18  is in the range of between 6 cm and 7 cm in length. This reduces the tendency of food to get caught in the lumen as well as any interference with peristalsis of the esophagus while producing force over a sufficient surface area to produce satiety. 
     In the embodiment illustrated in  FIG.  1   , bariatric device  15 , and corresponding method of causing satiety in a patient, includes providing at least a portion  20  of middle wall portion  17   b  that does not exert a substantial pressure or force. Such portion may be made from a flaccid material, such as a non-self-expandable material, or may be formed from a plurality of discrete wall portions that simply connect the proximal portion  17   a  to the distal portion  17   c , as more fully described in reference to  FIG.  14 A  below. These discrete wall portions may be interconnected to form a mesh or may be unconnected from each other to simply act as connectors between the proximal portion  17   a  and the distal portion  17   c . The device would be positioned such that the non-self expanding portion  20  covers the gastro-esophageal sphincter. This would allow the anti-reflux mechanism of the gastro-esophageal junction to operate generally normally because the wall of portion  20  would not exert any significant pressure on the sphincter. This embodiment allows the patient to belch, vomit, and the like, while resisting reflux. In bariatric device  15 , proximal wall portion  17   a  is self-expandable and is generally cylindrical in shape to conform to the shape and size of the abdominal portion of the esophagus and distal wall portion  17   c  is self-expandable and is generally frusto-conically in shape to conform to the shape and size of the proximal cardiac portion of the stomach. 
     Bariatric device  15  may include a fixation system  21 , which is capable of resisting distal migration of the device. Fixation system  21  may include a series of anchors  22  illustrated as a series of V-shaped downwardly directed appendages from wall  17 . Alternatively, the anchors may be in the shape of downwardly directed barbs or hooks, metallic anchors extending radially from said body, or the like. Such arrangement provides fixation against migration, typically distal migration, while allowing the device to be easily removed from the patient because the anchors may be configured to provide less resistance to proximal movement. In the embodiment illustrated in  FIG.  1   , the anchors are positioned at or near the esophageal-gastric junction, such as proximally at distal portion  17   c  of the wall. This positioning of the anchor takes advantage of the fact that the esophageal gastric junction is thicker and, therefore, stronger at this location. 
     A bariatric device  115  includes a wall  117  having a proximal wall portion  117   a  that applies outward pressure, such as generally radially outward pressure, to the abdominal portion of the esophagus, a distal portion  117   c  that applies outward pressure, such as generally radially outward pressure, to the proximal cardiac portion of the stomach, and a middle portion  117   b  that is positioned at the esophageal-gastric junction ( FIG.  2   ). As with bariatric device  15 , in bariatric device  115  the central portion  117   b  is made from a non-expandable material, such as a flaccid material  120 . Also, distal portion  117   c  includes an enlarged portion  119  that extends to more of the function of the cardia, such as the angle of His. Flaccid material  120  includes openings  123  that allow ingrowth of material. Openings  123  define at least in part a fixation system  121 . Fixation system  121  may include a secondary, or temporary, means for anchoring bariatric device  115  while allowing tissue to ingrowth through openings  123 . Such secondary fixation system may include stitches, staples, or the like. Openings  123  may be sized appropriately to accept such stitches or staples. The sutures could be dissolvable or non-dissolvable. Openings  123  may be as few as, for example, five openings in the flaccid material portion  120 . Alternatively, they may be a lattice of small holes that allow tissue ingrowth. The use of tissue ingrowth utilizes the body&#39;s reaction to the bariatric device  115  in order to assist in fixing the device against distal migration. Further, the tissue ingrowth, which results from the mucosa essentially incorporating the device into the anatomy of the patient, provides resistance to infection. This ingrowth can be in a portion of the device body or through the entire device body. While some irritation of the mucosa may occur when bariatric device  115  is removed, any such irritation should be relatively minor and readily healed. As with all fixation systems described herein, fixation system  121  may be used in combination with other fixation systems, such as fixation system  21 , or the like. Alternately, the tissue ingrowth may be used to promote permanence—in other words to incorporate the device into the body of the patient. 
     An alternative bariatric device  215  includes a body  216  having an expandable wall  217  ( FIGS.  4  and  5   ). Expandable wall  217  defines an internal chamber  24  throughout at least a portion of the proximal portion  217   a , middle portion  217   b  and distal portion  217   c  of wall  217 . Chamber  24  may be a single unitary chamber that extends the length of wall  217  or may be a series of separate chambers that are either interconnected or separated from each other. For example, a chamber may be positioned around proximal portion  217   a  of wall  217  that is sized and shaped to be positioned at the patient&#39;s abdominal esophagus and a chamber may be positioned at distal portion  217   c  that is sized and shaped to be positioned at the patient&#39;s cardia while no chamber is present at all or a portion of  217   b  that is configured in size to be at the esophageal-gastric junction of the patient. In this manner, wall  217  would not be substantially expandable at the gastro-esophageal sphincter, thereby reducing interference with normal operation of such sphincter, as previously discussed. 
     As can be seen in  FIG.  4   , a port  25  may be provided to chamber  24  in order to allow access by a needle  26  connected with a device  27  that is endoscopically inserted in the patient and used to either add fluid to or remove fluid from chamber  24 . In this manner, the amount of force exerted by wall  217  may be varied or adjusted. In this manner, for example, a greater amount of force may be applied to a morbidly obese patient, such as one that is more than 40 pounds overweight, while a lower amount of pressure may be applied to patients that are overweight or mildly obese, such as those that are 30 to 40 pounds overweight, for example. Bariatric device  25  is illustrated with a fixation system in the form of anchors  22 , although other fixation systems previously described may be utilized. Additionally, distal portion  217   c  may be radially symmetrical with respect to the longitudinal axis “L” of the device or may be non-symmetrical by including the enlarged portion of distal wall portion  217   c  as previously described. 
     As illustrated in  FIG.  5   , reservoir  24  of bariatric device  215  may, alternatively, be connected with a fluid reservoir  28  positioned within the patient and including a control  29  that is configured to selectively transfer between fluid reservoir  24  in the bariatric device and fluid reservoir  28  in the patient. In this manner, control  29  may control the amount of fluid in fluid chamber  24 , thereby adjusting the amount of force exerted by the wall  217  of the device on the conduit in which it is positioned. An optional patient operable control  31  may be provided and interconnected with internal control  29 , such as by a radio-frequency link  32 , in order to allow a patient or medical attendant to modify the amount of pressure exerted by wall  217 . 
     Control  29  may provide for a temporal adjustment of the amount of pressure exerted by bariatric device  215  on the patient&#39;s distal esophagus and/or proximal stomach. By way of example, control  29  may include an algorithm that causes fluid to be transferred from fluid reservoir  30  to fluid chamber  24  of the device  215  in order to increase the amount of pressure, typically radial pressure, exerted by wall  217  during general waking hours of the patient when satiety is desired. Control  29  can further be programmed to transfer fluid from reservoir  24  to reservoir  30  during periods of time when the patient is expected to be sleeping and satiety is not required. Patient control  31  may, alternatively, allow manual adjustment of the amount of force exerted by wall  214  of device  215 . For example, when the patient retires at night, the patient may operate user control  31  in order to instruct control  29  to transfer fluid from chamber  24  to fluid reservoir  30 , thereby reducing pressure exerted by wall  217 . When the patient awakes, the patient may then utilize user control  31  in order to cause control  29  to increase the amount of pressure exerted by wall  217 . This temporal control of the amount of force exerted by wall  217  should overcome any potential tachy phylaxis that may result in the diminishing response of the neurohormonal system of the patient to the force exerted by wall  217 . Alternatively, the temporal control may be utilized, where appropriate, to adjust the amount of pressure with respect to eating times of the patient, or the like. Control  29  may, alternatively, monitor certain hormonal levels of the patient in order to determine when the patient is expected to eat a meal and may even be a self-learning control system in order to learn the variations in the patient&#39;s hormonal levels. 
     An alternative bariatric device  315  may further include a restriction component  33  restricting discharge of food from lumen  18  ( FIG.  6   ). Restriction component  33  may be in the form of a chamber  34  extending within the lumen of body  316 . In the illustrative embodiment, restriction component  33  is adjacent to distal portion  317   c  of wall  317 , but could be at other locations along wall  317 . Chamber  34  may be increased or decreased in volume utilizing various techniques, such as by adding or withdrawing a fluid, such as a gas or a liquid, via a blunt needle  26  ( FIG.  7   ). Other known devices, such as an external electronic device that communicates with a control (not shown) and a pump/fluid reservoir within the patient, may be used to adjust the size of restriction component  33 . With such configuration, the external control may actuate the pump through the internal control in order to increase or decrease the size of chamber  24 . Alternatively, the internal control may be programmed to carry out the adjustment. Chamber  28  restricts the cross-section of lumen  18 . Such restriction resists egress from lumen  18  of walls  16  and thereby resists the continued ingestion of food past device  315 . This may be useful in patients who tend to continue to eat past satiety. 
       FIG.  8    illustrates an alternative bariatric device  415  having a body  416  with a restriction component  133  in the form of an inflatable reservoir or chamber  134 , which surrounds the distal portion  418   a  of the lumen  418 . Reservoir  134  provides an adjustable restriction wherein, as additional fluid is added to chamber  134 , the increase in the volume of the chamber restricts the diameter of lumen  418  thereby adjusting the ability to resist egress from the lumen of bariatric device  415  thereby providing a variable restriction to ingestion of food. Chamber  134  may also be capable of increasing the external diameter of the device wall  417   c  thereby placing additional pressure on stretch receptors at the cardia of the patient&#39;s stomach. 
     An alternative bariatric device  515  may include a body  516  having a wall  517  including an anti-reflux component  35  ( FIG.  9   ). Anti-reflux component  35  may be in the form of a one-way valve in order to resist reflux from the stomach to the esophagus. As best seen in  FIG.  9   , anti-reflux component  35  may be in the form of a tubular extension of lumen  518  that expands to allow distal movement of food but collapses to reduce reflux. 
     An alternative bariatric device  615  includes a body  616  having a wall  617  that is self-expandable at a proximal portion  617   a , a middle portion  617   b  and a distal portion  617   c , the latter being configured to the cardiac notch of the patient ( FIG.  10   ). Bariatric device  615  includes a fixation system  21 , such as a series of anchors  22 , at the esophageal-gastric junction of the patient. The entire surface of wall  617  is made of a self-expanding material. 
     An alternative bariatric device  715  illustrated in  FIG.  11    has a body  716  in which egress from the lumen  718  is from a discharge portion  40  of the device located at or near the patient&#39;s intestines. This provides additional weight loss by substantially bypassing the patient&#39;s stomach and discharging to the intestines. Device  715  may include a series of perforations  36  at discharge portion  40  in order to distribute the egress from lumen  718  along the small intestine of the patient. Use of bariatric device  715  may require dietary restrictions to avoid food collection in the elongated lumen. 
     Anchors may be positioned at various locations along the exterior of the wall of the device. For an example, an alternative bariatric device  815  is illustrated in  FIG.  12    with a body  816  having a wall  817  having anchors, such as V-shaped appendages, barbs, or hooks distributed along the outer wall of the body. The fixation system may also be in the form of a balloon-expandable wall  817   c  defining a chamber  37  that applies sufficient pressure on the conduit in which the device is located in order to resist distal migration of the device. The balloon can extend the device wall to produce fixation and can be deflated in order to allow the device to be removed.  FIG.  13    illustrates an alternative bariatric device  815 ′ having a body  816  with a wall  817  defining a lumen  818  without a chamber. Other fixation systems may be apparent to the skilled artisan, such as stitching, stapling, and the like. 
     An alternative bariatric device  915  illustrated in  FIG.  14    includes a body  916  having a wall  917  that is positioned virtually entirely within the patient&#39;s stomach. Wall  917  is of a size and shape to conform to the cardiac portion of the stomach, cardia, and is configured to exert pressure, typically radial pressure, on the cardia. Device  915  includes a fixation system  922  that engages the cardia or the esophageal-gastric junction. 
     As noted above, the non-self-expanding portion of bariatric device of the present invention may be formed from discrete wall portions. Referring to  FIG.  14 A , device  1015  is of similar construction to device  15  and includes a body  1016  having an expandable wall  1017 , which defines a lumen  1018 . Wall  1017  is similar to wall  17  and includes a proximal portion  1017   a  to exert pressure on the abdominal portion of the esophagus and a distal portion  1017   c  that is configured to exert pressure on the cardia. For further details of portions  1017   a  and  1017   c  reference is made to the previous embodiments. 
     In the illustrated embodiment, the central portion  1017   b  of the body  1016  is formed from discrete wall portions  1020 , which connect the proximal and distal portions  1017   a ,  1017   c  of wall  1017  together. Wall portions  1020  may act as tension members between the distal portion and the proximal portion and may further act as compression members to maintain the distal and proximal portions at a desired spacing, but which do not exert any significant outward or radial pressure on the gastro-esophageal junction. Wall portions  1020  may be generally equal in size and evenly spaced around the perimeter of body  1016  or may be unevenly spaced and, further, may have different widths and lengths. For example, the lengths of the wall portions may fall in a range of 0.75 cm to 1.5 cm. The number of wall portions may vary, with the illustrated embodiment depicting four wall portions that are generally evenly spaced around the perimeter of body  1016 . 
     As noted above, wall portions  1020  optionally form a non-self-expanding portion of wall  1017  and align with the gastro-esophageal junction to allow the junction to function normally. The spaces between the wall portions  1020  may comprise holes or openings or may be filled by a flexible membrane or flaccid material. 
     In addition, wall portions  1020  may provide fixation points, for example, for sutures to secure device  1015  at or near the gastro-esophageal junction in which case the material forming wall portions  1020  may formed from a relatively stiff material, such as fibers or fibrous material, for example, embedded in silicone, for example. 
     Further, the upper open end or entrance of body  1016  may be flared outwardly to bear or seal against the esophageal wall to essentially close off the space or gap between device  1015  and the esophagus. 
     Various delivery systems may be utilized to deliver any of the bariatric devices  15 - 1015  to the patient. Such a delivery system may include a tube device (not shown) into which the bariatric device is compressed. The tube device may be a stiff or flexible tube and be sized and shaped to easily fit within the patient&#39;s esophagus. Such a delivery system includes a deployment mechanism (not shown) to retract the bariatric device from the tube. As the bariatric device is removed from the tube, it assumes its expanded form. If a self-expanding wall is utilized, the bariatric device will assert pressure, such as a generally radial pressure, on the distal esophagus and/or the cardia of the patient when removed from the tube. If an expandable wall is utilized, such as a bladder, the bladder is inflated in order to exert pressure. Various markers, such as fluorescent markers, may be applied to the wall of the bariatric device in order to allow for fluoroscopic assist in the placement of the device. 
     A method  50  may be provided for monitoring and, if desired, adjusting the amount of satiety produced by the bariatric device and method ( FIG.  15   ). In method  50 , a bariatric device  15 - 1015  is inserted in the patient at  52  and a level of pressure, such as generally radial pressure, is applied by the body wall of the device. The level of satiety is monitored, such as by monitoring the patient&#39;s hypothalamus at  54 , such as with a Positron Emission Tomography (P.E.T.) scan. The P.E.T. scan produces a visual image of the hypothalamus that changes colors with the amount of activity of the hypothalamus. By observing the color of the hypothalamus through the P.E.T. scan, a determination is made at  56  whether an appropriate level of satiety is obtained. If it is, then the procedure is done at  58 . 
     If it is determined at  56  that an appropriate level of satiety is not being obtained, the process returns to  52  where a different level of pressure may be adjusted by the body. The adjustment of pressure may be in the form of adding or subtracting fluid from a bariatric device having an expandable wall by the use of a chamber  24 . Alternatively, the adjustment of the pressure may be in the form of deploying a different size or characteristic device, which is self-expandable and applies a different force to the patient through the self-expandable wall. The amount of satiety may be different for different patients. For example, a patient who is overweight may require a particular level of pressure, whereas a more obese, such as a morbidly obese, patient may require a higher level of satiety. Likewise, a child or an adolescent may require different levels of pressure. The ability to obtain immediate feedback on satiety strength allows the efficacy of the system to be established at deployment rather than monitoring the patient for weight loss and adjusting it after the patient has lost either too much or too little weight. 
     Alternately, the amount of satiety can be gauged by where the patient falls on the satiety continuum—that is whether they are hungry, satisfied, full or even nauseous. For a morbidly obese person, it may be desirable to apply sufficient pressure so that the patient is nauseous and then optionally reduced slightly so that the patient just below being nauseated or at a sub-nauseous level. This may be particularly useful when a remote control is being used in combination with an adjustable device where the patient may themselves adjust the level of pressure to maintain their desired or a prescribed level of satiety. 
     Any of the bariatric devices  15 - 1015  may be used as part of a multi-disciplinary comprehensive program. This may include the adjustment of medications as the patient experiences weight loss. For example, for patients taking diabetic medications, less insulin may be required as a patient loses weight. Also, blood pressure medications and other medications may be adjusted as the patient loses weight. 
     Because of the ability of the bariatric device  15 - 1015  to cause satiety, it is possible, in certain patients, that the patient will require nutritional supplements, such as protein liquids, in order to ensure adequate nutritional needs, such as protein intake. Also, anti-nausea medications may be given to the patient, especially at the beginning of the placement. This is because a bariatric device, according to the invention, may cause nausea at the beginning of the placement. 
     In order to reduce the likelihood of food getting caught in the lumen and in order to minimize interference with natural peristalsis in the esophagus, the length of the lumen is generally kept below 9 cm. In most embodiments, the length of the lumen is in the range of approximately 6 cm to approximately 7 cm. Widened portions of the body, such as distal portions  17   c - 1017   c , are not considered part of the lumen for determining the length of the lumen. The expandable wall, whether self-expanding or balloon-expandable, should provide consistent pressure over as large an area as possible in order to induce adequate satiety, consistent with an effort to keep the lumen as short as possible. 
     Thus, it is seen that the present invention introduces a new category of weight loss techniques: implied satiation. The invention advantageously utilizes stretch receptors, such as those located at the abdominal portion of the esophagus and/or esophageal-gastric junction and/or the cardiac portion of the stomach of the patient to cause satiety. In contrast to gastric bypass surgery and adjustable gastric bands, the present invention does not require surgical intervention. In that regard, the present invention provides a non-invasive or minimally invasive alternative. However, the invention may be utilized in combination with known restrictive and/or malabsorptive techniques, such as gastric bypass surgery and adjustable gastric bands to further help the patient lose weight. Advantageously, the present invention may be applied to patients who are contraindicated for surgery, such as those with mildly high obesity and for those at risk for surgery. Also, the invention may be used to achieve sufficient weight loss in morbidly obese patients to stabilize the patient for gastric bypass surgery. Moreover, the present invention may be properly sized for use with children and adolescence. Thus, the present invention provides a non-intrusive or minimally intrusive technique for addressing the increasing epidemic of obesity in adolescents and children, as well as adults. 
     The present invention also comprehends an implied satietor that is capable of exerting pressure at the patient&#39;s abdominal portion of the esophagus, esophageal-gastric junction and/or cardia, such as by suitable dimensioning of a self-expanding wall or by a mechanism for expanding the wall outwardly. Examples of such a mechanism may be a bladder mechanism whereby the wall could exert varying pressures. The present invention also has the capability of assisting in reducing esophageal leakage. This may further enhance the use of the invention in combination with other techniques, such as gastric bypass surgery, esophageal tumors, and the like. In addition to influencing the neurohormonal feedback mechanism present at the abdominal portion of the esophagus, the present invention is capable of resisting egress from the lumen of the satiety device. This provides additional benefit to certain patients by resisting their ability to ingest food beyond satiety. Because the device may be inserted endoscopically with fluoroscopic assist, the device may be suitably and accurately positioned at the desired location within the patient&#39;s esophagus, esophageal-gastric junction and/or cardia and adjustments made to the satiety device as required. Moreover, the device may be subsequently removed from the patient if indicated. The use of various fixation systems allow the device to be positioned at or near the abdominal portion of the esophagus, the esophageal-gastric junction and/or the cardia while resisting distal migration of the device. Moreover, the use of such fixation system may allow for the satiety device to be readily removed from the patient. 
     Evidence of the viability of the invention can be seen by its principle having been reduced to practice and found to cause weight loss in patients. The patients, who ranged from non-obese to morbidly obese, lost weight, generally over a one or two week period during which the device was in place. The patients experienced some initial nausea. They reported satiety throughout placement of the device. When the device was no longer present, the patients regained hunger. 
     Changes and modifications in the specifically described embodiments can be carried out without departing from the principles of the invention, which is intended to be limited only by the scope of the appended claims, as interpreted according to the principles of patent law including the doctrine of equivalents.