Source: https://patents.google.com/patent/EP2475328B1/en
Timestamp: 2019-04-18 22:51:33+00:00

Document:
Endoscopically delivered gastrointestinal implants, such as those described in commonly assigned U.S. Patent Nos. 7,025,791 and 7,608,114 to Levine et al. , provide the benefits of gastric bypass without the hazards of surgery. For example, an implant may include a thin-walled, floppy sleeve that is secured in the stomach or intestine with a collapsible anchor. The sleeve extends into the intestine and channels partially digested food, or chyme, from the stomach through the intestine in a manner that may cause weight loss and improve diabetes symptoms. The sleeve and anchor can be removed endoscopically when treatment is over or if the patient desires.
WO2004/087014 discloses an anchoring ring and a drum membrane that are collapsible. WOO2004/041133 discloses a fastener system comprising an annular shaped member having a surface having hooks. US2005/0102024 discloses a staple with helical shaped hooks. WO2006/002492 discloses a valve constriction device comprising a plurality of filaments, each having an engaging portion for engaging annular tissue of the valve being treated. US5630829 discloses a high hoop strength intraluminal stent. EP0701800 discloses a self-expanding anchor carrying hooks. Closest prior art is US2005/0085923 disclosing in figures 40A and 40B a gastrointestinal implant with a collapsible anchor with protrusions with a looped end.
The present invention provides an implant, according to claim 1. Embodiments of the present invention provide improved anchoring of an implant in the gastrointestinal tract and can increase the duration that an implant can be anchored in the intestine by encouraging stable tissue reactions to the implant. The collapsible anchor, which may, for example, be a wave anchor or a stent comprising a network of struts, is configured to be deployed within a lumen of the gastrointestinal tract in a mammalian body. Upon deployment, the collapsible anchor expands within the lumen, and the protrusion expands away from the anchor, pushing the loop against a wall of the lumen. Over time, the protrusion and the loop may penetrate the luminal wall, and the loop may project through the far side of the luminal wall. A pocket of scar tissue may form about the loop and through an opening in the loop, securing the anchor within the lumen. The implant may have additional protrusions, each of which is connected to the anchor and includes a loop. Each additional loop may also include an opening and may be adapted to penetrate the luminal wall upon deployment of the collapsible anchor.
Each loop may have an inner opening with a width of between 1 mm and 13 mm, or, more preferably, an inner diameter of 3 mm. Typically, the protrusion extends along a total length of between 6 mm and 13 mm from the collapsible anchor upon full deployment from the collapsible anchor. The protrusion and the loop may be formed of wire (e.g., nitinol wire) with a preferred diameter of 0.25 mm (0.010 inch) to 1.02 mm (0.040 inch), and more preferably 0.51 mm (0.020 inch).
The loop can be formed of a loop of wire, and the protrusion can be formed of a straight length of wire extending from the loop of wire. The loop may be oriented in a variety of directions with respect to the collapsible anchor. For example, the loop may define a plane that is perpendicular to the lumen wall when the protrusion is deployed. Alternatively, the loop may define a plane that is parallel to the lumen wall when the protrusion is deployed. When the protrusion is in a collapsed state, it may fold against or along a side of the collapsible anchor. When relaxed, straight protrusions typically extend outwards from the collapsible anchor at an angle of between about 45 degrees and about 135 degrees, or, more preferably, to an angle of about 80 degrees or about 90 degrees. At these angles, the expanded straight protrusion pushes the loop outward, causing an edge of the loop to engage the luminal wall.
The implant can be collapsed, for removal from the lumen, with the drawstring that may run through an opening in the loop or through additional retaining hooks or loops connected to the loop or the protrusion. Pulling on the drawstring collapses the protrusion towards the collapsible anchor, and away from the luminal wall. Collapsing an implanted helix may cause coils in the helix to shear fibrotic tissue formed about the helix depending on the spacing and orientation of the coils that make up the helix.
An implant with a protrusion and a loop can also include an unsupported, thin-walled sleeve coupled to the collapsible anchor and configured to extend into the lumen (e.g., the intestine) upon deployment of the collapsible anchor. The implant may also include a restrictor plate instead of or in addition to the thin-walled sleeve.
FIGS. 2A-2D are plan and elevation views of a straight protrusion with an open loop suitable for connection to an anchor.
FIGS. 4A-4P show various alternative protrusions with open loops.
FIGS. 5A-5C are perspective views of wave anchors with helical protrusions with open loops.
FIG. 6 is a perspective view of a loop projection with a helical neck.
FIGS. 7A-7C illustrate how a helical protrusion with an open loop penetrates the wall of the gastrointestinal tract and how a fibrotic encapsulation forms about and through the helical protrusion and the open loop.
FIG. 8 shows an implant that includes a sleeve extending from an anchor with open-tip protrusions.
An anchor may be used to secure a sleeve in the intestine of a patient for treating obesity and/or type-2 diabetes as described in commonly assigned U.S. Patent No. 7,025,791 ; U.S. Patent No. 7,608,114 ; U.S. Patent No. 7,476,256 ; U.S. Patent Application No. 10/858,852, filed on June 1, 2004, by Levine et al. ; U.S. Patent Application No. 11/330,705, filed on January 11, 2006, by Levine et al. ; U.S. Patent Application No. 11/827,674 filed on July 12, 2007, by Levine et al. .
As described in the above-referenced patents and patent applications, straight, sharp barbs fixed to a self-expanding anchor may be used to secure an implant to the duodenal wall. However, the body's healing response stimulates a progressive tissue proliferation around sharp barbs in response to the injury caused as the anchor pushes the sharp barbs into the wall of the duodenum. The inflammatory response to the injury produces a mix of granulation and more stable fibrous tissue (i.e., scar tissue). This causes thickening of the duodenal wall over time resulting in barbs disengaging from the tissue. As sharp barbs separate from the duodenal wall, the implant may become unstable and migrate or rotate within the duodenum.
Long barbs tend be better than short barbs at holding implants securely for longer periods. Without subscribing to any particular theory, it appears that longer barbs are more stable because it takes more time for the inflammatory thickening to separate longer barbs from the muscle layer. However, there is a practical limit to how long sharp barbs can be because longer sharp barbs are more likely to infiltrate surrounding organs. Very long sharp barbs can pierce through the muscle wall of the intestine and into adjacent structures and could potentially cause leaks, bleeding, or adhesions to other organs.
Protrusions with open loops (also called open heads), on the other hand, can secure an implant for longer periods of time while minimizing the risk of damage to nearby organs. In one embodiment, the protrusion, which is relatively narrow (e.g., about 1.52 mm (0.060 inch) wide) and relatively long (e.g., about 13 mm long), connects a relatively broad open loop (e.g., about 3 mm in diameter) to a collapsible anchor. Upon deployment, the protrusion pushes the open loop against the intestinal wall. Without being bound by any particular theory, initial research suggests that the muscle layer in the intestine stretches across the loop, and it eventually thins out or erodes enough to allow the loop to penetrate the luminal wall. A chronic inflammation response causes scar tissue to form around the loop and through the opening formed by the loop; this scar tissue can hold the loop securely. Because the loop is rounded or otherwise shaped to promote erosion through the muscle wall, the protrusion and the loop are less likely to pierce the scar tissue or surrounding organs.
FIGS. 1A-1D show an implant 100 suitable for deployment within the gastrointestinal tract distal to the pylorus. FIGS. 1A-1C show perspective, plan, and elevation views of the implant 100 in a relaxed state (from the top, the relaxed implant 100 looks circular); FIG. 1D is an elevation view of the implant 100 in a compressed state. Typically, the implant 100 is compressed for endoscopic deployment within the gastrointestinal tract. Once positioned properly within the gastrointestinal tract, the implant 100 expands to the relaxed state shown in FIGS. 1A-1C.
The implant 100 includes a collapsible wave anchor 102 that includes a plurality of protrusions 110, each of which extends outward from the wave anchor 102 when the implant 100 is in a relaxed state. The anchor 102 may have a relaxed diameter of about 40 mm or greater, e.g., about 45 mm, about 50 mm, or about 55 mm. Each protrusion 110 includes a rounded loop 112 at the end of a narrow, straight neck 114, and each loop 112 includes an opening whose inner width D is within the range (inclusive) of between about 1 mm and about 13 mm, and preferably a diameter D within a range of about 1 mm and about 6 mm, or, more preferably, about 3 mm. The outer diameter can be within a range of about 2 mm to about 8 mm, and the diameter of the wire used to form each protrusion 110 can be within a range of about 0.25 mm (0.010 inch) to about 0.76 mm (0.030 inch). Typically, the minimum bend radius of the wire limits the minimum inner diameter (it can be difficult to bend the wire too tightly), and the minimum desired pressure exerted by the loop 112 against the tissue limits the maximum inner diameter (bigger loops 112 may not exert enough pressure on the tissue to penetrate the tissue). The straight neck 114 has a length l of between about 6 mm and about 10 mm, for a total projection length L of between about 7 mm and about 13 mm. A crimp 116 or other suitable connection fixes the neck 114 to the wave anchor.
Each protrusion 110 folds down along the side of the wave anchor 102 when compressed for delivery, then springs up to extend nearly perpendicularly from the wave anchor 102 when released from the compressed state to the relaxed state. Specifically, the angle ϕ formed by the protrusion 110 and a leg of the wave anchor 102 may be between about 45° and about 135°, or, more preferably, between about 75° and 105°, e.g., about 80° or about 90°.
FIGS. 2A-2D are elevation and plan views of a single protrusion 110 formed of a single piece of nitinol wire with a diameter of about 0.51 mm (0.020 inch). The wire is bent to form a pair of struts 124 that can be crimped, bonded, or welded onto a single-wire leg of an anchor (e.g., wave anchor 102 in FIGS. 1A-1D) such that the single wire of the anchor leg nestles between the struts 124. The wire is bent to form the narrow, straight neck 114 and coiled twice to create the loop 112. The two loops of coil form a broad, blunt edge 120 that can engage and erode the luminal wall such that the loop 112 eventually penetrates the luminal wall. In this case, the loops also form a face 122 that defines a plane perpendicular to the long axis of the struts 124. When affixed to an anchor and implanted in a lumen, the face 122 is perpendicular to the long axis of the lumen and parallel to a cross section of the lumen. Alternatively, the loop 112 may be formed such that the face 122 is parallel to the long axis of the struts 124. In this alternative orientation, the face 122 is near parallel to the lumen's long axis and near perpendicular to the lumen's cross section when implanted.
FIGS. 4A-4C show open-loop protrusions of different shapes. FIG. 4A shows a protrusion 820 formed by bending wire into the shape of the Greek letter omega, Ω. An open, straight neck 822 connects the protrusion's loop 824 to a collapsible member 102. FIG. 4B shows a protrusion 830 formed by twisting wire into a loop. The twist forms the protrusion's neck 832 and the loop forms the protrusion's loop 834. FIG. 4C shows a protrusion 840 with a neck 842 covered by a seal 843. The seal 843, which may be made of a fluoropolymer, isolates the loop 844 from the anchor 102, and may prevent irritants from exiting the luminal wall via the channel formed by the protrusion 840. The seal 843 does not cover the loop 844, so tissue may grow through the loop 844. The protrusions 820, 830, and 840 shown in FIGS. 4A-4C may be separate pieces of wire bonded to an anchor or they may be formed of the same piece of wire that forms the anchor.
FIGS. 4D and 4E show an open-tip protrusion 850 with an erodible section 855 that forms part of a loop 854 connected to an anchor with a straight neck. After the protrusion 850 penetrates the luminal wall, inflammatory or fibrotic tissue grows through the loop 864, securing the protrusion 850 in the intestinal wall. Meanwhile, the erodible section 855 dissolves, turning the loop 854 into an open prong that can removed from tissue without tearing the tissue (not shown) that forms in the opening of the loop 854. Typically, the erodible section 855 is designed to dissolve during treatment, e.g., over six months, one year, two years, or possibly longer.
FIGS. 4F and 4G show an open-tip protrusion 860 with a loop 864 that can be detached from an anchor 102 with a narrow coupling neck 862. As above, inflammatory or fibrotic tissue (not shown) envelops the loop 864, securing the protrusion 860 in the intestinal wall. By disconnecting the anchor 102 from the protrusion 860, the anchor 102 can be withdrawn endoscopically without tearing or ripping the tissue that envelops the loop. In some cases, the detached anchor 102 may be reinserted into the intestine and re-attached to the protrusion 860.
FIGS. 4H-4O show alternative straight protrusions with open heads. FIGS. 4H and 4I shows protrusions 900 and 910, respectively, with open loops 902 and 912 that define planes parallel to the lumen wall when deployed. The open loop 902 of FIG. 4H is made of a wire loop that is concentric about an axis of a straight neck 904; whereas, the open head 912 of FIG. 4I is formed of a wire loop that is tangent to an axis of a straight neck 914. FIG. 4K shows a straight protrusion 930 with plural open loops distributed along the length of a straight protrusion 934 that extends from a collapsible anchor 102.
FIG. 4J shows a protrusion 920 with a corkscrew-like open head 922 perched atop a straight neck 924 coupled to an anchor 102. When deployed, the long axis of the open head 922 is roughly parallel to the long axis of the lumen, but can also be oriented perpendicular to the long axis of the lumen. Similarly, FIG. 4N shows a protrusion 960 with a whisk-shaped open head 962 at the end of a straight neck 964. Tissue may grow about and through the openings between the windings in both the corkscrew-like head 922 and the whisk-shaped head 962, just as in the helix protrusions described in greater detail below.
FIGS. 4L and 4M show bidirectional protrusions 940 and 950, respectively, each of which is coupled to a collapsible anchor 102. Each protrusion 940, 950 includes a coil-like open head 942, 952 that engages the luminal wall as the protrusion 940, 950 expands from its collapsed state.
FIG. 4O shows an alternative protrusion 970 formed of a paddle with one or more openings 972, each of which is about 0.41 mm (0.016 inch) wide. Tissue can form through the openings 972 to secure the protrusion 970 within the lumen.
The open heads may also be connected to the anchor with a detachable or erodible feature. FIG. 4P shows a protrusion 980 that includes a coiled open loop 982 connected to a straight neck 984 with a bio-erodible element 986. Upon deployment, the loop 982 erodes through the luminal wall and soon becomes encased in fibrotic tissue, securing the protrusion 980 and attached anchor 102 in place. Over time, the bio-erodible element 986 dissolves, causing the loop 982 to become detached from the protrusion 980. Once the head 982 is no longer connected to the protrusion 980, the protrusion 980 can be withdrawn without necessarily tearing the scar tissue encapsulating the head 982, making for easier removal of the implant.
Alternatively, the implant may include a helical protrusion instead of a straight protrusion. The helical protrusion acts as a coil spring that pushes the open loop into the lumen wall, but in a manner that distributes the load from the collapsible anchor to the contacting tissue over a longer length as compared to a straight protrusion of similar height. Upon initial engagement with the duodenal wall, the helix, if so designed, compresses. As the tissue and helix protrusion come to equilibrium the helix approaches full expansion, causing the loop to penetrate the luminal wall. Eventually, fibrotic tissue encapsulates the loop and the expanded helix, creating a pocket that holds the loop and helix securely. Like straight protrusions with open loops, helical protrusions with open heads may be designed for permanent, quasi-permanent, or temporary implantation.
FIGS. 5A-5C are perspective views of implants that include projections with helical protrusion: FIG. 5A shows basic helical protrusions; FIG. 5B shows helical protrusions with retaining loops; and FIG. 5C shows helical protrusions that include retaining loops and short end effects that promote initial penetration of the open loop into the muscle wall. FIG. 5A shows an implant 400 that includes five basic helical protrusions 410, each of which is coupled to a wave anchor 102 with a respective crimp 416. (Alternatively, the protrusions 410 may sutured or releasably coupled to the anchor 102.) Each helical protrusion 410 includes a helix 414 formed of several wire coils and terminates in a loop 412 formed of two loops of wire. The opening of each head 412 is parallel to the lumen defined by the wave anchor 102. Each helical protrusion 410 has a tapered profile, with the top coils (i.e., those farthest away from the wave anchor 102) being substantially smaller than the base coils (i.e., those closest to the wave anchor 102). Each coil in the helix 414 limits the penetration of the coil above it.
The top coils are sized to focus the force from the expanding implant 400 to penetrate the duodenal wall and to ultimately elicit the healing response. Top coils approximately 3 mm in diameter are small enough to start to burrow through the muscle layer. The base coils are larger than the top coils and are sized to substantially match and blend to the crowns (vertices) of the wave anchor 102. For example, a 7 mm diameter base coil blends well to the wave anchor 102 approximately 6 mm below the crowns, but larger base coils could be used for other attachment configurations and/or anchor configurations. Typically, the outer diameter of the largest coil in the helix 414 is within the range of about 1.5 mm to about 12 mm, and the coils have an inner diameter that ranges from about 1.0 mm to about 10 mm. The loop 412 can have an inner diameter within a range of about 1.0 mm and about 6.0 mm.
In the examples shown in FIGS. 5A-5C, the loop 412 is formed of two coils of uniform diameter that are stacked upon each other, approximating a solid cylinder that does not compress. Because the loop 412 is relatively incompressible, it erodes through the duodenal wall, but only to an extent determined by the length and compliance of the helix 414. A helix 414 with appropriate compliance typically prevents the loop 412 from penetrating much beyond the muscle layer of the duodenal wall.
FIG. 5B shows an implant 430 with several projections 440, each of which includes a retrieval element 442 that extends from the loop 412 towards the wave anchor 102. In the example shown in FIG. 5B, the retrieval element 442 is a loop of wire formed with an optional hypodermic tube 472, which provides an additional surface for fibrotic tissue to encapsulate; this further encapsulation may increase the anchoring strength. Each retrieval element 442 fits in the conical cavity defined by its associated helical neck 414 and can be used to exert a force normal to the axis of the conical cavity on the helical protrusion 410. For example, a normal force can be used to prevent or slow expansion of the helical protrusion 410 or to collapse an expanded helical protrusion 440. Other retrieval elements may be hooks, balls, or other suitable features for applying a normal force to the helix.
In the example shown in FIG. 5B, a constraint 444 threaded through the retrieval element 442 keeps the helical protrusion 440 in a fully or partially collapsed state. In some cases, the constraint 444 is a suture or biodegradeable element that allows the user to influence how quickly the helical protrusion 440 expands after implantation, which, in turn, affects how quickly the loop 412 penetrates the luminal wall. Releasing tension on the suture or engineering the decay time of the biodegradable element allows the helix 414 to open to its full height more slowly, prolonging the equilibrium time and slowing the effect of the helical protrusion 440 on the contacting tissue.
A drawstring (not shown) that runs through some or all of retrieval elements 442 can be used to withdraw the protrusions 440 from the luminal wall. Pulling on the drawstring applies a normal force directly to the loops 412, causing the loops 412 to collapse into the coils below to disengage the helix 414 from the surrounding tissue. As the coils collapse, one within the next, they act as a "cheese cutter": each coil helps to shear the surrounding tissue from the coil above it as the above coil passes through the lower coil, freeing the helical protrusion 440 from any scar tissue that may have grown through or around the wire in the loop 412 and the helix 414. Pulling on the drawstring also causes the anchor 102 to collapse for endoscopic withdrawal from the implantation site as described below.
FIG. 5C shows an implant 460 with an end effect 462 at the end of each helical protrusion 470. In this example, each end effect 462 is a post that is oriented in the center of a respective helical protrusion 470 and protrudes slightly beyond the loop 412 of the respective helical protrusion 470. The end effects 462, which may be sharpened to engage the contacting tissue more quickly, initiate an injury to the duodenal wall and lead the heads 412 through the duodenal wall. Because each end effect 462 pierces the luminal wall, it initiates the injury that causes fibrotic tissue to encapsulate its associated helical protrusion 470 more quickly. Quickly embedding the helical protrusion 470 is important for stabilizing and maintaining placement of the implant in a mobile vessel with pressurized luminal contents, such as the duodenum or intestines.
FIG. 6 is a perspective view of an alternative helical protrusion 510 with a retrieval element 542 formed of a single wire without a hypodermic tube. The wire is coiled to form a helix 514 and a loop 512, then folded and formed into a retrieval element 542. Excess wire extending from the tail of the retrieval element 542 is trimmed and may be sharpened to create an end effect 562. The base coil of the helix 414 can be trimmed and/or bent as necessary before the projection is attached to the wave anchor 102, e.g., with a crimp 416, as shown in FIGS. 5A-5C, or using any other suitable attachment. Alternatively, the helical protrusion can be fabricated with a post that runs up its center, and the post can be crimped or otherwise affixed to the anchor 102.
FIGS. 7A-7C show how the helical protrusion 410 shown in FIG. 5A engages a luminal wall to secure an implant 400 within the lumen. The implant 400 is inserted into the lumen in a compressed state, with the helical protrusion 410 collapsed against the collapsed anchor 102, as shown in FIG. 7A. Releasing the helical neck 414 allows the helical neck 414 to expand, causing a tent 603 to form in the duodenal wall 601, as shown in FIG. 7B. As the neck 414 continues to expand against the duodenal wall 601, it pushes the loop 412 through wall 601, as shown in FIG. 7C. Scar tissue 607 forms about and possibly through the loop 412 and neck 414. Without being bound by any particular theory, initial studies suggest that helical necks 414 tend to encourage more fibrotic encapsulation than straight necks of similar height because helical necks have more wire in contact with the tissue.
The compliance of the helical neck 414 affects how quickly the loop 412 penetrates the luminal wall 601. Initial studies suggest that the top-most coils in the helical neck 414 continue to push through tissue after initial contact until the contacting tissue and helix 414 come to equilibrium. If the helical neck 414 is as compliant as the luminal wall, however, then the neck 414 will not be able to push the loop 412 through the luminal wall 601. Since the compliance of the helical neck 414 is largely a function of wire diameter and pitch, increasing either the wire diameter or the pitch the wire diameter generally increases the rigidity of helical neck 414. Increasing the wire diameter too much may make it difficult to form the wire into tight loops to shape the loop 412. Wire with a diameter in the range of about 0.41 mm (0.016 inch) to about 1.02 mm (0.040 inch) is generally suitable for helical protrusions 410. Nitinol wire with a diameter of about 0.48 mm (0.019") offers a balance: it can be formed into tight bends for the end of the helical neck 414 and the loop 412, yet forms a helix that is stiffer than the luminal wall 601. It can also be packed into a capsule for endoscopic delivery. The diameter of the helix 414 can also be varied to further customize the transition in stiffness and tissue response.
Although FIGS. 5-7 show a helix 414 with a linear transition between successive coil diameters, alternative helixes can have other shapes, including parabolic profiles, cylindrical profiles, hourglass profiles, and conical profiles (e.g., with the vertex of the cone connected to the anchor). Alternatively, the helix 414 can be formed in a flattened coil that is narrow at the center and flares out from the center into a flat spiral shape. The helix 414 could also be formed of a post that terminates in a coil with its wrappings aligned or angled with respect to one another in a corkscrew-like fashion. Compared to other three-dimensional shapes, tapered shapes tend to be easier to disengage from a mating surface. Parabolic shapes transition more quickly from large coils to small coils, facilitating a lower profile protrusion. Similarly, transitions between coils or wraps in the helix 414 can be customized as desired. For example, the coils in the helix 414 can be sized such that each coil fits into the coil below. This sizing of successive coils facilitates a lower profile for packing into the delivery catheter and facilitates disengagement from the duodenal wall.
The compliance/stiffness of the protrusions disclosed herein can be characterized, in part, by the force required to deflect the protrusions from their respective relaxed (extended) states towards their respective collapsed states. For a protrusion with a straight neck (e.g., protrusion 110 of FIGS. 2A-2D), compliance may be defined, in part, by the normal force required to deflect the protrusion at room temperature by a given amount towards the strut of the collapsible anchor. Measurement shows that applying a force of at least about 0.44 N (0.1 lbf) normal to the head (i.e., parallel to the long axis of the lumen) completely collapses a straight-necked protrusion made of 0.25 mm (0.010-inch) diameter nitinol wire, with a total length of 13 mm, ending in a loop formed of two wraps of wire with an inner diameter of about 3 mm. Similar measurement shows that applying about 3.56 N (0.8 lbf) normal to the head deflects the head by about 6.35 mm (0.250 inch) for a straight-necked protrusion made of 0.51 mm (0.020-inch) diameter nitinol wire, with a total length of 11.5 mm, ending in a loop formed of two wraps of wire with an inner diameter of about 3 mm. Other straight-necked protrusions may be deflected by about 6.35 mm (0.250 inch) from their relaxed positions by forces within a range of about 3.56 N (0.80 lbf) to about 4.23 N (0.95 lbf).
In addition to the compliance of the helix as measured in the normal force to compress the helix, resistance to bending must be considered. Helix stiffness can also be characterized by the force required to deflect the helix sideways, i.e., in the plane normal to the long axis of the helix. A balance must be struck between compressability and rigidity. Deflecting a nitinol helical protrusion with a 6 mm height, 6 mm base coil diameter, 3 mm top coil diameter, 4.0 mm coil spacing, and 0.51 mm (0.020-inch) wire diameter sideways by 6.35 mm (0.250 inch) at room temperature takes a force of at least about 0.15 N (0.033 lbf). Increasing the wire diameter to about 0.71 mm (0.028 inch) increases the force to about 0.60 N (0.135 lbf) for a 6.35 mm (0.250-inch) deflection at room temperature. A preferred balance can be defined within the specifications above.
Each of the aforementioned implants may be deployed in the intestine, preferably in the duodenum, and more preferably in the duodenal bulb just distal to the pylorus. Typically, a doctor or other qualified person inserts the implant into the intestine with an endoscopic delivery device. During insertion, the delivery device holds the implant in a compressed state. Once in position, the implant is released from the delivery device and allowed to self-expand, causing each neck coupled to the anchor to push its respective loop against the intestinal wall. Some implants may include a sleeve coupled to the anchor, which can be deployed within the intestine as described in U.S. Patent No. 7,122,058 ; U.S. Patent No. 7,329,285 ; U.S. Patent No. 7,678,068 ; and U.S. Patent Application No. 11/057,861, filed on February 14, 2005, by Levine et al. .
An implant secured with protrusions tipped with open loops may be removed laparoscopically, surgically, or, more preferably, endoscopically with an endoscope. For example, an implant may be collapsed using a drawstring, then withdrawn from the intestine using an endoscope. Further details on endoscopic removal can be found in U.S. Application No. 11/318,083, filed on December 22, 2005, by Lamport and Melanson ; and in U.S. Application No. 12/005,049, filed on December 20, 2007, by Levine et al. .
FIG. 8 shows an implant 700 that includes an anchor 702 with a polymer covering 704. Protrusions 710 projecting from the anchor 702 support open loops 712 that can be used to create fibrotic encapsulations in the intestinal wall as described above. A sleeve 706 is coupled to the distal side of the anchor 702 for extension into the intestine. The sleeve 706 may be permanently or detachably affixed to the anchor 702. For instance, a detachable sleeve can be endoscopically attached to or removed from a permanently or semi-permanently secured anchor depending on treatment progress.
Typically, the sleeve 706 is floppy and conformable to the wall of the intestine when deployed. It also has a wall thickness of less than about 0.025 mm (0.001 inch) to about 0.13 mm (0.005 inch) and a coefficient of friction of about 0.2 or less. The polymer covering 704 and the sleeve 706 may be made of a fluoropolymer, such as ePTFE coated or impregnated with fluorinated ethylene polyethylene (FEP), or any other suitable material. The sleeve 706 and anchor covering 704 can be a single, integrally formed piece. They can also be separate pieces, depending on whether the anchor 702 is partially or wholly uncovered, as long as the anchor 702 forms a sufficiently good seal between the sleeve 706 and the stomach, pylorus, and/or intestine to funnel chyme through the sleeve 706. Each loop 712 remains uncovered or only partially covered to promote the in-growth of fibrotic tissue.
Anchors secured with loops and necks may also be used to secure restrictor plates within the gastrointestinal tract to treat obesity, such as the restrictor plates disclosed in U.S. Patent Application No. 10/811,293, filed on March 26, 2004, by Levine et al. ; U.S. Patent Application No. 11/330,705, filed on January 11, 2006, by Levine et al. ; and U.S. Patent Application No. 11/827,674, filed on July 12, 2007, by Levine et al. . An implant with a restrictor plate typically includes a restricting aperture that retards the outflow of food from the stomach to the intestine. The diameter of the aperture is less than 10 mm, is preferably less than 7 mm, and is more preferably initially in the range of about 3-5 mm. Alternatively, the aperture may be elastic and expandable under pressure from material flowing through the anchor and the aperture at elevated physiological pressures; as pressure increases, the aperture opens to greater diameters. The implant may include a sleeve that extends into the intestine.
While this invention has been particularly shown and described with references to example embodiments thereof, it will be understood by those skilled in the art that various changes in form and details may be made therein without departing from the scope of the invention encompassed by the appended claims. For example, all or part of the protrusions described above can be covered to further control interaction with contacting tissue. A bio-absorbable suture or adhesive could be used to affix the covering to the protrusion. As the bio-absorbable material degrades or is absorbed by the body, the covering is free to fan open, creating an added level of control of interaction between the protrusion and the surrounding tissue. Alternatively, the protrusion may be made from a polymer or a composite material, such as a non-degradable or biodegradable material. Implants can also include different types of protrusions, e.g., any combination of straight protrusions with open loops, helical protrusions with open loops, and even pointed barbs.
a drawstring configured to collapse the protrusion (110) towards the collapsible anchor (102).
The implant (100) of claim 1, wherein the anchor has a relaxed diameter of at least 40 mm, the protrusion (110) has a length of at least 5 mm, and the loop (112) defines an opening for tissue ingrowth.
The implant (100) of claim 1 or claim 2, wherein the protrusion (110) includes a straight neck (114) that connects the loop (112) to the collapsible anchor (102).
The implant (100) of claim 1 or claim 2, wherein the protrusion (410) includes a helix (414) that connects the loop (412) to the collapsible anchor (102).
The implant (100) of claim 4 wherein, in a collapsed state, the helix (414) collapses alongside the collapsible anchor (102).
an end effect at a tip of the loop (412), the end effect being a post (462) to pierce tissue.
The implant (100) of any one of the preceding claims wherein the loop (112) defines an opening with an inner width within a range of 1 mm to 13 mm.
The implant (100) of any one of the preceding claims wherein the protrusion (110) extends between 6 mm and 13 mm from the collapsible anchor (102) upon full deployment from the collapsible anchor (102).
The implant (100) of any one of the preceding claims wherein the loop (112) is formed of wire with a diameter of 0.25 mm (0.010 inch) to 1.02 mm (0.040 inch).
The implant (100) of any one of the preceding claims wherein, in a collapsed state, the protrusion (110) folds against the collapsible anchor (102).
The implant (100) of any one of the preceding claims wherein the loop (112) defines a plane that is substantially perpendicular to the wall of the lumen.
The implant (100) of any one of claims 1 to 10 wherein the loop (112) defines a plane that is substantially parallel to the wall of the lumen.
The implant (100) of any one of the preceding claims wherein the loop (112) is formed of a wire loop at an end of the protrusion (110).
The implant (100) of any one of the preceding claims further including additional protrusions (110) connected to the collapsible anchor (102), each additional protrusion (110) having an end formed in a loop (112).
an unsupported, thin-walled sleeve (706) coupled to the collapsible anchor (702) and configured to extend into the lumen upon deployment of the collapsible anchor (702).

References: Application No. 10
 Application No. 11
 Application No. 11
 Application No. 11
 Application No. 11
 Application No. 12
 Application No. 10
 Application No. 11
 Application No. 11