Patent Publication Number: US-2021186605-A1

Title: Flexible bipolar electrode and methods of manufacturing and use for treating medical conditions including obesity and constipation

Description:
CROSS-REFERENCE TO RELATED APPLICATIONS 
     This application is a continuation of PCT Application No. PCT/IB2019/000969, filed Aug. 27, 2019; which claims the benefit of U.S. Provisional Application Nos. 62/723,927, filed Aug. 28, 2018; and 62/748,873, filed Oct. 22, 2018; which applications are incorporated herein by reference in their entireties for all purposes. 
     The subject matter of this application is also related to the subject matter of the following patent applications and patents, which are incorporated herein by references in their entireties for all purposes: U.S. patent application Ser. No. 14/519,933, now U.S. Pat. No. 9,883,906; U.S. patent application Ser. No. 14/602,493, now U.S. Pat. No. 9,179,963; U.S. patent application Ser. No. 15/179,623; U.S. patent application Ser. No. 15/852,687; U.S. patent application Ser. No. 16/210,990; PCT Application No. PCT/IB2013/001203; PCT Application NO. PCT/IB2014/003083; PCT Application NO. PCT/IB2016/000953; and PCT Application NO. PCT/IB2017/000783. 
    
    
     BACKGROUND OF THE INVENTION 
     In bipolar energy delivery, electrodes of opposite polarities, typically adjacent to each other, may be brought in contact with a target tissue or material (the terms target tissue or target material may be used herein interchangeably, and when one is used it should be taken as applying to the other as well). Alternating Current (AC) Radiofrequency (RF), Direct Current (DC), or microwave energy may be delivered between the two poles, through the tissue or material, causing tissue effects. These effects may be minimal, transient changes in (e.g. cellular membrane potential modification as in nerve or cardiac stimulation), or warming accompanied by permanent tissue changes—ranging from protein coagulation, through triggering of cellular apoptosis mechanisms followed by scarring, to complete tissue fulguration and evaporation. 
     Advantages of using bipolar electrodes may include a relatively local/shallow and therefore well controlled effect, as well as avoidance of the need for using a dispersive “ground” or “patient” electrode, as is the case with monopolar ablation. 
     In some applications, there may be a need to deliver the energy in an elongate pattern, such as a straight, circular, ellipsoid, curvilinear, zigzag, or any other substantially continuous linear or non-focal pattern. 
     This may for example be achieved using two parallel elongate electrodes. Such electrodes may for example be manufactured as part of a PCB (Printed Circuit Board). Specialized types of PCBs such as flexcircuits allow relatively good flexibility in the direction perpendicular to the plain of the PCB. 
     However, in some situations, for example when tight constraints of shape and/or dimensions must be met, the flexibility required of the linear electrodes may be greater than what may be possible using such a PCB. Furthermore, flexibility may be required in the direction parallel to the PCB (i.e. within the plane of the PCB), while PCBs, including flexible PCBs, may be extremely inflexible in this direction. 
     In such situations, the most appropriate mechanical properties may be similar to those of a flexible electrical wire. Unfortunately, a wire does not lend itself to bipolar use, as it is typically a single continuous conductor. 
     Two parallel wires could theoretically be used, although they are continuously insulated and would be difficult to make into bipolar pairs, especially if using a bifilar wire. In addition, using two parallel wires as a bipolar pair may require ensuring a constant distance between the wires, for example by placing spacers between them, gluing them to each other, or some other method. Even so, the resulting parallel track will only work well if both wires are placed in good contact with the target tissue along the desired path, which may be difficult to achieve. This is because it may be easy for such a design to twist, in which case there may be a significant difference between the poles in the size of surface area contacting the tissue. This may result with undesirable outcomes, such as reduced, or increased, energy delivery, leading to missing or excessive lesions in the target tissue or material. 
     Thus, there is a need to provide an electrode that can easily be used for bipolar energy delivery, is flexible, strong, reliable, and maintains good contact of both polarities with the tissue regardless of its exact orientation, and at the same time is easy to manufacture at low cost. Such an electrode should be capable of delivering the energy focally, in an elongate pattern, or in a planar pattern (over surfaces/areas). 
     Of note, another important distinct feature of the current invention is the high flexibility, or deformability, of the electrode. In other words, the electrode of the invention may be as thin and as flexible as a simple electrical wire, and as such, may be easily inserted into small lumens, folded and straightened, deployed, and deformed to fit any required anatomy. 
     The mechanical activity of the stomach plays a major role in the digestive process in humans, both in health, and in disease states. Modifying this activity may be an effective way of treating gastrointestinal disease. The following brief anatomical, histological, and physiological background will make the concept clearer. 
     The gross anatomy of the normal human stomach is described in  FIG. 8A  which is a typical anterior view of a stomach  101 . The cardia  102  is a 1-2 cm segment distal to the esophagogastric junction  103 . The fundus  104  refers to the superior portion of the stomach that lies above an imaginary horizontal plane that passes through the esophagogastric junction. The antrum  105  is the smaller distal, one-fourth to one-third of the stomach. The narrow, 1-2-cm channel that connects the stomach and duodenum is the pylorus  106 . The lesser curve  107  refers to the medial shorter border of the stomach, whereas the opposite surface is the greater curve  108 . The angularis  109  is along the lesser curve of the stomach where the body and antrum meet. This junction is accentuated during peristalsis. The main body, or corpus COR of the stomach, extends between fundus  104  and antrum  105 . 
     The human gastric wall comprises four main layers as illustrated in  FIG. 8B . The innermost layer is the mucosa (MCS), followed by the submucosa (SMC), muscularis (MUS), and serosa (SER). 
     More particularly,  FIG. 8B  is a schematic illustration of a cross section through the gastric wall  110 , depicting these layers in more detail. 
     Shown in  FIG. 8B  from top to bottom are: Mucosa MCS with gastric glands  111  and muscularis mucosae  112 , which is a thin layer of smooth muscle within the mucosa. Submucosa SMC mainly comprises loose connective tissue and blood vessels. Muscularis MUS comprises three layers of smooth muscle: the innermost oblique  113  layer (unique to the stomach), the middle circular  114  layer and outermost longitudinal  115  layer. Serosa SER comprises loose connective tissue and blood vessels, and the visceral peritoneum layer  116 . 
     The enteric nervous system (ENS) is one of the main divisions of the autonomic nervous system and comprises a mesh-like network of neurons that governs the function of the gastrointestinal tract. 
     The neurons of the ENS form two plexuses: the myenteric (Auerbach&#39;s) plexus (MP) between the inner and outer layers of the muscularis and the submucosal (Meissner&#39;s) plexus (SP) located in the submucosa. 
     Interstitial cells of Cajal are specialized cells which also form networks that are widely distributed within the submucosal, intra-muscular and inter-muscular layers of the gastrointestinal tract. 
     Physiological emptying of the stomach results from a grinding and pumping action comprising rings of circular muscle contractions that propagate from the main body (corpus) to the antrum, pushing digesta into the duodenum. This process has been described as gastric peristalsis. ( All together now: from pacemakers to gastric peristalsis . Costa M,  J Physiol.  2006 Feb. 15; 571(Pt 1): 1.) 
     This peristalsis is initiated by a “pacemaker” which was localized to an area in the midcorpus along the greater curve, with potentials generated regularly at a mean frequency of about 3 cycles/min and propagated, increasing in amplitude and velocity as they approach the pylorus. 
     According to the current understanding of gastric physiology, contractions in the stomach are myogenic (i.e. are independent of neural activity). The origin of the myogenic activity in the stomach was tracked to the Interstitial Cells of Cajal (ICCs), with those ICCs in the Myenteric plexus responsible for slow longitudinal propagation, and those within the circular muscle layer responsible for fast “ring” contractions. 
     The relationship between gastric emptying and obesity is very complex. Some studies suggest a more rapid gastric emptying in obesity, although the opposite has been reported in some experimental settings. ( Gastrointestinal motility in obesity . Wisen et al.,  J Intern Med.  1995 April; 237(4): 411-8) 
     The above gives rise to the idea that disrupting the interstitial cells network may impede gastric motility, thereby promoting satiation and satiety and slowing gastric emptying, and therefore may be a potential treatment for obesity. 
     Backing for this notion is found in a classic study, in which extracellular measurements of electrical activity done on intact stomachs of living humans, showed that isolation of the distal stomach from the natural pacemaker (due to complete transection of the gastric corpus) resulted in the appearance of a new pacemaker with a slower frequency. ( Human gastric pacesetter potential. Site of origin, spread, and response to gastric transection and proximal gastric vagotomy . Hinder et al.  Am J Surg.  1977 January; 133(1): 29-33.) 
     Based on the above concept, injections of botox into the gastric mucosa at the area of the antrum have shown efficacy in weight reduction, both in rats ( The Effect of Intragastric Administration of Botulinum Toxin Type A on Reducing Adiposity in a Rat Model of Obesity Using Micro - CT and Histological Examinations . Park et al.,  Gut Liver.  2017 November; 11(6): 798-806), and in humans ( Intragastric injection of botulinum toxin. A real alternative for obesity treatment? A systematic review . Sanchez et al.,  Nutr Hosp.  2017 Nov. 16; 34(5):1482-1488. doi: 10.20960/nh.1220.) 
     Several patent applications and granted patents have described use of ablation in the stomach for treatment of various medical disorders, including obesity. 
     U.S. Pat. No. 6,427,089 by Knowlton teaches treating obesity by use of an endoluminal device incorporating a microwave antenna for inducing contraction of gastric volume or reducing the distensibility of the stomach. 
     U.S. Pat. No. 7,282,050 by Starkebaum et al. teaches ablation of the exterior of the stomach to alter gastric function for the treatment of obesity. 
     U.S. Pat. No. 7,468,060 by Utley et al. teaches tightening of the pyloric sphincter using ablation and/or mediating receptive relaxation of muscles in the stomach, for treating obesity and other disorders. 
     U.S. Pat. No. 8,641,711 by Kelly et al. teaches treatment of metabolic syndrome or obesity by controlled ablation of tissue within the wall of the gastro-intestinal tract, mainly in the jejunum. 
     US application 2006/0217698 A1 by Starkebaum el al. teaches treating obesity by endoluminal ablation of gastric mucosa for reduction of ghrelin production, or ablation of the submucosa, nerves, or muscle tissue to induce gastroparesis. 
     US application 2005/0240239 A1 by Boveja el al. teaches treating obesity by endoluminal ablation of the intrinsic gastric pacemaker area and optional implantation of an artificial pacemaker for slower pacing of the stomach. 
     All the above suggest creation of focal or area lesions, and do not look at the stomach as a whole. Such an approach may cause damage to the gastric wall by creating large lesions. A more physiologically oriented approach is needed. 
     Since, as described above, gastric motility is mediated by the interstitial cells of Cajal, obesity may be viewed as a tachy-arrhythmia of the stomach, and as such may be treated by controlling propagation of signals through the stomach wall using thin ablation lines, which may alter the behavior of the stomach as a whole. 
     Such an alternative approach was described in granted U.S. Pat. Nos. 9,883,906 and 9,179,963 by Ben-Ezra et al., both incorporated herein in their entirety. 
     Additional, more specific embodiments, including detailed attributes of devices and methods for treating gastro-intestinal diseases according to the above approach are described herein. 
     The same devices may be used for inducing contraction of tissue along the ablated lines, to modify the mechanical behavior of the stomach, such as its distensibility, motility, and capability to propagate gastric contents. 
     Other gastrointestinal related disorders, such as constipation, gastroparesis, gastro-esophageal reflux disease, dumping syndrome, bloating, belching, nausea, cyclic vomiting, binge eating disorder, peptic ulcer disease, gastritis, anorexia nervosa, bulimia, irritable bowel syndrome, diabetes, and more, may also be treated using similar approaches, as detailed below. 
     Of note, devices and methods described herein with regard to the stomach, are meant to generally apply to other gastrointestinal organs as well. 
     SUMMARY OF THE INVENTION 
     The current invention relates to any situation in which it may be beneficial to deliver bipolar energy to a target material or tissue, using a flexible, or deformable, member. This may typically be used in medical applications such as various tissue ablation procedures, including but not limited to cardiac ablation performed for rhythm control, endoscopic surgery on the GI tract for hemorrhage control or polyp removal, ablation in the stomach for treating obesity or gastric motility disorders e.g. dumping syndrome, or anywhere in the GI tract for various forms of irritative bowel syndrome, constipation, etc., bladder ablation for overactive bladder or other micturition disorders, endometrial ablation for menorrhagia etc. It may also be useful in many other medical or non-medical applications, such as, but not limited to, welding of polymers (these would typically be polymers containing polar molecules, e.g. PVC or polyurethane) for example during fusion of pipes, sheets, or balloons for various industrial purposes. Specific embodiments described herein are related to the field of gastroenterology, and more specifically to the modulation of the activity of gastro-intestinal organs using minimally invasive, endoscopic means, to alleviate obesity, constipation, or other gastro-intestinal related conditions. 
    
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
         FIG. 1A —is a simplified schematic top view of a flexible bipolar electrode according to an embodiment of the current invention. 
         FIG. 1B —schematic three-dimensional depiction of a flexible bipolar electrode according to an embodiment of the current invention. 
         FIG. 2A —is a simplified schematic side view of a flexible spiral bipolar electrode according to an embodiment of the current invention. 
         FIG. 2B —is a simplified schematic top view of a flexible spiral bipolar electrode according to an embodiment of the current invention. 
         FIG. 2C —is a simplified schematic top view of a flexible spiral bipolar electrode and contact points according to an embodiment of the current invention. 
         FIG. 2D —is a simplified schematic cross section (at line D in  FIGS. 2A-2C ) of a flexible spiral bipolar electrode according to an embodiment of the current invention. 
         FIG. 2E —is a simplified schematic cross section (at line E in  FIGS. 2A-2C ) of a flexible spiral bipolar electrode according to an embodiment of the current invention. 
         FIG. 3A —is a simplified schematic cross section (at line D in  FIGS. 2A-2C ) of a flexible spiral bipolar electrode according to an embodiment of the current invention. 
         FIG. 3B —is a simplified schematic cross section (at line E in  FIGS. 2A-2C ) of a flexible spiral bipolar electrode according to an embodiment of the current invention. 
         FIG. 4A —is a simplified schematic cross section (at line D in  FIGS. 2A-2C ) of a flexible spiral bipolar electrode according to an embodiment of the current invention. 
         FIG. 4B —is a simplified schematic cross section (at line E in  FIGS. 2A-2C ) of a flexible spiral bipolar electrode according to an embodiment of the current invention. 
         FIG. 4C —is a simplified schematic three-dimensional depiction of a flexible spiral bipolar electrode according to an embodiment of the current invention. 
         FIG. 5 —is a simplified schematic three-dimensional depiction of a flexible spiral bipolar electrode according to an embodiment of the current invention. 
         FIG. 6A —is a simplified schematic cross section of a flexible spiral bipolar electrode according to an embodiment of the current invention. 
         FIG. 6B —is a simplified schematic three-dimensional depiction of a flexible spiral bipolar electrode according to an embodiment of the current invention. 
         FIG. 7A —is a simplified schematic cross section of a manufacturing jig according to an embodiment of the current invention. 
         FIG. 7B —is a simplified schematic top view of a manufacturing jig according to an embodiment of the current invention. 
         FIG. 8A —is a simplified schematic anterior view of a human stomach. 
         FIG. 8B —is a simplified schematic cross section through the wall of a human stomach. 
         FIG. 9A —is a simplified schematic anterior view of a human stomach with an ablation pattern according to an embodiment of the current invention. 
         FIG. 9B —is a simplified schematic anterior view of a human stomach with an ablation pattern according to an embodiment of the current invention. 
         FIG. 9C —is a simplified schematic anterior view of a human stomach with an ablation pattern according to an embodiment of the current invention. 
         FIG. 9D —is a simplified schematic anterior view of a human stomach with an ablation pattern according to an embodiment of the current invention. 
         FIG. 9E —is a simplified schematic anterior view of a human stomach with an ablation pattern according to an embodiment of the current invention. 
         FIG. 9F —is a simplified schematic anterior view of a human stomach with an ablation pattern according to an embodiment of the current invention. 
         FIG. 9G —is a simplified schematic anterior view of a human stomach with an ablation pattern according to an embodiment of the current invention. 
         FIG. 9H —is a simplified schematic anterior view of a human stomach with an ablation pattern according to an embodiment of the current invention. 
         FIG. 10A —is a simplified schematic anterior view of a human stomach with an ablation pattern according to an embodiment of the current invention. 
         FIG. 10B —is a simplified schematic anterior view of a human stomach with an ablation pattern according to an embodiment of the current invention. 
         FIG. 10C —is a simplified schematic anterior view of a human stomach with an ablation pattern according to an embodiment of the current invention. 
         FIG. 10D —is a simplified schematic anterior view of a human stomach with an ablation pattern according to an embodiment of the current invention. 
         FIG. 11A —is a simplified schematic anterior view of a human stomach with an ablation pattern according to an embodiment of the current invention. 
         FIG. 11B —is a simplified schematic anterior view of a human stomach with an ablation pattern according to an embodiment of the current invention. 
         FIG. 11C —is a simplified schematic anterior view of a human stomach with an ablation pattern according to an embodiment of the current invention. 
         FIG. 11D —is a simplified schematic anterior view of a human stomach with an ablation pattern according to an embodiment of the current invention. 
         FIG. 11E —is a simplified schematic anterior view of a human stomach with an ablation pattern according to an embodiment of the current invention. 
         FIG. 12A —is a simplified schematic frontal view of a global pattern ablation device according to an embodiment of the current invention. 
         FIG. 12B —is a simplified schematic frontal view of a global pattern ablation device according to an embodiment of the current invention. 
         FIG. 12C —is a simplified schematic frontal view of a global pattern ablation device according to an embodiment of the current invention. 
         FIG. 13 —is a simplified schematic frontal view of a regional pattern ablation device according to an embodiment of the current invention. 
         FIG. 14A —is a simplified schematic frontal view of a local pattern ablation device according to an embodiment of the current invention. 
         FIG. 14B —is a simplified schematic frontal view of a local pattern ablation device according to an embodiment of the current invention. 
         FIG. 15 —is a simplified schematic anterior view a human large intestine. 
         FIG. 16A —is a simplified schematic anterior view of an ablation pattern in a human large intestine. 
         FIG. 16B —is a simplified schematic anterior view of an ablation pattern in a human large intestine. 
         FIG. 17 —is a simplified schematic anterior view of an ablation device in a human large intestine. 
         FIG. 18A —is a simplified three-dimensional view of an ablation device with spiral bipolar and parallel electrodes according to an embodiment of the current invention. 
         FIG. 18B —is a simplified schematic side view of an ablation device with spiral bipolar and parallel electrodes in its deployed state according to an embodiment of the current invention. 
         FIG. 18C —is a simplified schematic side view of an ablation device with spiral bipolar and parallel electrodes in its crimped state according to an embodiment of the current invention. 
     
    
    
     DETAILED DESCRIPTION OF THE INVENTION 
     Flexible Bipolar Electrode 
       FIG. 1A  is a schematic top view of an embodiment of the current invention. More particularly, shown in  FIG. 1A  is elongate flexible bipolar electrode  1 , which may comprise a non-conductive, optionally flexible “core”  2 , and at least two conductors  3  and  4 , wherein each may comprise multiple, alternating contacts  5  and  6 . 
     As seen in  FIG. 1A , connecting each of conductors  3  and  4  to an opposite electrical pole may result in contacts  5  and  6  representing alternating positive and negative poles along electrode  1 . Thus, electricity flowing through the tissue or target material between each adjacent pair of opposite poles  5  and  6  may warm the tissue and result with an effect, which may depend on the power delivered, as well as on the tissue and electrode properties. 
       FIG. 1B  is a schematic three-dimensional sketch of a possible embodiment of the concept described in  FIG. 1A . 
     More particularly, shown in  FIG. 1B  is elongate flexible bipolar electrode  1 , which may comprise a non-conductive, optionally flexible “core”  2 , and at least two conductors  3  and  4 , wherein each may comprise multiple, alternating contacts  5  and  6 . 
     Core  2  may be made of a flexible non-conductive material, preferably heat resistant, for example it may be made of silicone, polyurethane, pvc, polyimide, polyester, etc. 
     Conductors  3  and  4  and contacts  5  and  6  may be made of a conductive material such as copper, silver, gold, stainless steel, nickel, NiTi, etc. 
     The embodiment shown in  FIGS. 1A and 1B  may be manufactured by injection molding core  2  over conductors  3  and  4 . Alternatively it may be manufactured by dipping conductors  3  and  4  in the material of core  2 , to be followed by exposing the contacts  5  and  6 . In some embodiments, manufacturing may be by 3D printing or co-extrusion of core  2  simultaneously with conductors  3  and  4 . 
     A preferred embodiment of the current invention is shown in  FIGS. 2A-2E . 
     As will be described in detail below, the invention comprises an elongate flexible spiral bipolar electrode  10  made of two insulated conductors, twisted together to form a twisted pair, a braid, or other similar structure with the insulation removed at one or more locations where the conductors are exposed, forming a bipolar pair on at least one of the sides of the electrode, such that the exposed areas of the two conductors form a line of alternating electrical poles. 
       FIG. 2A  is a schematic side view of a preferred embodiment of the electrode. 
     More particularly, shown in  FIG. 2A  is elongate spiral bipolar electrode  10  which may comprise conductor  11  which may have a diameter “a” and may be covered by insulation layer  12  which may have a thickness “b”, and conductor  13  which may have a diameter “c” and may be covered by insulation layer  14  which may have a thickness “d”. For clarity, insulation layers  12  and  14  are depicted transparent, so conductors  11  and  13  are seen through them. Conductor  11  together with insulation layer  12  and conductor  13  together with insulation layer  14  may sometimes herein be collectively referred to as “wires”  11  and  13 . 
     Wires  11  and  13  may be wound around each other, preferably at the same direction (either clockwise or counterclockwise), such that they may form a twisted pair, a braid, or other similar embodiment along which they may be symmetrically dispersed. Twisting or braiding maintains close proximity of the wires down the length. This mechanical augmentation can be achieved through adhesive bonding of the two wires, fusion of the two insulation materials, etc. 
     Typically, diameters “a” and “c” of conductors  11  and  13  may be equal, and thicknesses “b” and “d” of insulation layers  12  and  14  may be equal. However, in some embodiments, these parameters may be intentionally not equal to each other. 
     Gap “g” marks the distance between the surfaces of insulation layers  12  and  14 . Although depicted here as a significant distance, gap g may be very small, or zero, i.e. no gap may exist between insulation layers  12  and  14 . In other words, insulation layer  12  and  14  may touch each other. Furthermore, in some embodiments the insulation materials may be adhesively, chemically, thermally, or otherwise bonded or fused together, or originally formed as a single element. 
     Although not depicted in  FIG. 2A , in some embodiments, additional conductors or spiral elements may be incorporated into electrode  10 , for modifying its mechanical, electrical, or other properties. For example, electrode  10  may comprise a total of three, four, or more wires instead of just two. All or just some of these wires may be electrically active. Alternatively, the additional wires may be used only for ensuring a specific dimensional gap between the electrically active wires  11  and  13 , or they may serve to affect the strength, durability, or other properties of electrode  10 . 
     Dashed line A, parallel to the general longitudinal direction of electrode  10 , marks the outermost “peaks” of the spiraled wires before removal of insulation. 
     Dashed line B, parallel to line A, may be at a distance C from it, and marks the extent to which insulation layers  12  and  14  may be removed according to the current disclosure. Thus, in the area seen in  FIG. 2A  between lines A and B, insulation layers  12  and  14  may be removed, leaving conductors  11  and  13  exposed, such that each of conductors  11  and  13  may be in contact with the target tissue or material at tissue contact points Q and P respectively. 
     Line D, generally perpendicular to line A, passes through a “peak” and tissue contact point Q of conductor  11 , and marks the location of the cross section shown in  FIG. 2D . 
     Line E, generally perpendicular to line A, and parallel to line D at a distance of F from it, passes through a “peak” and tissue contact point P of conductor  13 , and marks the location of the cross section shown in  FIG. 2E . 
     Distance F between lines D and E may be the distance between two intermittent poles of electrode  10 . Distance F may be a function of the frequency, or pitch, of electrode  10 , and may typically be equal to half the inverse of this pitch. For example, in a case where the pitch of the spiral of each of conductors  11  and  13  may be 8 coils per inch, distance F may be 1/16 of an inch, or 1.5875 mm. 
     Specifications of the wires, diameters, insulation type and thickness, pitch, hardness, etc. may vary according to the application. Typical wires used for electrode  10  may be similar to magnet wire. 
     For example, typical specifications for wires used in an electrode  10  for a medical device application, such as a device intended for ablation in a urinary bladder, may be similar to the following: 
     Conductor material: may typically be fully annealed, electrolytically refined copper, or aluminum, or any other appropriate material. 
     Conductor diameter: typically, 0.001″-1″ or greater, preferably 0.005″-0.020″ 
     Insulation material: may typically be polyvinyl formal (Formvar), polyurethane, polyamide, polyester, polyester-polyimide, polyamide-polyimide (or amide-imide), polyimide, silicone, or any other appropriate material. 
     Insulation thickness: typically, 0.0001″-0.005″ or greater, preferably 0.0005″-0.001″. 
     Whole electrode diameter: typically, 0.001″-1″ or greater, preferably 0.002″-0.050″ 
     Pitch: typically, 1-500 coils per inch or greater, preferably 5-20 coils per inch. 
     The dimensions of gap g may typically be 0-0.1″, preferably 0-0.01″. 
     Furthermore, adhesion or fusion of the insulation materials can be used to augment the retention force of the wires twisted together. 
       FIG. 2B  is a schematic top view of the preferred embodiment of the electrode described above and in  FIG. 2A . 
     More particularly, shown in  FIG. 2B  is elongate spiral bipolar electrode  10  which may comprise conductor  11  which may have a diameter a and may be covered by insulation layer  12  which may have a thickness b, and conductor  13  which may have a diameter c and may be covered by insulation layer  14  which may have a thickness d. In the interest of clarity, insulation layers  12  and  14  are depicted transparent, so conductors  11  and  13  are seen through them. 
     Rectangular dashed box “W”, having a longitudinal axis parallel to the general longitudinal direction of electrode  10 , marks the outermost area (as seen from this top view) of electrode  10  where insulation layers  12  and  14  may be removed, leaving conductors  11  and  13  exposed, such that each of conductors  11  and  13  may be in contact with the target tissue or material at tissue contact points Q and P respectively. 
     Line D, generally perpendicular to longitudinal axis of rectangular box “W”, passes through a “peak” and tissue contact point Q of conductor  11 , and marks the location of the cross section shown in  FIG. 2D . 
     Line E, generally perpendicular to longitudinal axis of rectangular box “W”, and parallel to line D at a distance of F from it, passes through a “peak” and tissue contact point P of conductor  13 , and marks the location of the cross section shown in  FIG. 2E . 
       FIG. 2C  is a schematic top view of the preferred embodiment of the electrode described above and in  FIGS. 2A and 2B , also showing tissue contact points P and Q. 
     More particularly,  FIG. 2C  shows elongate spiral bipolar electrode  10  including all elements shown in  FIG. 2B . In addition,  FIG. 2C  includes rectangular dashed box W, having a longitudinal axis parallel to the general longitudinal direction of electrode  10 , which marks the outermost area of electrode  10  where insulation layers  12  and  14  may be removed, as seen from this top view, leaving conductors  11  and  13  exposed, such that each of conductors  11  and  13  are in contact with the target tissue or material at tissue points P and Q. 
     Tissue contact points P and Q are shown forming a line of intermittent alternating poles. Elongate ablation area  15  marks the area of tissue effect or ablation, which may result from delivery of energy, e.g., AC, DC, RF, microwave, etc. to conductors  11  and  13  when in contact with a target tissue. The current may flow through the tissue, between each adjacent tissue contact point pairs P and Q, thus creating ablation lesions that coalesce to form elongate ablation area  15 , which may typically be substantially continuous. 
     Line D, generally perpendicular to the longitudinal axis of rectangular box W, passes through a “peak” and tissue contact point Q of conductor  11 , and marks the location of the cross section shown in  FIG. 2D . 
     Line E, generally perpendicular to longitudinal axis of rectangular box W, and parallel to line D at a distance of F from it, passes through a “peak” and tissue contact point P of conductor  13 , and marks the location of the cross section shown in  FIG. 2E . 
       FIG. 2D  is a schematic cross section of the preferred embodiment of the electrode described above and in  FIGS. 2A-2C . 
     More particularly,  FIG. 2D  is a cross section through line D of  FIGS. 2A-2C . Seen in  FIG. 2D  is elongate spiral bipolar electrode  10  comprising conductors  11  and  13 . Conductor  11 , covered by insulation layer  12 , may be located at the upper part of electrode  10  in this cross section. Conductor  13 , covered by insulation layer  14 , may be at the bottom part of electrode  10  in this cross section. Perimeter  16  marks the outer margins of the circle formed by the spiraled wires  11  and  13 . 
     Also seen in this figure is gap “g”, which as mentioned above, may be very small, or even equal to zero. 
     Dashed line A marks the outermost “peaks” of the spiraled insulated wires before removal of insulation. 
     Line B, parallel to line A, may be at a distance C from it, and marks the extent to which insulation layers  12  and  14  may be removed in this embodiment. Thus, in the area seen in  FIG. 2D  between lines A and B, insulation layer  12  may be removed, leaving conductor  11  exposed, such that it may be in contact with the target tissue or material at tissue point or points Q. 
       FIG. 2E  is a schematic cross section of the preferred embodiment of the electrode described above and in  FIGS. 2A-2D . 
     More particularly,  FIG. 2E  is a cross section through line E of  FIGS. 2A-2C . Seen in  FIG. 2E  is elongate spiral bipolar electrode  10  comprising conductors  11  and  13 . Conductor  13 , covered by insulation layer  14 , may be located at the upper part of electrode  10  in this cross section. Conductor  11 , covered by insulation layer  12 , may be at the bottom part of electrode  10  in this cross section. 
     Perimeter  16  marks the outer margins of the circle formed by the spiraled wires  11  and  13 . Also seen is Gap “g” between the surface of insulation layers  12  and  14 . 
     Dashed line A marks the outermost “peaks” of the spiraled wires before removal of insulation. 
     Line B, parallel to line A, may be at a distance C from it, and marks the extent to which insulation layers  14  may be removed according to the current disclosure. Thus, in the area seen in  FIG. 2E  between lines A and B, insulation layer  14  may be removed, leaving conductor  13  exposed, such that it may be in contact with the target tissue or material at tissue point or points P. 
     In the current embodiment, the exposed side of the wires should be oriented towards the tissue, so that contact points P and Q may be in contact with the tissue, forming a line of alternating poles, so that when an electrical current is applied to conductors  11  and  13 , the tissue may be ablated. 
     In some embodiments, exposure of conductors  11  and  13  may be performed on two or more sides of electrode  10 . This is shown in  FIGS. 3A and 3B  which are identical to  FIGS. 2D and 2E  respectively in all details, apart from also showing dashed lines “M” and “N” which denote another area of removal of insulation and exposure of conductors. This increases the chances that the conductors will be in contact with tissue even if the electrode is not oriented as intended. 
     Exposure of conductors  11  and  13  may optionally be performed for example on three, four, or more sides of electrode  10 . In fact, insulation may be removed from all around electrode  10 , and conductors  11  and  13  may still be insulated from each other, as sufficient insulation may remain between them. This is depicted in  FIGS. 4A-4C . 
       FIG. 4A  is a schematic cross section of an embodiment of electrode  10 . More particularly, seen in  FIG. 4A  is elongate spiral bipolar electrode  10  comprising conductors  11  and  13 . Conductor  13 , covered by insulation layer  14 , may be located at the upper part of electrode  10  in this cross section. Conductor  11 , covered by insulation layer  12 , may be at the bottom part of electrode  10  in this cross section. 
     Perimeter  16  marks the outer margins of the circle formed by the spiraled wires  11  and  13 . 
     Circular dashed line R denotes an area of removal of insulation and exposure of conductors, which in the embodiment shown may be all around electrode  10 . 
     The parts of insulation layers  12  and  14  outside dashed line “R” may be removed, while the parts of insulation layers  12  and  14  enclosed within dashed line “R”, may not be removed, and may remain in the electrode, separating conductors  11  and  13 , even when electrode  10  is bent or twisted. This may be extremely beneficial, as the exact orientation of electrode  10  relative to the tissue no longer matters, as long as there is contact between electrode  10  and the tissue. At any orientation, the parts of exposed conductors  11  and  13  in contact with the tissue may form a line of alternating poles and enable bipolar energy delivery to the tissue along that line. 
       FIG. 4B  is a schematic cross section of the same embodiment of electrode  10 , at an adjacent location along electrode  10  to that shown in  FIG. 4A .  FIG. 4B  is essentially the same as  FIG. 4A  with the difference being that conductor  11  is seen here at the bottom and conductor  13  at the top. 
       FIG. 4C  is a three-dimensional depiction of the same embodiment of electrode  10 . In this illustration, insulation layers  12  and  14  are shown as fused to each other and are marked by the number  12  only. 
     In all of the embodiments described herein, conductors  11  and  13  may each be made of a single strand or filar, or of several strands or filars braided or twisted together. A braided or twisted conductor may be more flexible and durable than a single strand conductor but removing the insulation from it may be more difficult. 
       FIG. 5  is a schematic three-dimensional sketch of yet another possible embodiment of the concept described in  FIGS. 4A-4C . 
     More particularly, shown in  FIG. 4  is elongate flexible spiral bipolar electrode  20 , which is shown in contact with a piece of target tissue “T”. In the interest of clarity, electrode  20  is depicted semi-transparent and a longitudinal section of tissue T is shown along its line of contact with electrode  20 . Electrode  20  may comprise a non-conductive, optionally flexible core  21 , and at least two spiral conductors  22  and  23 , at a distance “m” from each other. The distance between two adjacent coils may be “n”, which may typically be equal to “m”, but may optionally be different. As with the embodiment shown in  FIGS. 4A-4C , spiral conductors  22  and  23  may be exposed along their whole length, but since they only come into contact with the target tissue or material along one side of core  21 , tissue contact points “P” and “Q” may form a linearly alternating series of poles. Ablated areas “Abl” between tissue contact points Q and P denote areas that may be ablated or otherwise affected by delivering energy to electrode  20  and may typically coalesce to form a substantially continuous line of tissue effect along the course of electrode  20 . 
     Yet another embodiment, is electrode  30  which may be manufacturable using 3D printing or extrusion, followed by twisting, is shown in  FIGS. 6A and 6B . 
     In this embodiment, an insulator core is coated by conductors on two of its sides. The structure is then twisted along its longitudinal axis to achieve alternating poles along electrode  30 . 
     More particularly,  FIG. 6A  is a cross section of electrode  30  showing from left to right: conductor  31 , insulator core  32 , conductor  33 . 
       FIG. 6B  is a schematic three-dimensional depiction of electrode  30 . 
     More particularly,  FIG. 6B  shows electrode  30  comprising insulator core  32  with conductors  31  and  33  on both sides, twisted to form alternating poles. 
     In some embodiments, the current invention may be used to deliver energy to whole areas instead of in a linear fashion. This may for example be achieved by placing any of the above described embodiments side by side, optionally in a staggered positioning, so as to create a surface of alternating poles (in a “chess board” pattern). 
     In use, any of the above described embodiments may be brought into contact with a target tissue or material. This may be done in any way as known in the art, including but not limited to direct topical application to skin or any other external tissue, endoscopically, percutaneously, surgically, etc. and with the aid of catheters and/or balloons as necessary. 
     Various forms of electrical energy may be delivered to the electrode. For example, typical power settings for ablating lines in a human urinary bladder using any of the above embodiments may be Radio Frequency energy at approximately 500 KHz, 30-50 Watts for 1-3 seconds. 
     Manufacturing Methods 
     A manufacturing method specifically relevant to the embodiment described in  FIGS. 5 and 6  may be three-dimensional printing of conductive ink over an elongate polymer, which may serve as core  21 . 
     The advantage of using this method is that post processing for removal of insulation is not required. On the other hand, it may be time consuming, expensive, and it may also be difficult to achieve accurate and dependable electrical properties using this method. 
     Going back to the embodiments described in  FIGS. 2A-4C , various manufacturing methods may be available. 
     Methods for manufacturing the wires of electrode  10  are well known in the art, as materials and methods similar to those used for manufacturing magnet wire may be used for insulating and twisting wires  11  and  13 . Mechanical retention of the two wires can be augmented through adhesive bonding of the two wires, fusing of the two insulation materials, etc. 
     After twisting together wires  11  and  13 , insulation layers  12  and  14  may be removed using any of the following methods: 
     Mechanical abrasion: 
     This may include but is not limited to grinding, sanding, bead-blasting, or filing using solid abrasives. 
     Alternatively, insulation may be removed using sharp blades. Yet alternatively, jets of fluid may be used to abrasively remove insulation. 
     Thermal abrasion: 
     Electrical or laser energy may be used to heat and remove insulation. 
     Chemical abrasion: 
     Abrasive chemicals including acids may be used to erode the insulation and remove it. 
     As described previously, removal of insulation using any of the above methods may be performed on one side, two or more sides, or all sides of electrode  10 . 
     To enable accurate and easy removal of insulation, various methods and tools may be employed. By way of example, a jig that may be used for this purpose is described in  FIGS. 7A and 7B . 
       FIG. 7A  is a schematic simplified cross section of jig  40  used for manufacturing of electrode  10 . 
     More particularly,  FIG. 7A  includes the exact same details as  FIG. 2D , and in addition it also shows jig  40 , which may have a C-shaped cross section. Shaft  41  of jig  40  is seen surrounding electrode  10  from all sides apart from its upper side. The open edges of jig  40  may reach dashed line B. The area of electrode  10  between dashed lines A and B may not be covered by jig  40 . This may enable accurate exposure of the uncovered area of electrode  10  to be exposed to any of the abrasion methods mentioned above, for removal of insulation layers  12  and  14 , only in this area. 
       FIG. 7B  is a schematic simplified top view of jig  40  used for manufacturing of electrode  10 . 
     More particularly,  FIG. 7B  shows, from right to left: electrode  10 , distal attachment  43 , jig aperture  42 , jig shaft  41 , tension means  45 , and proximal attachment  44 . 
     Jig aperture  42  is the open part of the C-shaped cross section of jig shaft  41 . Its ends are marked with sashed lines, as it may reach both ends of jig shaft  41 . Distal attachments  43  and proximal attachment  44  may be any type of fixture that may enable cinching electrode  10 , and adjustment of the degree of force and tension applied to electrode  10 , such as a Tuohy Borst valve. Tension means  45  may be a spring or any other mean of applying tension to electrode  10 , preferably in an adjustable manner. 
     During manufacturing of electrode  10 , jig  40  may be used to remove insulation at a desired area using the following method: electrode  10  (prior to removal of insulation) may be threaded into shaft  41  of jig  40 , and cinched at both ends by attachments  43  and  44 . The degree of tension may be adjusted using attachments  43  and  44  and tension means  45 , so that electrode  10  is taut but not excessively stretched. This may for example be achieved by measuring the tension using force gauge, or by tension means  45  being pre-set to a specific force. Once properly mounted in the jig, abrasion processes may be applied to the exposed are of electrode  10 , accessible through jig aperture  42 . 
     Of note, jig shaft  41  may be made of a rigid and durable material such as stainless steel to prevent it from eroding during use. It may alternatively or additionally be comprised of materials that may provide protection to the rest of electrode  10  from thermal or chemical effects such as various types of polymers including but not limited to polycarbonate, PVC, etc. 
     In some embodiments, jig shaft  41  may comprise two or more apertures to enable removal of insulation from multiple sides of electrode  10 . 
     In some embodiments, electrode  10  may be rotated inside jig shaft  41  during the insulation removal process, so that multiple areas of its circumference may be exposed to the process, and insulation may be removed from all or part of its circumference. 
     In some embodiments, removal of insulation may be done intermittently, i.e. only in various areas along electrode  10 . A jig  40  having several intermittent jig apertures  41  may be used for this purpose. 
     Alternatively, as shown in  FIGS. 6A and 6B , manufacturing of electrode  30 , which may be functionally identical to electrodes  10  and  20 , may be achieved by a specific method in which bare conductors are twisted along a non-conductive core. This method may be used to produce an electrode similar to the one shown in  FIGS. 4A-4C , in a quicker, cheaper, and more efficient way than removing insulation from twisted wires or 3D printing over a non-conductive core. Such process may be done as a co-extrusion of both core  32  and conductors  31  and  33 , or each of core  32  and conductors  31  and  33  may be extruded separately, and then they may be braided together to achieve a structure similar to that described in  FIGS. 3B and 4 . 
     In some embodiments, the electrodes described herein may be used for sensing electrical signals and tissue impedance. 
     Treating Medical Conditions Including Obesity and Constipation 
     The current invention further includes methods and devices for treating obesity and other gastrointestinal conditions, by producing certain ablation patterns on the gastric wall. The ablation patterns may comprise ablation lesions through which propagation of electrical, neural, or hormonal activity may be reduced or otherwise modified. By modifying this propagation, the ablation patterns are intended to modify the behavior of the organ as a whole. Areas of the stomach or organ, which may be completely or partially isolated from each other by the ablation patterns, will herein be referred to as “partitions”. 
     Global Ablation Patterns 
     In some embodiments, depicted in  FIGS. 9A-9F , the ablation patterns may be global. The meaning of “global” here is that the pattern may be dispersed over substantially the whole organ. 
     Of note, the patterns may typically comprise thin lines, relative to the gaps between the lines, such that although the lesions extend over the whole organ, most of the organ&#39;s surface may remain free of lesions, i.e. unablated. 
     Examples of such ablation patterns are shown in  FIGS. 9A-9F  in a stomach, although the treatment may be applied to many other organs. As will be explained below, the “global” patterns may extend over substantially all the organ, or at least over a large part of it. 
     In some embodiments, at least three fourths of the stomach area may be treated (i.e. no partition may be larger than a fourth of the total inner surface area of the stomach). In other embodiments, at least two thirds of the stomach area may be treated (i.e. no partition may be larger than a third of the total inner surface area of the stomach). In yet other embodiments, at least a half of the stomach area may be treated (i.e. no partition may be larger than a half of the total inner surface area of the stomach). 
     More particularly,  FIG. 9A  is a schematic anterior view of a stomach  101 , with an ablation pattern  20 A ablated on its wall. Pattern  120 A is a substantially continuous spiral line extending from fundus  104  to antrum  105  or pylorus  106 . In some embodiments, pattern  120 A may comprise several such lines, parallel to each other. 
     Such a pattern may slow both axial and circumferential propagation through the gastric wall, which may reduce the rate of gastric emptying. 
       FIG. 9B  is a schematic anterior view of a stomach  101 , with an ablation pattern  120 B ablated on its wall. Pattern  120 B may comprise several substantially continuous lines, parallel to the longitudinal axis of the stomach, extending from fundus  104  to antrum  105  or pylorus  106 . 
     Such a pattern may slow circumferential propagation through the gastric wall, which may reduce the efficacy of peristaltic contractions, and prolong gastric emptying time. 
       FIG. 9C  is a schematic anterior view of a stomach  101 , with an ablation pattern  120 C ablated on its wall. Pattern  120 C may comprise several substantially continuous lines, perpendicular to the longitudinal axis of the stomach, and optionally spanning the whole circumference of the stomach, which may be distributed from the area of fundus  104  to antrum  105  or pylorus  106 . 
     Such a pattern may slow axial propagation through the gastric wall. 
       FIG. 9D  is a schematic anterior view of a stomach  101 , with an ablation pattern  120 D ablated on its wall. Pattern  120 D is essentially a combination of patterns  120 B and  120 C, thus creating a grid of longitudinal and perpendicular lines. 
     Such a pattern may slow both axial and circumferential propagation through the gastric wall. 
       FIG. 9E  is a schematic anterior view of a stomach  101 , with an ablation pattern  120 E ablated on its wall. Pattern  120 E may comprise a substantially continuous line generally parallel to the longitudinal axis of the stomach, and optionally spanning the whole circumference of the stomach, essentially separating greater curve  108  from the lesser curve  107  and pylorus  106 . 
     In some embodiments, pattern  120 E may comprise several such lines, parallel to each other. 
     Such a pattern may slow propagation through the gastric wall, of signals from greater curve  108  to pylorus  106 . 
       FIG. 9F  is a schematic anterior view of a stomach  101 , with an ablation pattern  120 F ablated on its wall. Pattern  120 F may comprise a substantially continuous line generally perpendicular to the longitudinal axis of the stomach, and optionally spanning the whole circumference of the stomach, essentially separating greater curve  108  from the lesser curve  107  and pylorus  106 . 
     In some embodiments, pattern  120 F may comprise several such lines, parallel to each other. In some embodiments pattern  120 F may span only part of the circumference of the stomach, or may be at an angle to the longitudinal axis of the stomach (rather than perpendicular to it). 
     Such a pattern may slow propagation through the gastric wall, of signals from the proximal part of stomach  101  to antrum  105  and pylorus  106 . 
     In some embodiments, pattern  120 F or similar patterns may be used to create a constricting ring or band around the middle of the stomach. Such a constriction may serve to impede flow of gastric contents towards the antrum, which may slow gastric emptying, increase satiety, and reduce obesity. 
     The “ring” or “band” constriction which may result from the ablation of a pattern  120 G or similar, which may be intended to cause gastric tissue shrinkage, is depicted in  FIG. 9G . The pattern may be a complete circle comprising a substantially continuous line as in  FIG. 9G , or it may comprise an open circle or several overlapping segments resulting with a segmented circumferential constriction ring pattern  120 H, as shown in  FIG. 9H . Such a pattern may prevent excessive constriction and may still allow gastric pacemaker signals to pass, albeit at a slower pace. Various other constriction patterns may be possible including but not limited to wavy or zig zag circumferential lines. 
     Additional embodiments may include different global patterns such as zig zag lines instead of the spiral lines in pattern  120 A, or the straight lines in patterns  120 B- 120 F, point ablations (for example at any of the line intersections in  FIG. 9D ), or any combination of the above. 
     Regional Ablation Patterns 
     In some embodiments, depicted in  FIGS. 10A-10D , the ablation patterns may be regional. The meaning of “regional” here is that the pattern may be dispersed over substantially most of a specific region of the stomach. Typically, such regions may include but are not limited to antrum  105 , pylorus  106 , and corpus COR of stomach  101 . 
     Of note, the patterns may typically comprise thin lines, relative to the gaps between the lines, such that although the lesions extend over most of the treated region, most of the surface of this region may remain free of lesions, i.e. unablated. 
     Examples of such ablation patterns are shown in  FIGS. 10A-10D  in a stomach, although the treatment may be applied to many other organs. As will be explained below, the “regional” patterns may extend over substantially all the treated region, or at least over a large part of it. 
     More particularly,  FIG. 10A  is a schematic anterior view of a stomach  101 , with an ablation pattern  130 A ablated on the wall of stomach  1  at the region of antrum  5 . Pattern  30 A comprises several substantially continuous spiral lines extending from the proximal to the distal end of antrum  105 . The lines may be substantially parallel to each other. In some embodiments, pattern  130 A may comprise only one such line. 
     Such a pattern may slow both axial and circumferential propagation through the wall of antrum  105 , which may reduce the rate of gastric emptying. 
       FIG. 10B  is a schematic anterior view of a stomach  101 , with an ablation pattern  130 B ablated on the wall of stomach  101  at the region of antrum  105 . Pattern  130 B may comprise several substantially continuous lines, parallel to the longitudinal axis of the stomach, extending from the proximal to the distal end of antrum  105 . 
     Such a pattern may slow circumferential propagation through the wall of antrum  105 , which may reduce the efficacy of peristaltic contractions, and prolong gastric emptying time. 
       FIG. 10C  is a schematic anterior view of a stomach  101 , with an ablation pattern  130 C ablated on the wall of stomach  101  at the region of antrum  105 . Pattern  130 C may comprise several substantially continuous lines, perpendicular to the longitudinal axis of the stomach, and optionally spanning the whole circumference of the stomach, extending from the proximal to the distal end of antrum  105 . 
     Such a pattern may slow axial propagation through the wall of antrum  105 , which may reduce the rate of gastric emptying. 
       FIG. 10D  is a schematic anterior view of a stomach  101 , with an ablation pattern  130 D ablated on the wall of stomach  101  at the region of antrum  105 . Pattern  130 D is essentially a combination of patterns  130 B and  130 C, thus creating a grid of longitudinal and perpendicular lines. 
     Such a pattern may slow both axial and circumferential propagation through the wall of antrum  105 , which may reduce the rate of gastric emptying. 
     Local Ablation Patterns 
     In some embodiments, depicted in  FIGS. 11A-11D , the ablation patterns may be local. The meaning of “local” here is that the pattern may be created at a specific location, typically with a small area within stomach  101 . Typically, such locations may include but are not limited to the inferior aspect of antrum  105 , the middle of the greater curve  108 , and the proximal end of the corpus COR. 
     Of note, the patterns may typically comprise thin lines, relative to the gaps between the lines, such that although the lesions extend over most of the treated location, most of the surface of this location may remain free of lesions, i.e. unablated. 
     Examples of such ablation patterns are shown in  FIGS. 11A-11D  in a stomach, although the treatment may be applied to many other organs. 
     More particularly,  FIG. 11A  is a schematic anterior view of a stomach  101 , showing an ablation pattern  140  ablated on the wall of stomach  101 , located by way of example at the following locations:  140 A—at the inferior aspect of antrum  105 ,  140 B—at the middle of the greater curve  108 , and  140 C—at the proximal end of the corpus COR. although shown here in these locations, pattern  140  may be ablated at any location in the stomach. 
     Pattern  140  comprises eight lines extending radially from a central point, and a circular line around them. The lines may be substantially continuous, and may be at equal distances from each other. In some embodiments, pattern  140  may comprise any number of radial lines, typically 3-12 lines. In some embodiments, pattern  140  may comprise the circular line only. 
     Such a pattern may slow or prevent propagation from the treated location. 
       FIG. 11B  is a schematic anterior view of a stomach  101 , showing an ablation pattern  141  ablated on the wall of stomach  101 , located by way of example at the following locations:  141 A—at the inferior aspect of antrum  105 ,  141 B—at the middle of the greater curve  108 , and  141 C—at the proximal end of the corpus COR. although shown here in these locations, pattern  141  may be ablated at any location in the stomach. 
     Pattern  141  comprises eight lines extending radially from a central point. The lines may be substantially continuous, and may be at equal distances from each other. In some embodiments, pattern  141  may comprise any number of radial lines, typically 3-12 lines. 
     Such a pattern may slow or prevent propagation from the treated location. 
       FIG. 11C  is a schematic anterior view of a stomach  101 , showing an ablation pattern  142  ablated on the wall of stomach  101 , located by way of example at the following locations:  142 A—at the inferior aspect of antrum  105 ,  142 B—at the middle of the greater curve  108 , and  142 C—at the proximal end of the corpus COR. although shown here in these locations, pattern  142  may be ablated at any location in the stomach. 
     Pattern  142  comprises a spiral line extending from a central point, creating a flat spiral at the treated location. The line may be substantially continuous. In some embodiments, pattern  142  may comprise several such lines, substantially parallel to each other. 
     Such a pattern may slow or prevent propagation from the treated location. 
     Other Ablation Patterns 
       FIG. 11D  is a schematic anterior view of a stomach  101 , showing an ablation pattern  143  ablated on the wall of stomach  101 . 
     Pattern  143  is essentially a combination of a “local” pattern  140 A and a “global” pattern  120 F. Although shown here in these locations, pattern  143  may be ablated at any location in the stomach. 
     Such a pattern may slow or prevent propagation of signals from the treated location. 
     In some embodiments, any combination of the patterns and locations described herein may be used. 
     In some embodiments, the goal of treatment may alternatively or additionally be to reduce the volume and/or distensibility of at least a portion of the stomach. The fundus  104  of the stomach is normally very distensible, and is where food normally accumulates during meals. Reducing the volume and/or distensibility of the fundus may therefore promote early satiety and alleviate obesity. Such a therapy may be used instead of, or as an adjunct to bariatric surgery including gastric bypass, placement of gastric bands, etc. It may be delivered at fundus  4  as depicted in  FIG. 11E , or at other areas of the stomach. 
     More particularly,  FIG. 11E  is a schematic anterior view of a stomach  101 , with an ablation pattern  145  ablated on the wall of stomach  101  at the region of fundus  104 . Dashed line  144  marks a possible pre-treatment contour of fundus  104 , whereas line  144 ′ marks a possible post-treatment contour of fundus  104 . 
     Although the specific pattern  145  shown here is similar to local ablation pattern  141 , any pattern that may reduce the volume of the fundus may provide the desired effect. Thus, for example other patterns, such as, but not limited to patterns  130 A- 130 D and  140 - 142  described herein, may be used in the fundus or other relevant gastric areas to reduce their volume and/or compliance. 
     Lesion Depth 
     The lesions making up the above described ablation patterns may be of various depths and may include several of the gastric wall layers shown in  FIG. 8B . 
     Typically, lesions may extend through the mucosa MCS, submucosa SMC, and at least part of the muscularis MUS. In some embodiments, the lesions may be completely transmural, reaching the serosa SER, however visceral peritoneum  116  may typically be avoided, so as not to risk extension of the lesion to adjacent organs. 
     In some embodiments, skipping of mucosa MCS or at least the outermost layers of mucosa MCS, or reduction of the extent of thermal damage to those layers may be achieved by cooling those layers as known in the art. This may be done for example by cooling of the contents of the stomach or organ prior to or during the procedure, or by application of a continuous infusion of cooled fluid at the ablation sites, optionally through the ablation device itself. 
     Typically, a longer ablation time and total energy may need to be used in order to induce a tissue contraction as opposed to just limiting propagation of signals in the organ wall. The normal adult human gastric wall is 4-6 mm thick. Typical depths of lesions for affecting signal propagation may be 0.2-4 mm, preferably 0.5-2 mm. Typical depths of lesions for inducing tissue shrinkage and constriction may be 2-6 mm, preferably 3-5 mm. 
     Control of the depth of ablation may be achieved by several methods. In case of bipolar electrodes as described herein, the distance between the two poles affects the depth of ablation at any given power, and may therefore be pre-determined and constructed to produce the desired depth. The power, duration, and energy density of the delivered treatment may also be modified to control the depth of the lesions. 
     The temperature of the tissue may be measured by thermistors and used to stop ablation once temperature reaches a predetermined threshold. 
     Effects of Ablation Patterns: 
     As previously stated, the goal of creating the above lesion patterns in the stomach or organ wall, may be to modify propagation of signals through the wall in order to affect a change in behavior of the organ as a whole. 
     This may for example be achieved by a partial block of the connection between ICCs. Alternatively this may be achieved by a complete block of contacts between ICCs. 
     A partial or complete block of conduction between neurons within the Submucosal Plexus SP and/or Myenteric Plexus MP may constitute another mechanism by which the effects of treatment may be achieved. 
     Direct propagation between muscle cells is not considered a significant pathway of signal conduction in the gut, however blocking of such conduction by the lesions of the current treatment may also contribute to modifying peristalsis. 
     The above may for example be achieved by delivering energy sufficient to create a scar within the tissue. Typically, such a scar may develop over time during the healing process following the ablation, and may involve deposition of collagen. Gentle lesions causing minimal, thin scarring, may be sufficient to block propagation of signals in the gastrointestinal wall. Wider and deeper lesions may additionally or alternatively cause more extensive scarring, which may affect the mechanical properties of the ablated organ. 
     Thus, another mechanism which may contribute to treatment of obesity is a potential decrease of gastric volume by creating lesions sufficient to cause its contraction, or a decrease in its elasticity. 
     In some embodiments of the current invention, the goal of the treatment may be modulation of the natural propagation of intrinsic signals within the stomach with the objective of opposing the known effects of such intrinsic activity. For example, the intrinsic activity is known to maintain smooth muscle relaxation. Thus, disturbing this activity may cause an increase in stomach tone that may promote early satiety (when the stomach resting tone is increased to a degree of certain rigidity). 
     For example, the intrinsic activity is known to mediate sphincter relaxation. Thus, disturbing this activity may cause an increase in sphincter tone that may promote early satiety (by delaying gastric emptying) and/or alleviate reflux (by increasing gastro esophageal junction/sphincter tone). 
     In another example—intrinsic muscle activity is known to have an important role in stirring the gastric contents, and improving digestion. Disturbing such stirring may result in more of the gastric content being only partially digested, which may cause prolonged gastric emptying times, increased satiety and reduced food intake. 
     In another example—intrinsic gastric activity is known to cause “wavy” movements of the gastric serosa, thus optimally exposing (unfolding) all gastric crypts. Disturbing such activity may allow eroded gastric mucosa to remain less exposed to the gastric content, thus alleviating erosive gastritis. 
     In yet another example, coordinated gastric relaxation, mediated by the internal gastric conduction system, normally allows the stomach to rapidly increase in volume to accommodate large meals. Disruption of such coordinated relaxation sequences may hinder the ability to consume large amounts of food in a short time (help prevent binge eating). 
     In another example, the coordinated gastric activity normally generates a strong pacemaker signal that can affect the entire GI tract. Disrupting such activity may reduce the amplitude of gastric activity, thus reducing the excitation of the entire GI, alleviating symptoms of irritable bowel syndrome. 
     In another example, when the stomach is empty for a prolonged period of time, intrinsic activities cause gastric contraction which minimizes the gastric volume and the sensation of hunger. Disrupting such activity may reduce the ability of the stomach to inhibit hunger, thus enabling treatment of anorexia nervosa, and anorexia of other causes. 
     In another example—in case of digestion of toxin or bacteria laden food (or other obnoxious stimuli), multiple foci generate widespread non-coordinated gastric activity resulting in a functional paralysis of the stomach, accompanied by an acute sensation of nausea. By limiting the ability of each focus to reach the entire stomach, nausea of various causes may be alleviated. 
     In another example, the coordinated contraction of the stomach (mediated by the intrinsic conduction system) is important to increase gastric pressure to propel food out of the stomach and into the duodenum and/or the esophagus (in case the esophageal sphincter pressure is lower than the pyloric pressure). Disturbing such coordinated contraction may attenuate increases in gastric pressure, alleviating reflux symptoms, delaying gastric emptying, reducing belching and bloating and more. 
     In yet another example, coordinated gastric activity is required for vomiting. Disturbing such intrinsic conduction may inhibit the ability to vomit, as a potential treatment in cases of bulimia and/or cyclic vomiting. 
     In another example, the refractory period after a contraction is an important mechanism that helps to prevent “re-entry” circles of self-perpetuating contractions. When a certain stomach zone contracts, it becomes refractory, thus preventing the same contraction to now travel back to its origin. By isolating parts of the stomach, re-entry circles may become possible, thus disturbing the normal activity of the stomach and potentially causing continuous rapid contractions of the stomach. Such contractions may reduce gastric emptying, induce a lack of appetite, and even travel along the GI tract to increase intestinal motility and alleviate constipation and/or ileus. 
     In an embodiment, a narrow isolated tissue strip may be created, leading from the body of the stomach to the fundus of the stomach. The strip may have two openings on both ends of the strip. The strip may be designed in the shape of a “winding road”, so that propagation along the tissue strip takes longer that the propagation in adjacent tissue (where propagation may occur along straight lines). Thus, a propagating signal traveling form the body to the fundus may advance in two ways: either directly, or through the strip. The propagating signal traveling through the strip may arrive at the fundus later than signals traveling directly (through the un-modified gastric tissue). If the delay is long enough, the delayed signal may reach the fundus after it has already contracted and already completed the refractory period, re-exciting the fundus in a “re-entry” mechanism. Typically, in order to incite re-entry, the tissue strip must have a linear length (minimal length of conduction through the strip) that is at least two times that of the parallel path, and at least 10 cm in length. 
     Non-Ablative Applications 
     The above described novel bi-polar wire electrode may also be used to treat GI disorders by delivering electrical currents to stimulate GI smooth muscle contractions. Due to the flexible nature of the novel wire electrode an electrode, array can cover a large surface area while remaining easy to insert into the GI tract, easy to pass through the GI tract, and even easy to swallow with comfort. 
     Such a multi bipolar electrode array may be used to deliver electrical currents to contract GI smooth muscle, in order to “train” the muscle and eventually modify its structure and activity. In one example, an electrode array may deliver stimulation to the distal esophagus, to tighten the esophageal sphincter and increase its tone, to treat gastroesophageal reflux. This array may be advanced into the esophagus on a semi-rigid tube, or alternatively it may be swallowed by the patient and held at the desired location by anchoring the proximal wire to the patient (for example, taping to the cheek, or anchoring to a tooth). In another example, such an electrode array may be inserted through the anus, expanded to contact the rectal wall and it then may be used to stimulate the rectum to increase rectal tone, to treat constipation and/or soiling. 
     Such stimulation therapies usually necessitate repetitive treatment sessions. Since both conditions are not life threatening a viable therapeutic solution must be extremely comfortable to use repetitively. The novel bi-polar electrode allows electrode array designs that can expand to contact large surface areas. 
     Bi-Polar nitinol wire electrode—Another possible application is to couple the novel wire electrode to a nitinol wire. When current is applied through the electrode wire, the nitinol is activated to assume a structure that approximates the electrodes to the desired surface/material. 
     Energy Types 
     Although described below using electrical energy at Radio-Frequency (RF), any modality and type of energy known in the art to be used for therapeutic ablation of tissue, may be used for the purpose of creating the ablation patterns described herein. These modalities may include but are not limited to microwave or high frequency electrical ablation, irreversible electroporation, ultrasound, cryoablation, laser, mechanical scoring, and more. The conductors of the devices described herein may typically be substituted for appropriate ablation elements compatible with the other modalities, for example—cooled conductors or tubes for passage of cooled gas for cryoablation, optic fibers for laser, etc. 
     Devices 
     Following are descriptions of embodiments of devices intended to create the ablation patterns mentioned above. 
       FIGS. 12A-12C  describe devices intended for creating global ablation patterns,  FIG. 13  is an example of a device for creating regional ablation patterns, and  FIGS. 14A-14B  describe devices intended for creating local ablation patterns. 
     More particularly,  FIG. 12A  is a schematic frontal view of device  150 A which may be used to create a global ablation pattern in a human stomach, shown here in its fully expanded state, outside the body. Device  150 A may comprise conductors (or ablation elements)  161  mounted over an expandable member  153  which may typically be an inflatable balloon, but may also be any other appropriate expandable member as known in the art, such as a wire cage. Expandable member  153  may be mounted over a flexible shaft  152  which may pass through sheath  154 , with seal  164  between them. Sheath port  159  may be in fluid communication with the lumen of the treated organ, through the lumen of sheath  154 . Shaft  152  may comprise a handle  151  at its proximal end. An expansion port and lumen  155  may provide access for inflation of expandable member  153  through openings  156  in shaft  152  in case of a balloon, or for a cable or other element for expansion, in case of a different form of expandable member. An optional lumen  157  extending through shaft  152  may allow introduction of device  150 A into a patient&#39;s body over a guidewire  158 . Optional tip  163  may be located at the distal end of expandable member  153 , securing it to shaft  152 . Conductors  161  may be connected via cable  162  to RF generator RFG, or other energy source as appropriate. 
     As seen in  FIG. 12A , expandable member  153 , in the current embodiment comprising an inflatable balloon, may have a shape compatible with the inner volume of a typical stomach. Balloon  153  may for example be made of a relatively or completely noncompliant material e.g. high durometer polyurethane, or PEBAX, so as to achieve a defined and stable shape and volume upon complete inflation. In such case, balloons of various sizes may be used to fit different patients. Alternatively, balloon  153  may be manufactured of a compliant material such as latex or low durometer polyurethane, and inflated to the appropriate size for each specific patient. 
     Inflation may typically be performed using air, but may also be done using other gases, or fluid such as saline. 
     Expansion of expandable member  153  to a volume larger than that of the empty stomach may be beneficial, for example by flattening or eliminating the gastric folds (rugae), thus improving contact between conductors  161  and the gastric wall. 
     Conductors  161  may typically be any type of ablation element capable of transmitting the required energy to the organ wall to create the desired ablation patterns. Monopolar electrodes may be used, in which case they may typically be used with a dispersive/patient/ground electrode elsewhere on the patient&#39;s body, e.g. on the patient&#39;s thigh or back. 
     Conductors  161  may be made of multiple electrically isolated segments, that may be activated in succession or synchronously. 
     Bipolar electrodes may be used for conductors  161 . Such bipolar electrodes may for example be two parallel conductors at a constant distance from each other. In some preferred embodiments, spiral bipolar electrodes, such as those described herein and in provisional application 62/723,927 filed 28 September, 2018 incorporated herein in its entirety, may be used. Again, a single pair of such spiral bipolar electrode, or several separate segments thereof, may be used. 
     Conductors  161  may typically be connected to expandable member  153  using methods known in the art, including adhesion, use of clips, threading through loops in the balloon, etc. 
     Conductors  161  may further be slideable over the balloon, and pulled into their final position by inflation of the balloon. 
     The dimensions of flexible shaft  152  may typically be: 
     Length: typically 20 cm-120 cm; preferably 40 cm-100 cm 
     Outer Diameter: typically 2 mm-30 mm; preferably 5 mm-15 mm 
     The dimensions of sheath  154  may typically be: 
     Length: typically 10 cm-90 cm; preferably 30 cm-60 cm 
     Outer Diameter: typically 4 mm-40 mm; preferably 6 mm-25 mm 
     Although device  150 A is appropriate and designed for use without visualization, in some embodiments shaft  152  further comprises or alternatively allows for insertion of means for visualization such as fiber optic means or a digital camera, typically with appropriate means of illumination for viewing the inside of the treated organ prior to or during the ablation procedure. Such visualization means may enable viewing of the lumen of the organ through expandable member  153 , for example by expandable member  153  being a transparent balloon, and such camera being located in the middle of expandable member  153 . 
     Device  150 A is shown here with conductors  161  arranged spirally around expandable member  153 , a version appropriate for creating ablation pattern  120 A shown in  FIG. 9A . Different arrangement of conductors  161 , compatible with patterns  120 B- 130 D, and  141 - 143 , may be used to create any of those ablation patterns shown in  FIGS. 9B-11E . 
     In use, following performance of a gastroscopy, a guidewire may be left in the stomach, extending out of pylorus  106  into the duodenum. Device  150 A may be inserted over guidewire  158 , which may help to guide it such that the distal end of shaft  152  enters the duodenum, and tip  163  is positioned at pylorus  106 . Insertion of device  150 A may be performed in its crimped state, i.e. with sheath  154  covering shaft  152  and expandable member  153  all the way to tip  163 . 
     Following insertion of shaft to the desired depth, sheath  154  may be retracted to expose expandable member  153  and conductors  161 . Expandable member  153  may then be expanded until it fills the gastric cavity and conductors  161  may come into contact with the gastric wall. Suction through sheath port  155  may be used to remove any residual fluids between the device and gastric wall. Contact of conductors  161  with the stomach wall may be verified as will be detailed below. Ablation may be performed by delivering energy from RFG to conductors  161 . 
     Following ablation, the stomach may be inflated with fluid or air to assist removal of device  150 A. Expandable member  153  may be collapsed or deflated, and sheath  154  may then be pushed forward to cover expandable member  153  and conductors  161 . Device  150 A may then be retracted and removed from the patient&#39;s body. 
       FIG. 12B  shows device  150 B which is a variation of device  150 A in which instead of a single balloon  153 , two balloons  153 ′ and  153 ″ may be used, which may make deployment and retraction of the device easier. In some embodiments, balloon  153 ″, which may fill the fundus to provide a counter force to balloon  153 ′ and stabilize it in place, may be inserted into the stomach separately, for example prior to insertion of device  150 B. 
       FIG. 12C  shows device  150 C which is a variation of device  150 A in which shaft  152  may not extend beyond the distal tip of balloon  53 , and a guidewire lumen may be absent. This embodiment may be inserted “blindly” or using fluoroscopy, or ultrasound guidance, and proper positioning of the device may depend on inflation of balloon  153  to match the shape of the stomach. 
       FIG. 13  shows a device for creation of the regional ablation pattern  130 C, shown in  FIG. 10C . 
     More particularly,  FIG. 13  is a schematic frontal view of stomach  101  with device  160  in it, shown in its fully deployed state within antrum  106 . 
     Device  160  may be generally similar to device  150 C, however it may comprise a smaller expandable member, so that it fits within antrum  106 . Shaft  152  may be flexible enough to allow bending so that the tip of shaft  152  may reach pylorus  106 , and rigid enough to allow control of its position. 
     With modification of the arrangement of conductors  161 , device  160  may be used to create regional ablation patterns  130 A- 130 D shown in  FIGS. 10A-10D . 
     Device  160  may be used to place the same patterns in other regions of the stomach as well. 
       FIG. 14A  shows a device for creation of the local ablation pattern  140 B shown in  FIG. 11A . 
     More particularly,  FIG. 14A  is a schematic frontal view of stomach  101  with device  170 A in it, shown in its fully deployed state depressed against greater curve  108 . 
     Device  170 A may be similar to a device previously described in PCT application IB2017/000783 filed Jun. 6, 2017. It comprises an inflatable balloon  172  mounted over a rigid, substantially straight shaft  173  and sheath  174 . The main difference may be that conductors  171  may be the same as described for devices  150 A- 160  above, preferably using the bipolar electrodes described herein. 
     A different version of device  170 A adapted for creation of the local ablation patterns  140 A and  140 C shown in  FIG. 11A , is shown in  FIG. 14B . 
     More particularly,  FIG. 14B  is a schematic frontal view of stomach  101  with device  170 B in it, shown in its fully deployed state depressed against the proximal end of greater curve  108 . 
     Shaft  173 ′ and sheath  174 ′ of device  170 B may be rigid or semi rigid, but both may be curved at the same radius, which enables device  70 B to reach more proximal or more distal areas of stomach  101 . 
     In some embodiments, shaft  173 ′ may be configured to be actively curved following insertion into the stomach, such that treatment may be delivered to more proximal areas, such as fundus  104 . 
     In some embodiments, device  170 B or similar to it may be used to deliver the fundus contracting therapy described in  FIG. 11E . 
     In some embodiments, conductors  161  may be embedded or printed over balloon  153  of any of the above embodiments. 
     In some embodiments, the flexible bipolar electrodes described herein may be incorporated in a single device together with other electrodes of different types. In some embodiments, the other electrodes may be monopolar electrodes that may be coupled with a distant dispersive patient electrode. In some embodiments, the other electrodes may be bipolar, coupled either with a distant patient electrode, or with other bipolar electrodes on the same device. In some of these embodiments, the additional coupled bipolar electrodes on the device may be far from each other. In yet another embodiment, the additional coupled electrodes may be at a short distance from each other. A specific embodiment of such a device incorporating spiral bipolar electrodes together with parallel near-field bipolar electrodes is described in  FIGS. 18A-C . The benefit of using this combination of electrodes is that the parallel electrodes lend themselves to manufacturing as part of a PCB (Printed Circuit Board) but cannot fold in a direction perpendicular to their longitudinal axis, while the flexible spiral bipolar electrodes may be easily folded in any direction, thus enabling creation of lesions perpendicular to the longitudinal ones, which may be desirable in various situations. 
     More particularly,  FIG. 18A  is a simplified three-dimensional depiction of tissue ablation device  300  at its deployed state. Depicted are (from the left in a counter-clockwise direction) spiral bipolar electrodes  302 , inner shaft  304 , external sheath  306 , parallel (or “rail track”) bipolar electrodes (only one of these is annotated, for clarity), longitudinal PCB legs  310  (in this embodiment there are 8 legs, only 4 are annotated for clarity), distal tip  312 , and expandable element  314 . 
     Typically, longitudinal PCB legs  310  may be slidably positioned over expandable element  314  (in the current image a balloon), which in turn may be mounted over inner shaft  304 , which may be slidably positioned within external sheath  306 . Flexible spiral bipolar electrodes  302 , which may for example be any of the electrodes described above in  FIGS. 1-6 , may be attached to longitudinal PCB legs  310 , such that when expandable element  314  is fully expanded, electrodes  302  may straighten out, and when element  314  is collapsed, electrodes  302  may fold, as shown in  FIG. 18C . Parallel electrodes (or “rail track” electrodes)  308  are elongate conductors, at least two on each PCB leg  310  that may be positioned at a small distance from each other, typically 0.1 mm-2 mm. When energized, current may flow between the two parallel conductors, affecting the tissue between them, along their length. 
       FIGS. 18B and 18C  are simplified schematic side views of device  300  in its deployed and crimped states respectively. 
     More particularly,  18 B shows device  300  at its deployed state. In this schematic illustration only 4 PCB longitudinal legs  310  are shown. The complete structure comprised of the electrodes and balloon is seen protruding out of external sheath  306  and ready for ablating tissue. 
       FIG. 18C  shows device  300  at its crimped state. The complete structure comprised of the electrodes and balloon is seen folded inside external sheath  306 . 
     In use, device  300  may be inserted into a patient&#39;s body via an orifice at its crimped state, and it may then be deployed to so that the electrodes may be in contact with the inner walls of a hollow organ. Following ablation external sheath  306  may be advanced distally over the device to crimp it and enable removal from the patient&#39;s body. 
     Procedure 
     The devices and procedures described herein may typically be applied endoscopically. In some embodiments, insertion of devices into the target organs may be performed surgically. 
     In some embodiments, a combined surgical and endoscopic approach may be used, wherein some aspects of the procedure may be performed endoscopically, and others surgically. 
     In some embodiments, such as those shown in  FIGS. 12A-12C , treatment may typically be delivered at once, without moving the device during the procedure. In some embodiments, for example those shown in  FIGS. 13-14B , several energy deliveries may be performed, each with the device at a different position, to achieve the complete ablation pattern required. 
     In some embodiments, various forms of mapping of gastric activity may be performed prior to ablation in order to determine the pattern of activity in the stomach, including for example location of pacemaker, conduction pathways, any aberrant sources of activity, conduction velocity, or gastric emptying velocity. 
     This may for example be accomplished by using real time video analysis of endoscopic clips of the inside of the stomach, to image gastric motility. 
     This may also optionally be performed using high definition ultrasound of the stomach wall. 
     Another possible way of analyzing gastric activity is using electrode arrays endoscopically inserted into the stomach or placed surgically on its outer surface. 
     By employing such methods, determination of aberrant sources of gastric activity, or exact localization of the gastric pacemaker may be used to plan the appropriate lesion patterns. 
     As will be detailed below, in some embodiments, the data collected using any of the above methods may be saved into a database together with other relevant clinical information of the patient, so that correlations may be sought between gastric activity patterns and their clinical manifestations. 
     In some embodiments, the above acquired data may be used to create computerized simulations of the current gastric activity, as well as of the anticipated effects of the intended interventions on target organ activity and/or or structure, to enable planning of the appropriate ablation pattern. 
     Ensuring Proper Device Fit 
     Good contact between the electrodes or other ablation elements and the organ wall may be crucial for achieving good ablation results. Various approaches may be used to ensure good contact despite variability in the anatomy of target organs between different patients. 
     In some embodiments, ablation devices of several sizes may be available, and the appropriate size may be chosen by the user. Choosing the device may be based on measurements made endoscopically or using imaging, or by use of a sizing device. Such sizing device may for example be a balloon which may be inserted into the target organ prior to the ablation device, and may be inflated to a known pressure or volume. Once inflated, verification of fit may be done using imaging, endoscopy, measurement of impedances between electrodes on the surface of such a device, or any other method as known in the art. 
     For example, a sizing device may comprise multiple electrical contacts, shaped as points, strips, or other shapes, distributed over its surface. Measurement of impedances between the electrodes and/or between the electrodes and a reference electrode inside or outside the patient&#39;s body, may be performed. In some embodiments, such measurements may be done simultaneously during inflation of the sizing device balloon. By plotting impedances against inflated volume and/or device diameter at certain locations along the device, and/or other device dimensions, optimal device dimensions, that may be defined as those at which the best contact is measured, may be identified, in real time or after the procedure. An appropriate ablation device size, inflation volume, and/or shape may be chosen accordingly. 
     In some embodiments, such a sizing device may comprise a compliant balloon so that it can be used for all, or most patient sizes. In some embodiments, sizing devices of different sizes, that comprise non-compliant balloons, may each fit only a specific organ size or range of sizes, and several sizes of such sizing devices may be available to choose from. In some embodiments, the sizing device may comprise a transparent balloon, and either enable insertion of an endoscope into the balloon, or it may comprise a camera inside the balloon, so that visual confirmation of good wall contact may be done through the balloon. 
     In some embodiments, the ablation device may also function as the sizing device. In some embodiments, an ablation device of the “one-size-fits-all” type may comprise a compliant balloon and sliding electrodes, which may be pulled in by the inflating balloon until the balloon fills the organ snugly, and the electrodes may then be in good contact with the organ wall. 
     Determination of proper contact between conductors  161  and the gastric wall may be done using any of measurement of impedance through conductors  161 , by measuring temperature near conductors  161 , or by use of imaging, including fluoroscopy, or ultrasound. In some embodiments, stimulation of the gastric wall by delivering a current through conductors  161  may be done, while measuring the effect on heart rate or its variability, a significant effect may be evidence of good contact. 
     Colon Treatment for Constipation 
     While the above devices and methods may be used for treating the stomach as well as other gastrointestinal organs for various conditions, specific embodiments of such devices and methods, especially suited for treating constipation, will be described next. 
     Constipation is a huge medical problem, affecting approximately 80 million people in the US alone. 
     Of particular interest is constipation that develops as a consequence of age related changes in the colon. 
     Studies in humans have shown that aging is associated with excessive relaxation of the ascending colon, probably caused by decreased cholinergic function in this area ( Changes in neuromuscular structure and functions of human colon during ageing are region - dependent.  Broad et al.,  Gut  2018; 0: 1-14). 
     Similar changes probably take place in the cecum as well, which according to clinical observations, demonstrates age related dilatation. Such relaxation and dilatation may lead to reduced propulsion of stool, which may result in constipation and even fecal impaction. 
     Reducing the volume of the cecum and right (ascending) colon, and/or decreasing their compliance, may improve movement of stool through the large intestine, as a treatment for constipation. Another treatment modality contemplated here is ablation of the colonic mucosa to reduce water absorption within the colon. 
     The above may be achieved for example by producing ablation patterns that may result in any of scarring of the colonic wall, reduction of its volume, reduction of its capacity to store stool, or reduction of its capacity to absorb water. 
     In addition, the inventors believe that the dilatation and relaxation of the colon may, at least in part, be mediated by a rapid arrhythmia pattern of conduction within the colon, much like the fibrillation seen in the atria of the heart. In both cases dilatation is accompanied by loss of contraction force and loss of expected periodic activity. Partitioning of the colon (as described above for the stomach) may prevent such fibrillations of the colon and may allow normal colon function. Typical ablation patterns may create partitions of the colon, mostly isolated form the rest of the organ. 
       FIG. 15  is a simplified anterior view illustration of a human large intestine  180 . 
     More particularly, starting from the left lower quadrant and moving clockwise are seen cecum  181 , ascending (right) colon  182 , transverse colon  183 , descending (left) colon  184 , sigmoid colon  185 , and rectum  186 . The appendix  187  is seen connected to cecum  181 . Dashed line  188  marks a possible contour of a dilated cecum and ascending colon. 
     The normal adult human cecum and right colon wall thickness is 1.5 mm on average, with a range of roughly 1.2 mm to roughly 2 mm. 
     Some possible treatment ablation patterns are depicted in  FIGS. 16A-16B . Of note, ablation patterns are shown here on a normally sized colon, as its diameter is expected to decrease following treatment. 
     More particularly,  FIG. 16A  is a simplified schematic anterior view of spiral ablation pattern  190 A, produced in the wall of a human large colon. 
     Spiral ablation pattern  190 A may typically extend from the cecum to the hepatic flexure (between ascending colon  182  and transverse colon  183 ). It may start anywhere in the cecum or right colon and may comprise a single line or multiple substantially parallel lines, at the same clockwise direction, or at opposite directions. Pattern  190 A may have a constant pitch, i.e. the distance between each two adjacent loops of the spiral may be constant, or, as depicted in  FIG. 16A , the pitch may vary, for example it may gradually or abruptly increase from cecum  181  towards transverse colon  183 . Such a change in pitch may create a gradient in the compliance and/or diameter of the intestine along the treated segment, which may promote movement of stool towards the rectum. 
     In another embodiment depicted in  FIG. 16B , a pattern of interlaced half circles along the cecum and ascending colon may be used. 
     More particularly,  FIG. 16B  is a simplified schematic anterior view of spiral ablation pattern  190 B, produced in the wall of a human large colon. 
     As with pattern  190 A, pattern  190 B may typically extend from the cecum to the hepatic flexure, and may have a constant or variable pitch. 
     Patterns  190 A and  190 B may enable decreasing the volume of the intestine while preserving the contractility of at least the untreated tissue between the thin ablation lines, as well as the propagation of intrinsic activity within the intestinal wall. These patterns may also avoid excessive stricture of the intestine as the full circumference of the colon is not ablated at any one location. 
     With any ablation pattern used in the cecum, avoiding the ileo-cecal valve and opening of the appendix may be important for prevention of strictures, bowel obstruction, and appendicitis. 
     Avoiding these structures may be achieved for example by endoscopically identifying them and covering them with thermal shields, or by positioning the ablation device such that it does not ablate these locations. 
     Performance of cecal and or ascending colon ablation for creating ablation patterns such as  190 A and  190 B or similar, may be achieved by various devices and methods. 
     An example of an embodiment of a cecal and/or ascending colon ablation device is described in  FIG. 17 . 
     More particularly,  FIG. 17  is a simplified schematic anterior view of ablation device  200  in large colon  180 . The distal ileum ILE is seen connecting to cecum  181  adjacent appendix  187 . Device  200 , which may be generally similar to the devices described in  FIGS. 12A-14B , comprises a flexible shaft  201 , a balloon  202 , an electrode or electrode array  203 , a guiding element lumen  205 , typically going from proximal to distal end of flexible shaft  201 , and an inflation lumen  206 . Not shown, for the sake of clarity, is an external sheath that may optionally be used to encase balloon  202  and electrode array  203 . A guiding element  204  such as a guidewire or balloon catheter may be used to guide device  200  to its target position. Guiding element  204  may have at its distal end an anchor  207  which may be a balloon, a shaped bend or a kink in guiding element  204 , or any other expansion means or anchoring means as known in the art. RFG cable  208  connects electrodes  203  with the external RF generator RFG. 
     In use, in some embodiments, a colonoscopy may be performed prior to ablation. Device  200  may be inserted through the working channel of the colonoscope, which may typically have an inner diameter of ˜3.7 mm. 
     Since this lumen diameter is very small, it may be preferable to insert ablation device  200 , which may have a larger diameter, in a different way. For example, the ablation device may be connected to a colonoscope, in a manner that enables it to be pulled alongside the colonoscope. 
     Alternatively, guiding element  204  may be inserted through the working channel of the colonoscope and left in place with anchor  207  at its tip positioned in the cecum or even inside the ileum. In some embodiments, guiding element  204  may be a balloon catheter and anchor  207  may be a balloon, which can be inflated to anchor it in place at the cecum or inside the distal ileum. 
     Ablation device  200  may be inserted over guiding element  204  by threading element  204  into guiding element lumen  205 . Device  200  may be advanced until the distal opening of lumen  205  reaches anchor  207 . At this position, location of the ileo-cecal valve and appendix relative to device  200  may be known, so they may be protected from ablation. 
     If an external sheath is used, it may be pulled back at this stage, and balloon  202  may be inflated until electrode array  203  is in contact with the intestinal wall. Energy may be delivered to perform the ablation, balloon may be deflated and pulled back, optionally into the external sheath. 
     The target depth of lesions created for treatment of the cecum and/or ascending colon may typically be 0.5-1 mm. 
     Power settings for the ablation procedures described above may be: 
     For creating block of signal propagation: 
     Duration: typically 0.2-3 seconds, preferably 0.5-2 seconds 
     Power: typically 5-50/watt/cm2, preferably 10-30/watt/cm2 
     Energy density: typically 1-20 J/cm2, preferably 2-15 J/cm2 
     For contracting tissue and reducing volume: 
     Duration: typically 0.5-20 seconds, preferably 0.5-5 seconds 
     Power: typically 10-100/watt/cm2, preferably 20-50/watt/cm2 
     Energy density: typically 5-40 J/cm2, preferably 10-30 J/cm2 
     Proportional Ablation Depending on the Severity of the Disease 
     The extent to which ablation of the colon is performed, in both length of colon treated, and depth of the lesions, may be adjusted according to the disease severity and/or patient characteristics, as detailed below. 
     In some embodiments, proportional ablation of progressively more colon may be performed, if needed. For example, some patients may do well with only a right colon ablation, but if necessary, for example if the response is insufficient, the treating physician may continue to ablate additional segments of the colon, and ablate the transverse colon, descending colon, sigmoid colon etc. For severely constipated patients the majority of the colon may need to be ablated. For elderly patients a right colon ablation may be sufficient. 
     In some embodiments, the choice of which layers of the colon to ablate, may be based on disease severity and anticipated response. 
     The mucosal layer of the colon is the surface layer that absorbs water. In some embodiments, ablation of the surface mucosal layer may reduce the capacity of the colon to absorb water, which may lead to more fluid in the colon and aid constipation. This modality of treatment may, in some embodiments, require ablation of large areas of mucosa, as opposed to just lines of ablation. 
     The deeper layers of the colon (muscle/submucosa) are mainly involved in contraction and scarring. In some embodiments, ablating the deeper layers of the colon may increase scarring and decrease distensibility of the colon, which may aid motility. 
     Thus, either superficial layer ablation for reducing fluid absorption, or deep layer ablation for inducing scarring and contraction of the colon, or both, may be performed as part of the treatment for constipation. 
     Feedback Regarding Extent of Therapy 
     In some embodiments, the process of gastric or colonic activity analysis may be repeated following treatment, to determine whether further treatment is required. 
     In some embodiments, sizing devices such as those described above, may be used during the ablation procedure, immediately after it, or several days or weeks after it, to assess the degree of change in organ size and/or compliance. In some embodiments, the sizing devices may alternatively or additionally be configured to calculate the change in compliance of the organ by measuring the change in pressure per unit volume inflated into the balloon while inside the organ. For example, in some embodiments, a sufficient treatment may be defined as a reduction of between 5% and 20% in the post-treatment vs pre-treatment measurements of the optimal device dimensions. In some embodiments, a sufficient treatment may be defined alternatively or additionally, as a similar reduction in organ compliance. 
     If treatment is deemed insufficient, the user may decide to repeat it. 
     Data Usage 
     Any measurements of gastrointestinal organ dimensions, compliance, impedance, activity, motility, or other parameters, obtained using the devices and methods disclosed herein, as well as patient&#39;s clinical, demographic, procedural, and follow-up data, may optionally be used in various ways. 
     Typically, with the consent of the patients, such data may be gathered in a database, either locally, e.g. on a computer or local network, or on a distant or cloud based storage means. 
     In some embodiments, an algorithm may be provided, that may compare the current patient&#39;s parameters to the data in the database for supporting choice of device sizes and power settings, based on comparable historical procedure results. 
     For example, for treating a constipation patient, the algorithm may identify in the database previously treated patients with constipation, similar age, cecum size and cecum compliance, and recommend the device size and power settings that resulted in the best clinical outcome. 
     In some embodiments, additional patient information, such as results of skin elastography may be used to predict response to ablation and determine recommended power settings. While preferred embodiments of the present invention have been shown and described herein, it will be obvious to those skilled in the art that such embodiments are provided by way of example only. Numerous variations, changes, and substitutions will now occur to those skilled in the art without departing from the invention. It should be understood that various alternatives to the embodiments of the invention described herein may be employed in practicing the invention. It is intended that the following claims define the scope of the invention and that methods and structures within the scope of these claims and their equivalents be covered thereby. 
     LIST OF ANNOTATIONS 
       
     
       
         
           
               
               
               
               
             
               
                   
               
               
                 # 
                 Name 
                 Significance 
                 Comments 
               
               
                   
               
             
            
               
                  1 
                 elongate flexible 
                   
                 Embodiment demonstrating 
               
               
                   
                 bipolar 
                   
                 very general concept of 
               
               
                   
                 electrode 
                   
                 linearly alternating poles 
               
               
                  2 
                 Core 
                   
                   
               
               
                  3 
                 conductor 
                   
                   
               
               
                  4 
                 conductor 
                   
                   
               
               
                  5 
                 contact 
                   
                 Continuous with conductor 3 
               
               
                  6 
                 contact 
                   
                 Continuous with conductor 4 
               
               
                  10 
                 elongate flexible 
                   
                 main preferred embodi- 
               
               
                   
                 spiral bipolar 
                   
                 ment—made of two wires  
               
               
                   
                 electrode 
                   
                 twisted together 
               
               
                  11 
                 conductor 
                   
                   
               
               
                  12 
                 insulation layer 
                   
                   
               
               
                  13 
                 conductor 
                   
                   
               
               
                  14 
                 insulation layer 
                   
                   
               
               
                  15 
                 elongate 
                 marks the area of tissue 
                   
               
               
                   
                 ablation area 
                 ablation or effect, which may 
                   
               
               
                   
                   
                 result from delivery of energy 
                   
               
               
                   
                   
                 to conductors 11 and 13 when 
                   
               
               
                   
                   
                 in contact with a target tissue 
                   
               
               
                  16 
                 perimeter 
                 marks the outer margins of the 
                   
               
               
                   
                   
                 circle formed by the spiraled 
                   
               
               
                   
                   
                 wires 11 and 13 
                   
               
               
                 a 
                   
                 diameter of conductor 11 
                   
               
               
                 b 
                   
                 thickness of insulation layer 
                   
               
               
                   
                   
                 12 
                   
               
               
                 c 
                   
                 diameter of conductor 13 
                   
               
               
                 d 
                   
                 thickness of insulation layer 
                   
               
               
                   
                   
                 14 
                   
               
               
                 g 
                 gap 
                 marks the gap between the 
                   
               
               
                   
                   
                 insulation layers 
                   
               
               
                 Dashed 
                   
                 marks the outermost “peaks” 
                   
               
               
                 line A 
                   
                 of the spiraled wires before 
                   
               
               
                   
                   
                 removal of insulation 
                   
               
               
                 Dashed 
                   
                 marks the extent to which 
                   
               
               
                 line B 
                   
                 insulation layers 12 and 14 
                   
               
               
                   
                   
                 may be removed 
                   
               
               
                 C 
                   
                 distance between lines A and 
                   
               
               
                   
                   
                 B 
                   
               
               
                 D 
                   
                 marks the location of the cross 
                 passes through a “peak” and 
               
               
                   
                   
                 section shown in FIG. 2D 
                 tissue contact point Q of 
               
               
                   
                   
                   
                 conductor 11 
               
               
                 E 
                   
                 marks the location of the cross 
                 passes through a “peak” and 
               
               
                   
                   
                 section shown in FIG. 2E 
                 tissue contact point P of 
               
               
                   
                   
                   
                 conductor 13 
               
               
                 F 
                   
                 distance between lines D and 
                   
               
               
                   
                   
                 E 
                   
               
               
                 Q 
                 Tissue contact 
                   
                 at line D 
               
               
                   
                 point 
                   
                   
               
               
                 P 
                 Tissue contact 
                   
                 at line E 
               
               
                   
                 point 
                   
                   
               
               
                 W 
                 Rectangular 
                 marks the outermost area of 
                   
               
               
                   
                 dashed box 
                 electrode 10 where insulation 
                   
               
               
                   
                   
                 layers 12 and 14 may be 
                   
               
               
                   
                   
                 removed, as seen from top 
                   
               
               
                   
                   
                 view 
                   
               
               
                 R 
                 Circular dashed 
                 denotes an area of removal of 
                   
               
               
                   
                 line 
                 insulation and exposure of 
                   
               
               
                   
                   
                 conductors 
                   
               
               
                  20 
                 elongate flexible 
                 printed electrode 
                   
               
               
                   
                 spiral bipolar 
                   
                   
               
               
                   
                 electrode 
                   
                   
               
               
                  21 
                 flexible core 
                   
                   
               
               
                  22 
                 spiral conductor 
                   
                   
               
               
                  23 
                 spiral conductor 
                   
                   
               
               
                 m 
                   
                 distance between conductors 
                   
               
               
                   
                   
                 22 and 23 
                   
               
               
                 n 
                   
                 distance between conductors 
                   
               
               
                   
                   
                 23 and 22 
                   
               
               
                 T 
                 tissue 
                   
                   
               
               
                 Abl 
                 ablated (or 
                   
                   
               
               
                   
                 affected) areas 
                   
                   
               
               
                  30 
                 elongate flexible 
                 another printed or extruded 
                   
               
               
                   
                 spiral bipolar 
                 electrode 
                   
               
               
                   
                 electrode 
                   
                   
               
               
                  31 
                 conductor 
                   
                   
               
               
                  32 
                 insulator core 
                   
                   
               
               
                  33 
                 conductor 
                   
                   
               
               
                  40 
                 jig 
                   
                   
               
               
                  41 
                 Jig shaft 
                   
                   
               
               
                  42 
                 Jig aperture 
                   
                   
               
               
                  43 
                 Distal 
                   
                   
               
               
                   
                 attachment 
                   
                   
               
               
                  44 
                 Proximal 
                   
                   
               
               
                   
                 attachment 
                   
                   
               
               
                  45 
                 Tension means 
                   
                   
               
               
                 101 
                 Stomach 
                   
                   
               
               
                 102 
                 Cardia 
                   
                   
               
               
                 103 
                 Esophagogastric 
                   
                   
               
               
                   
                 junction 
                   
                   
               
               
                 104 
                 Fundus 
                   
                   
               
               
                 105 
                 Antrum 
                   
                   
               
               
                 106 
                 Pylorus 
                   
                   
               
               
                 107 
                 Lesser curve 
                   
                   
               
               
                 108 
                 Greater curve 
                   
                   
               
               
                 109 
                 Angularis 
                   
                   
               
               
                 COR 
                 Corpus 
                   
                   
               
               
                 MCS 
                 Mucosa 
                   
                   
               
               
                 SMC 
                 Submucosa 
                   
                   
               
               
                 MUS 
                 Muscularis 
                   
                   
               
               
                 SER 
                 Serosa 
                   
                   
               
               
                 110 
                 Gastric wall 
                   
                   
               
               
                 111 
                 Gastric glands 
                   
                   
               
               
                 112 
                 Muscularis 
                   
                   
               
               
                   
                 mucosae 
                   
                   
               
               
                 113 
                 Oblique muscle 
                   
                   
               
               
                   
                 layer 
                   
                   
               
               
                 114 
                 Circular muscle 
                   
                   
               
               
                   
                 layer 
                   
                   
               
               
                 115 
                 Longitudinal 
                   
                   
               
               
                   
                 muscle layer 
                   
                   
               
               
                 116 
                 Visceral 
                   
                   
               
               
                   
                 peritoneum 
                   
                   
               
               
                 SP 
                 Submucosal 
                   
                   
               
               
                   
                 Plexus 
                   
                   
               
               
                 MP 
                 Myenteric 
                   
                   
               
               
                   
                 Plexus 
                   
                   
               
               
                 120A 
                 Global spiral 
                   
                   
               
               
                   
                 ablation pattern 
                   
                   
               
               
                 120B 
                 Global linear 
                   
                   
               
               
                   
                 axial ablation 
                   
                   
               
               
                   
                 pattern 
                   
                   
               
               
                 120C 
                 Global linear 
                   
                   
               
               
                   
                 circumferential 
                   
                   
               
               
                   
                 ablation pattern 
                   
                   
               
               
                 120D 
                 Global grid 
                   
                   
               
               
                   
                 ablation pattern 
                   
                   
               
               
                 120E 
                 Global axial 
                   
                   
               
               
                   
                 midline ablation 
                   
                   
               
               
                   
                 pattern 
                   
                   
               
               
                 120F 
                 Global 
                   
                   
               
               
                   
                 circumferential 
                   
                   
               
               
                   
                 midline ablation 
                   
                   
               
               
                   
                 pattern 
                   
                   
               
               
                 120G 
                 Circumferential 
                   
                   
               
               
                   
                 “constriction 
                   
                   
               
               
                   
                 ring” ablation 
                   
                   
               
               
                   
                 pattern 
                   
                   
               
               
                 120H 
                 Segmented 
                   
                   
               
               
                   
                 circumferential 
                   
                   
               
               
                   
                 “constriction 
                   
                   
               
               
                   
                 ring” ablation 
                   
                   
               
               
                   
                 pattern 
                   
                   
               
               
                 130A 
                 Regional spiral 
                   
                   
               
               
                   
                 ablation pattern 
                   
                   
               
               
                 130B 
                 Regional linear 
                   
                   
               
               
                   
                 axial ablation 
                   
                   
               
               
                   
                 pattern 
                   
                   
               
               
                 130C 
                 Regional linear 
                   
                   
               
               
                   
                 circumferential 
                   
                   
               
               
                   
                 ablation pattern 
                   
                   
               
               
                 130D 
                 Regional grid 
                   
                   
               
               
                   
                 ablation pattern 
                   
                   
               
               
                 140 
                 Local ablation 
                   
                   
               
               
                 A,B,C 
                 pattern x + 
                   
                   
               
               
                   
                 circle 
                   
                   
               
               
                 141 
                 Local ablation 
                   
                   
               
               
                 A,B,C 
                 pattern x 
                   
                   
               
               
                 142 
                 Local ablation 
                   
                   
               
               
                 A,B,C 
                 pattern spiral 
                   
                   
               
               
                 143 
                 Combined 
                   
                   
               
               
                   
                 ablation pattern 
                   
                   
               
               
                   
                 (global 
                   
                   
               
               
                   
                 circumferential 
                   
                   
               
               
                   
                 midline and 
                   
                   
               
               
                   
                 local x + circle) 
                   
                   
               
               
                 144 
                 Outline of 
                   
                   
               
               
                   
                 gastric wall 
                   
                   
               
               
                   
                 around untreated 
                   
                   
               
               
                   
                 fundus 
                   
                   
               
               
                 144′ 
                 Outline of 
                   
                   
               
               
                   
                 gastric wall 
                   
                   
               
               
                   
                 around treated 
                   
                   
               
               
                   
                 fundus 
                   
                   
               
               
                 145 
                 Ablation pattern 
                   
                   
               
               
                   
                 for shrinkage of 
                   
                   
               
               
                   
                 fundus 
                   
                   
               
               
                 150A 
                 Global pattern 
                   
                 Shaft goes into duodenum, 
               
               
                   
                 ablation device 
                   
                 single balloon 
               
               
                 151 
                 Handle 
                   
                   
               
               
                 152 
                 Shaft 
                   
                   
               
               
                 153 
                 Expandable 
                   
                   
               
               
                   
                 member/ 
                   
                   
               
               
                   
                 balloon 
                   
                   
               
               
                 154 
                 Sheath 
                   
                   
               
               
                 155 
                 Expansion port 
                   
                   
               
               
                   
                 and lumen 
                   
                   
               
               
                 156 
                 Openings 
                   
                   
               
               
                 157 
                 Guidewire 
                   
                   
               
               
                   
                 lumen 
                   
                   
               
               
                 158 
                 Guidewire 
                   
                   
               
               
                 159 
                 Sheath port 
                   
                   
               
               
                 161 
                 Conductors 
                   
                   
               
               
                 162 
                 Cable 
                   
                   
               
               
                 163 
                 Tip 
                   
                   
               
               
                 164 
                 Seal 
                   
                   
               
               
                 RFG 
                   
                   
                   
               
               
                 150B 
                 Global pattern 
                   
                 As in 150A, two balloons 
               
               
                   
                 ablation device 
                   
                   
               
               
                 153′ 
                 Smaller balloon 
                   
                   
               
               
                 153″ 
                 Additional 
                   
                 Fills fundus 
               
               
                   
                 balloon 
                   
                   
               
               
                 150C 
                 Global pattern 
                   
                 Single balloon, shaft ends at 
               
               
                   
                 ablation device 
                   
                 pylorus 
               
               
                 160 
                 Regional pattern 
                   
                   
               
               
                   
                 ablation device 
                   
                   
               
               
                 170A 
                 Local pattern 
                   
                   
               
               
                   
                 ablation device 
                   
                   
               
               
                 171 
                 Conductors 
                   
                   
               
               
                 172 
                 Balloon 
                   
                   
               
               
                 173 
                 Rigid shaft 
                   
                   
               
               
                 174 
                 Sheath 
                   
                   
               
               
                 173′ 
                 Curved rigid 
                   
                   
               
               
                   
                 shaft 
                   
                   
               
               
                 174′ 
                 Curved sheath 
                   
                   
               
               
                 180 
                 large intestine 
                   
                   
               
               
                 181 
                 cecum 
                   
                   
               
               
                 182 
                 ascending 
                   
                   
               
               
                   
                 (right) colon 
                   
                   
               
               
                 183 
                 transverse colon 
                   
                   
               
               
                 184 
                 descending (left) 
                   
                   
               
               
                   
                 colon 
                   
                   
               
               
                 185 
                 sigmoid colon 
                   
                   
               
               
                 186 
                 rectum 
                   
                   
               
               
                 187 
                 dilated cecum 
                   
                   
               
               
                   
                 and ascending 
                   
                   
               
               
                   
                 colon 
                   
                   
               
               
                 190A 
                 Spiral ablation 
                   
                   
               
               
                   
                 pattern in cecum 
                   
                   
               
               
                   
                 and ascending 
                   
                   
               
               
                   
                 colon 
                   
                   
               
               
                 190B 
                 Interlacing half 
                   
                   
               
               
                   
                 circles ablation 
                   
                   
               
               
                   
                 pattern in cecum 
                   
                   
               
               
                   
                 and ascending 
                   
                   
               
               
                   
                 colon 
                   
                   
               
               
                 200 
                 Cecum and/or 
                   
                   
               
               
                   
                 ascending colon 
                   
                   
               
               
                   
                 ablation device 
                   
                   
               
               
                 201 
                 Flexible shaft 
                   
                   
               
               
                 202 
                 Balloon 
                   
                   
               
               
                 203 
                 Electrode array 
                   
                   
               
               
                 204 
                 Guiding element 
                   
                   
               
               
                 205 
                 Guiding element 
                   
                   
               
               
                   
                 lumen 
                   
                   
               
               
                 206 
                 Inflation lumen 
                   
                   
               
               
                 207 
                 anchor 
                   
                   
               
               
                 208 
                 RFG cable 
                   
                   
               
               
                 ILE 
                 Distal ileum 
                   
                   
               
               
                 300 
                 Tissue ablation 
                   
                   
               
               
                   
                 device with 
                   
                   
               
               
                   
                 combined spiral 
                   
                   
               
               
                   
                 flexible bipolar 
                   
                   
               
               
                   
                 electrodes and 
                   
                   
               
               
                   
                 rail track 
                   
                   
               
               
                   
                 electrodes 
                   
                   
               
               
                 302 
                 Flexible spiral 
                   
                   
               
               
                   
                 bipolar 
                   
                   
               
               
                   
                 electrodes 
                   
                   
               
               
                 304 
                 Inner shaft 
                   
                   
               
               
                 306 
                 External sheath 
                   
                   
               
               
                 308 
                 Parallel “rail 
                   
                   
               
               
                   
                 track” electrodes 
                   
                   
               
               
                 310 
                 Longitudinal 
                   
                   
               
               
                   
                 PCB legs 
                   
                   
               
               
                 312 
                 Distal tip 
                   
                   
               
               
                 314 
                 Expandable 
                   
                   
               
               
                   
                 element