WO2012007043A1 - Procédé et dispositifs destinés à créer un circuit de recyclage de la bile en boucle fermée isolé des aliments - Google Patents

Procédé et dispositifs destinés à créer un circuit de recyclage de la bile en boucle fermée isolé des aliments Download PDF

Info

Publication number
WO2012007043A1
WO2012007043A1 PCT/EP2010/060267 EP2010060267W WO2012007043A1 WO 2012007043 A1 WO2012007043 A1 WO 2012007043A1 EP 2010060267 W EP2010060267 W EP 2010060267W WO 2012007043 A1 WO2012007043 A1 WO 2012007043A1
Authority
WO
WIPO (PCT)
Prior art keywords
bile
absorbing portion
chyme
intestinal
flow
Prior art date
Application number
PCT/EP2010/060267
Other languages
English (en)
Inventor
Mark S. Zeiner
Thomas Edward Albrecht
Mark Steven Ortiz
Michele D'arcangelo
Alessandro Pastorelli
Federico Bilotti
Almino Cardoso Ramos
Jose M. Berger
Michael J. Stokes
Original Assignee
Ethicon Endo-Surgery, Inc.
University Of Cincinnati
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Application filed by Ethicon Endo-Surgery, Inc., University Of Cincinnati filed Critical Ethicon Endo-Surgery, Inc.
Priority to PCT/EP2010/060267 priority Critical patent/WO2012007043A1/fr
Publication of WO2012007043A1 publication Critical patent/WO2012007043A1/fr

Links

Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F5/00—Orthopaedic methods or devices for non-surgical treatment of bones or joints; Nursing devices; Anti-rape devices
    • A61F5/0003—Apparatus for the treatment of obesity; Anti-eating devices
    • A61F5/0013—Implantable devices or invasive measures
    • A61F5/0076—Implantable devices or invasive measures preventing normal digestion, e.g. Bariatric or gastric sleeves
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/00234—Surgical instruments, devices or methods, e.g. tourniquets for minimally invasive surgery
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/11—Surgical instruments, devices or methods, e.g. tourniquets for performing anastomosis; Buttons for anastomosis
    • A61B17/1114—Surgical instruments, devices or methods, e.g. tourniquets for performing anastomosis; Buttons for anastomosis of the digestive tract, e.g. bowels or oesophagus
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/12—Surgical instruments, devices or methods, e.g. tourniquets for ligaturing or otherwise compressing tubular parts of the body, e.g. blood vessels, umbilical cord
    • A61B17/12022—Occluding by internal devices, e.g. balloons or releasable wires
    • A61B17/12027—Type of occlusion
    • A61B17/12036—Type of occlusion partial occlusion
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/12—Surgical instruments, devices or methods, e.g. tourniquets for ligaturing or otherwise compressing tubular parts of the body, e.g. blood vessels, umbilical cord
    • A61B17/12022—Occluding by internal devices, e.g. balloons or releasable wires
    • A61B17/12027—Type of occlusion
    • A61B17/1204—Type of occlusion temporary occlusion
    • A61B17/12045—Type of occlusion temporary occlusion double occlusion, e.g. during anastomosis
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/12—Surgical instruments, devices or methods, e.g. tourniquets for ligaturing or otherwise compressing tubular parts of the body, e.g. blood vessels, umbilical cord
    • A61B17/12022—Occluding by internal devices, e.g. balloons or releasable wires
    • A61B17/12131—Occluding by internal devices, e.g. balloons or releasable wires characterised by the type of occluding device
    • A61B17/12136—Balloons
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B2017/00743—Type of operation; Specification of treatment sites
    • A61B2017/00818—Treatment of the gastro-intestinal system
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/11—Surgical instruments, devices or methods, e.g. tourniquets for performing anastomosis; Buttons for anastomosis
    • A61B2017/1139—Side-to-side connections, e.g. shunt or X-connections

Definitions

  • the present invention relates, in general, to devices and methods for surgically modifying organs and vessels to alter the digestion of a patient with the aim to treat metabolic disorders, such as morbid obesity and related co-morbidities, such as diabetes, heart disease, stroke, pulmonary disease, and accidents.
  • metabolic disorders such as morbid obesity and related co-morbidities, such as diabetes, heart disease, stroke, pulmonary disease, and accidents.
  • the present invention focuses on methods and devices for primarily influencing and modifying the entero-hepatic bile cycling rather than the digestive tract. To this end, the following possible approaches and mechanisms of action on the entero-hepatic bile cycling are contemplated:
  • a particular aim of the present invention is to provide methods and devices for accelerating the entero-hepatic bile cycling of a patient, which are less invasive and involve fewer anatomical modifications than known gastrointestinal bypass surgery.
  • a portion of the intestine which has physiological bile absorbing characteristics such as a segment of ileum, is selected and removed from the gastrointestinal tract, while it remains attached to its lymphatic fluid and blood supplies, and the adjacent segments of the remaining intestine are connected to each other to re-establish the continuity of the intestine, and the selected and isolated bile absorbing portion connected in fluid communication with the biliary fluid from the biliary tree.
  • the previously selected and isolated bile absorbing portion of intestine is directly anastomosed to the gall bladder.
  • the isolation of the bile absorbing portion of the intestine from chyme is performed by isolating the chyme flow from an intestinal wall portion within the bile absorbing portion of the intestine, for instance by diverting the chyme flow through a dedicated chyme channel implant, and fluid connect the biliary tree with the isolated intestinal wall portion.
  • a further aim of the invention is to provide a surgical device for diverting biliary fluid, comprising:
  • - isolation means adapted to engage a bile absorbing portion of the intestine of a patient and isolate said bile absorbing portion from a flow of chyme
  • a bile flow communication duct having a proximal end adapted to couple with the biliary tree and a distal end adapted to connect to the isolated intestinal bile absorbing portion such as to create a fluid communication bypass therebetween.
  • the fluid communication between the biliary tree and the bile absorbing portion of intestine is established by extending a catheter or a natural vessel, such as a vein, from the bile absorbing portion of intestine to the biliary flow in the biliary tree.
  • the natural bile flow in the biliary tree is artificially obstructed downstream or distally from the fluid communication with the isolated bile absorbing intestinal tract, for instance by means of an external clip or an internal plug device, such that the entire bile flow produced by the liver is diverted to be reabsorbed by the isolated bile absorbing intestinal tract.
  • FIG. 1 illustrates a method for accelerating the entero-hepatic bile cycling of a patient in accordance with a first embodiment of the invention
  • FIG. 2 illustrates a method for accelerating the entero-hepatic bile cycling of a patient in accordance with a second embodiment of the invention
  • FIG. 3 illustrates a method for accelerating the entero-hepatic bile cycling of a patient in accordance with a third embodiment of the invention
  • FIG. 4 and 5 illustrate alternative methods for accelerating the entero-hepatic bile cycling of a patient in accordance with a fourth and fifth embodiment of the invention
  • FIG. 6 illustrates a method and devices for accelerating the entero-hepatic bile cycling of a patient in accordance with a sixth embodiment of the invention
  • FIG. 7 illustrates a method and devices for accelerating the entero-hepatic bile cycling of a patient in accordance with a seventh embodiment of the invention
  • FIG. 7A is a schematic view in longitudinal cross section of a chyme channel implant for implementing the method in figure 7;
  • FIG. 8 illustrates a method and devices for accelerating the entero-hepatic bile cycling of a patient in accordance with an eighth embodiment of the invention
  • FIG. 8A is a schematic view in longitudinal cross section of a chyme channel implant for implementing the method in figure 8;
  • FIG. 8B illustrates an alternative anchoring method and device for anchoring a chyme channel implant to resist peristaltic forces
  • FIGS. 9 and 10 illustrate method steps and devices for accelerating the entero-hepatic bile cycling of a patient in accordance with a nineth embodiment of the invention
  • figure 1 is a partial view of the abdominal cavity of a patient, depicting the gastrointestinal tract with the esophagus 1 , stomach 2, duodenum 3, jejunum 4, ileum 5, colon 6 and mesentery with lymphatic fluid and blood supply vascularization 7, as well as the hepatic-biliary system with the liver, the biliary tree 8 with gall bladder 9, the pancreatic duct 10 and the mayor duodenal papilla of Vater 1 1 through which the bile and pancreatic fluid normally enter the duodenum 3, as well as method steps to surgically alter the digestion and particularly accelerate the entero- hepatic bile cycling of a patient.
  • the method comprises the steps of selecting a bile absorbing portion 12 of the intestine 3, 4, 5 and isolating it from a flow of chyme in the gastrointestinal tract, while preserving the lymphatic fluid and blood supply vascularization 7 of the bile absorbing portion 12 and, subsequently, creating a bile flow communication 13 or path 14 between the biliary tree 8 and the isolated intestinal bile absorbing portion 12, wherein said bile flow communication 13 or path 14 is also isolated from chyme.
  • the isolated intestinal bile absorbing portion 12 is preferably a segment of ileum 5 or, alternatively, a segment of duodenum 3 distal (downstream with respect to the chyme flow direction) from the papilla of Vater 1 1 , or a portion of jejunum 4.
  • the intestinal bile absorbing portion 12 itself is totally removed from the intestine, e.g. by proximal and distal resection thereof using an endocutter stapler or surgical clamps and scissors and manual suturing.
  • this phase of the procedure which can be both open or laparoscopic, it is important to preserve the mesentery and blood supply vascularization 7 of the resected intestinal portion 12 in order to maintain its capability to reabsorb bile and recycle it back in the patient's blood stream.
  • the adjacent distal and proximal bowel stumps 13, 14 of the remaining intestine are connected to each other by means of an entero-entero- anastomosis 15 to re-establish the small bowel continuity.
  • an entero-entero- anastomosis 15 to re-establish the small bowel continuity.
  • Such a re-anastomosis of the intestine can be performed with a ci rcu lar stapler or by means of hand sutu red anastomosis.
  • the isolated intestinal bile absorbing portion 12 is then approximated to the gall bladder 9 and connected thereto through a bile diversion anastomosis 16, thereby creating lumen continuity with fluid communication with the biliary fluid from the biliary tree 8.
  • the bile diversion anastomosis 1 6 between the gall bladder 9 and the isolated intestinal bile absorbing portion 12 can be performed using a stapler, e.g. a circular stapler inserted from a first resection end of portion 12 to anastomose a second resection end thereof with the gall bladder 9, or by manual lumen aperture and suturing or by means of the application of an anastomostic pressure ring device.
  • the isolated intestinal bile absorbing portion 12 can be anastomosed to the gall bladder 9 by means of a side-to-end anastomosis forming a T- shaped lumen structure, as shown in figure 4A, or the initially tubular intestinal bile absorbing portion 12 can be longitudinally cut open to become a patch shaped wall portion which is sutured onto a previously created window opening in the gall bladder 9 to achieve a full body incorporation of the isolated intestinal bile absorbing portion 12 wall in the gall bladder 9 wall, compare figure 4B.
  • portion 12 is completely closed in order to avoid leakage of bile in the abdominal space.
  • the gall bladder 9 provides sufficient lumen wall and space for easily accessing the anastomotic site with a circular stapler and executing the bile diversion anastomosis 16.
  • the method contemplates the step of maintaining the bile tree open and unobstructed, such that a first partial bile flow in the gall bladder 9 is diverted towards the isolated bile absorbing portion of intestine 12 and a residual second partial bile flow enters the duodenum through the biliary tree 8.
  • the invention it is contemplated by the invention to divert a predominant part or the entire bile produced by the organism to the isolated intestinal bile absorbing portion 12, e.g. by plugging the biliary tree 8 from inside and/or by strangling it externally so that the bile doesn't flow preferentially or cannot flow at all down the bile duct and into the duodenum.
  • Biliary tree closure can be accomplished by endoluminally deploying a plug device 18 in the biliary tree 8, preferably proximal (upstream) of the junction point with the pancreatic d u ct 1 0 , for instance using a specifically modified ERCP (Endoscopic retrograde cholangiopancreatography) tech nique, in which the plug device 1 8 is detachably supported and deployed by a stent and comprises a circumferential sealing edge adapted to provide a flow preventing engagement of the plug device 18 with the bile duct wall, as well as one or more anchoring portions which interact with the bile duct wall to prevent displacement of the plug device 18 after withdrawal of the stent.
  • ERCP Endoscopic retrograde cholangiopancreatography
  • FIG. 2 illustrates a further embodiment of the invention, according to which the isolated intestinal bile absorbing portion 12, instead of being anastomosed with the gall bladder 9, is anastomosed to a proximal resection stump of the previously resected biliary tree 8 (preferably proximal of the junction with the pancreatic duct 10, in order to preserve the natural pancreatic fluid discharge in the duodenum) , or to a previously resected portion 19 of duodenum wall containing the hepatopancreatic ampulla and papilla of Vater 1 1 (thereby discharging both bile and pancreatic fluids in the isolated intestinal portion 12).
  • This method allows the entire flow of bile to be collected and reabsorbed in the isolated intestinal bile absorbing portion 12, thus enabling a total bile diversion, isolation from chyme and cycle acceleration.
  • the distal resection stump must be closed, e.g. by means of suture or stapling and , analogously, after resection of portion 1 9 of duodenum wall containing the hepatopancreatic ampulla and papilla of Vater 1 1 , the thus created aperture in the duodenum 3 must be equally closed, e.g. by means of suture or stapling, to prevent leakage of body fluids in the abdominal space.
  • the method steps and variants concerning the selection and isolation of the intestinal bile absorbing portion 12 are the same described with reference to figure 1 .
  • Figure 3 illustrates a further embodiment in which the isolated intestinal bile absorbing portion 12 is surgically anastomosed to the biliary tree 8 (preferably proximal of the junction with the pancreatic duct 10, in order to preserve the natural pancreatic fluid discharge in the duodenum), while the biliary tree 8 in fluid communication with portion 12 remains also in fluid communication with the duodenum at the sphincter of Oddi.
  • the lumen wall of the biliary tree 8 is cut longitudinally and anastomosed with the intestinal bile absorbing portion 12, resulting in a partial bile diversion and cycle acceleration.
  • a complete bile diversion would be obtainable by closing the bile tree 8 distally from the bile diversion anastomosis 16, e.g. using the plug device 18 and methods described in connection with the embodiment of figure 1 .
  • the method steps and variants concerning the selection and isolation of the intestinal bile absorbing portion 12 can be the same as previously described with reference to figure 1 .
  • Figure 6 illustrates a further embodiment which obviates possible problems or difficulties to move the selected and resected bile absorbing portion 12 towards the gall bladder 9.
  • the isolated intestinal bile absorbing portion 12 is put in bile fluid communication with the biliary tree 8 by means of extending an additional bile conveying duct 20, for instance a catheter or a natural lumen such as a vein of the patient, from the gall bladder 9 or biliary tree 8 to the isolated intestinal bile absorbing portion 12 in order to discharge the thus diverted bile flow over a certain distance in the intestinal bile absorbing portion 12, without any necessity to displace portion 12 towards the gall bladder 9.
  • an additional bile conveying duct 20 for instance a catheter or a natural lumen such as a vein of the patient
  • a complete bile diversion would be obtainable by closing the bile tree 8, e.g. using the plug device 18 and methods described in connection with the embodiment of figure 1 .
  • the method steps and variants concerning the selection and isolation of the intestinal bile absorbing portion 12 can be those previously described with reference to the embodiment of figure 1 .
  • Figures 7 and 8 illustrate embodiments, in which the isolation of the intestinal bile absorbing portion 12 from the flow of chyme is performed by isolating the chyme flow itself from an intestinal wall portion 21 within the selected bile absorbing portion 12 of the intestine by means of a dedicated chyme channel implant 22.
  • the chyme channel implant 22 is configured and dimensioned to be deployable inside the intestine and comprises a tubular chyme passage channel 23 having a preferably funnel shaped proximal open end 24 adapted to receive the chyme flow conveyed by the intestinal peristalsis and a preferably funnel shaped distal open end 25 adapted to release the chyme from channel 23 distally into the intestine, as well as a laterally open bile collecting cavity 26 isolated from the chyme passage channel 23 and configured to define together with an adjacent portion of intestinal wall a substantially sealed bile collecting and absorbing chamber 27.
  • the bile collecting cavity 26 comprises a radially external ring cavity formed around the chyme passage channel 23 and axially delimited by radially protruding proximal 28 and distal 29 lumen sealing portions.
  • the lumen sealing portions 28, 29 are preferably expandable from an initially collapsed radially smaller configuration in order to allow endoluminal transport of the chyme channel implant 22 to the selected intestinal bile absorbing portion 12 and subsequent deployment thereof by expanding the lumen sealing portions 28, 29.
  • the lumen sealing portions 28, 29 may comprise expandable balloon segments which can be permanently expanded by injection of an expansion fluid, such as a saline solution, or a solidifying expansion agent, such as a hardening polymer foam or paste.
  • an expansion fluid such as a saline solution, or a solidifying expansion agent, such as a hardening polymer foam or paste.
  • At least one of the lumen sealing portions 28, 29, preferably the proximal lumen sealing portions 28 can further define a bile passage hole 30 which opens into the bile collecting cavity 26 and to which a bile conveying tube 31 , such as a catheter or a natural endogenous structure, can be coupled from inside the intestine for creating the bile fluid path to the inside of the bile collecting and absorbing chamber 27, as illustrated in figures 8 and 8A.
  • a bile conveying tube 31 such as a catheter or a natural endogenous structure
  • the chyme channel implant 22 it is possible to obtain an accelerated bile reabsorbtion without chyme contact, while leaving the selected bile absorbing portion of intestine 12 in its natural anatomical environment.
  • the bile collecting and absorbing chamber 27 is created by delivering the chyme channel implant 22 (which is still in its initial collapsed configuration) with the help of an enteroscope transanally to the previously selected intestinal bile absorbing portion 12, e.g. a distal segment of the ileum 5 and deploying the chyme channel implant 22 by expanding its lumen sealing portions 28, 29.
  • a catheter is laparoscopically extended and fluid connected between the biliary tree 8 and the selected intestinal bile absorbing portion 12 inside the bile collecting and absorbing chamber 27, thereby creating a shunt between the biliary tree 8 and the intestinal bile absorbing portion 12 that totally diverts bile separate from the chyme flow and accelerates the bile cycling.
  • a prosthetic shunting structure for provid i ng the bi le conveyi ng tu be 31 wou ld be to u se an endogenous structure, such as a segment of bile duct or of the saphenous vein of the patient.
  • a further alternative solution to the implantation of a prosthetic shunting structure contemplates to transect the biliary tree 8 and anastomose its distal stump with the intestinal bile absorbing portion 12, with the result to divert the bile directly and totally.
  • the following two favorite positions for transecting the biliary tree 8 are identified:
  • Figure 8 illustrates an embodiment of an alternative endoscopic approach and devices to divert the bile flow to the bile collecting and absorbing chamber 27, in which a catheter is extended endolumenally from the biliary tree 8 inside the intestine down to the chyme channel implant 22 and coupled to its bile passage hole 30 to create the bile conveying tube 31 .
  • the latter can be additionally anchored in the gastrointestinal tract, e.g. by means of a gastric coil 32 which can elastically deform from an extended configuration adapted for transoral or transnasal transportation thereof into the stomach 2, to a wound arched or circular configuration adapted to shape interfere with the stomach such as to provide an anchor for an anchoring wire 33 which is connected to the intraluminal bile conveying tube 31 or directly with the chyme channel implant 22.
  • a gastric coil 32 which can elastically deform from an extended configuration adapted for transoral or transnasal transportation thereof into the stomach 2, to a wound arched or circular configuration adapted to shape interfere with the stomach such as to provide an anchor for an anchoring wire 33 which is connected to the intraluminal bile conveying tube 31 or directly with the chyme channel implant 22.
  • the anchoring wire 33 can be connected to a previously created plication 34 in the stomach wall, as schematically shown in figure 8B.
  • the method step of isolating the intestinal bile absorbing portion 12 from a flow of chyme comprises the step of resecting the intestine at a proximal end B of the selected portion 12, e.g.
  • a distal end region C of the bile absorbing portion 12 has not been resected from and remains attached to the gastrointestinal tract.
  • the remaining proximal resection stump A of the intestine (which was initially proximally adjacent to the portion 12, as shown in figure 9) is connected in anastomosis at or distally from the distal region C of the bile absorbing portion 12, thereby creating an anatomical Y - structure without chyme flow in the branched bile absorbing portion 12.
  • the Y-structure can be advantageously created using a translumenal guide wire approach to define the Y-anatomy and transport and deploy an anastomotic ring device at the entero-entero anastomotic site at A-C, in combination with a multiple access port or single incisional laparoscopic surgery (SILS) bile diversion anastomosis 16.

Abstract

La présente invention concerne un procédé destiné à détourner du fluide biliaire, comprenant les étapes consistant à isoler une partie de l'intestin absorbant la bile (12) d'un écoulement de chyme, tout en préservant la vascularisation de ladite partie absorbant la bile, et à créer une communication fluidique de bile entre l'arbre biliaire (8, 9) et la partie intestinale isolée absorbant la bile (12), ladite communication fluidique de bile (13, 14, 16, 20, 31) étant également isolée du chyme.
PCT/EP2010/060267 2010-07-16 2010-07-16 Procédé et dispositifs destinés à créer un circuit de recyclage de la bile en boucle fermée isolé des aliments WO2012007043A1 (fr)

Priority Applications (1)

Application Number Priority Date Filing Date Title
PCT/EP2010/060267 WO2012007043A1 (fr) 2010-07-16 2010-07-16 Procédé et dispositifs destinés à créer un circuit de recyclage de la bile en boucle fermée isolé des aliments

Applications Claiming Priority (1)

Application Number Priority Date Filing Date Title
PCT/EP2010/060267 WO2012007043A1 (fr) 2010-07-16 2010-07-16 Procédé et dispositifs destinés à créer un circuit de recyclage de la bile en boucle fermée isolé des aliments

Publications (1)

Publication Number Publication Date
WO2012007043A1 true WO2012007043A1 (fr) 2012-01-19

Family

ID=43875212

Family Applications (1)

Application Number Title Priority Date Filing Date
PCT/EP2010/060267 WO2012007043A1 (fr) 2010-07-16 2010-07-16 Procédé et dispositifs destinés à créer un circuit de recyclage de la bile en boucle fermée isolé des aliments

Country Status (1)

Country Link
WO (1) WO2012007043A1 (fr)

Cited By (1)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US10449075B2 (en) 2015-12-15 2019-10-22 Steven Sounyoung Yu Biliary diversion catheter

Citations (5)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US20040167614A1 (en) * 1997-06-28 2004-08-26 Anson Antony Walter Expandable device
EP1508312A1 (fr) * 2003-08-20 2005-02-23 Ethicon Endo-Surgery, Inc. Dispositif facilitant la malabsorption nutritionnelle
WO2007142833A1 (fr) * 2006-05-30 2007-12-13 Boston Scientific Scimed, Inc. Stent anti-obésité
US20100081883A1 (en) 2008-09-30 2010-04-01 Ethicon Endo-Surgery, Inc. Methods and devices for performing gastroplasties using a multiple port access device
US20100081864A1 (en) 2008-09-30 2010-04-01 Ethicon Endo-Surgery, Inc. Methods and devices for performing gastrectomies and gastroplasties

Patent Citations (5)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US20040167614A1 (en) * 1997-06-28 2004-08-26 Anson Antony Walter Expandable device
EP1508312A1 (fr) * 2003-08-20 2005-02-23 Ethicon Endo-Surgery, Inc. Dispositif facilitant la malabsorption nutritionnelle
WO2007142833A1 (fr) * 2006-05-30 2007-12-13 Boston Scientific Scimed, Inc. Stent anti-obésité
US20100081883A1 (en) 2008-09-30 2010-04-01 Ethicon Endo-Surgery, Inc. Methods and devices for performing gastroplasties using a multiple port access device
US20100081864A1 (en) 2008-09-30 2010-04-01 Ethicon Endo-Surgery, Inc. Methods and devices for performing gastrectomies and gastroplasties

Cited By (1)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US10449075B2 (en) 2015-12-15 2019-10-22 Steven Sounyoung Yu Biliary diversion catheter

Similar Documents

Publication Publication Date Title
CA2902191C (fr) Dispositifs et procedes de formation d'une anastomose
US7452363B2 (en) Applier for fastener for single lumen access anastomosis
EP2651314B1 (fr) Systèmes de contournement d'un site d'anastomose
AU2011202352B2 (en) Single lumen access deployable ring for intralumenal anastomosis
US20060217748A1 (en) Method for Hybrid Gastro-Jejunostomy
WO2012007044A1 (fr) Dispositif destiné à un détournement transluminal de la bile
WO2013087096A1 (fr) Dispositif de manchon endoluminal et procédés pour déployer un manchon endoluminal dans le tractus gi
WO2012007045A1 (fr) Dispositif et procédé de détournement sous-cutané de la bile
WO2012007048A1 (fr) Appareil et procédé destinés à détourner les sucs biliopancréatiques déchargés à l'intérieur du tractus intestinal d'un patient
WO2013004263A1 (fr) Dispositif de raccordement pour anastomose entre un organe creux et un conduit
WO2012007043A1 (fr) Procédé et dispositifs destinés à créer un circuit de recyclage de la bile en boucle fermée isolé des aliments
US20230172626A1 (en) Endoscopic transluminal stent access and delivery system
US20240074759A1 (en) Pressure profile magnetic compression anastomosis devices
AU2007201158B2 (en) Method for hybrid gastro-jejunostomy
WO2013004267A1 (fr) Cathéter, en particulier destiné à diriger des sécrétions biliopancréatiques

Legal Events

Date Code Title Description
121 Ep: the epo has been informed by wipo that ep was designated in this application

Ref document number: 10732715

Country of ref document: EP

Kind code of ref document: A1

NENP Non-entry into the national phase

Ref country code: DE

122 Ep: pct application non-entry in european phase

Ref document number: 10732715

Country of ref document: EP

Kind code of ref document: A1