WO2020006279A1 - Dispositifs, systèmes et méthodes de traitement de l'obésité - Google Patents

Dispositifs, systèmes et méthodes de traitement de l'obésité Download PDF

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Publication number
WO2020006279A1
WO2020006279A1 PCT/US2019/039575 US2019039575W WO2020006279A1 WO 2020006279 A1 WO2020006279 A1 WO 2020006279A1 US 2019039575 W US2019039575 W US 2019039575W WO 2020006279 A1 WO2020006279 A1 WO 2020006279A1
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WIPO (PCT)
Prior art keywords
cecum
medical device
patient
therapeutically effective
effective period
Prior art date
Application number
PCT/US2019/039575
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English (en)
Inventor
Alexander S. GANZ
Robert A. Ganz
Travis Sessions
Steven Berhow
Michael W. Augustine
Original Assignee
Emerald Ridge Medical, LLC
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.)
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Publication date
Application filed by Emerald Ridge Medical, LLC filed Critical Emerald Ridge Medical, LLC
Priority to EP19825234.8A priority Critical patent/EP3813729A4/fr
Publication of WO2020006279A1 publication Critical patent/WO2020006279A1/fr

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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
    • A61F5/0036—Intragastrical devices
    • 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
    • A61B17/12131—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
    • 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
    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/82—Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/86—Stents in a form characterised by the wire-like elements; Stents in the form characterised by a net-like or mesh-like structure
    • A61F2/88—Stents in a form characterised by the wire-like elements; Stents in the form characterised by a net-like or mesh-like structure the wire-like elements formed as helical or spiral coils
    • 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
    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/82—Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/86—Stents in a form characterised by the wire-like elements; Stents in the form characterised by a net-like or mesh-like structure
    • A61F2/90—Stents in a form characterised by the wire-like elements; Stents in the form characterised by a net-like or mesh-like structure characterised by a net-like or mesh-like structure
    • 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
    • A61F5/0036—Intragastrical devices
    • A61F5/004—Intragastrical devices remotely adjustable
    • 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
    • A61F5/0036—Intragastrical devices
    • A61F5/004—Intragastrical devices remotely adjustable
    • A61F5/0043—Intragastrical devices remotely adjustable using injection ports
    • 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
    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02—Prostheses implantable into the body
    • A61F2/04—Hollow or tubular parts of organs, e.g. bladders, tracheae, bronchi or bile ducts
    • A61F2002/045—Stomach, intestines
    • 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
    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/95—Instruments specially adapted for placement or removal of stents or stent-grafts
    • A61F2002/9505—Instruments specially adapted for placement or removal of stents or stent-grafts having retaining means other than an outer sleeve, e.g. male-female connector between stent and instrument
    • 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
    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/95—Instruments specially adapted for placement or removal of stents or stent-grafts
    • A61F2002/9528—Instruments specially adapted for placement or removal of stents or stent-grafts for retrieval of stents
    • 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
    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/95—Instruments specially adapted for placement or removal of stents or stent-grafts
    • A61F2/962—Instruments specially adapted for placement or removal of stents or stent-grafts having an outer sleeve
    • A61F2/966—Instruments specially adapted for placement or removal of stents or stent-grafts having an outer sleeve with relative longitudinal movement between outer sleeve and prosthesis, e.g. using a push rod
    • A61F2002/9665—Instruments specially adapted for placement or removal of stents or stent-grafts having an outer sleeve with relative longitudinal movement between outer sleeve and prosthesis, e.g. using a push rod with additional retaining means
    • 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
    • A61F2230/00—Geometry of prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof
    • A61F2230/0063—Three-dimensional shapes
    • A61F2230/0071—Three-dimensional shapes spherical
    • 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
    • A61F2230/00—Geometry of prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof
    • A61F2230/0063—Three-dimensional shapes
    • A61F2230/0091—Three-dimensional shapes helically-coiled or spirally-coiled, i.e. having a 2-D spiral cross-section

Definitions

  • Obesity is a common and important issue in the U.S. and worldwide that involves over 500 million obese people total. This number includes approximately 35-40% of adults in the U.S. with an associated cost of approximately $315 billion dollars for obesity-related diseases.
  • the global economic impact of obesity and related diseases approaches $2 trillion, much of that due to shortened lifespans, obesity-associated comorbidities, and lost productivity.
  • obesity is directly related to heart disease and diabetes. Diabetes affects 382 million people worldwide, and up to 30 million adults in the U.S., with a U.S. cost of about $245 billion and an approximate worldwide cost of $600 billion per annum. Effective treatment of obesity in many cases can reverse diabetes and ameliorate heart disease, so effective treatment of obesity is an urgent medical need.
  • endoscopic suturing devices endoscopic sleeve gastrectomies
  • barrier/liner devices e.g., those of GI dynamics, of Boston, Massachusetts, or ValenTx, of Maple Grove, Minnesota
  • ablate duodenal mucosa e.g., those of Fractyl, of Lexington, Massachusetts.
  • Intragastric balloons e.g., Orbera®, of Apollo Endosurgery, or ReShapeTM, of ReShape Medical Inc.
  • Intragastric balloons for treating obesity also exist. These are solid balloons that are placed and inflated in the stomach to cause gastric distention and create a sense of fullness and satiety.
  • Embodiments disclosed herein address, resolve, ameliorate, and/or eliminate one or more of the disadvantages of known approaches for treating obesity and illnesses related thereto.
  • various methods, systems, and devices for treatment of obesity are achieved in less invasive manners, are more economical, are safer, are more effective, and/or are advantageous in other or further ways than one or more of the previously known approaches.
  • Embodiments of devices, systems, and methods that can be used in the treatment of obesity and related illnesses are disclosed.
  • the cecum of an obese patient is enlarged to a pathophysiological size for a therapeutically effective period.
  • the distention may be achieved by introduction of an object that is of foreign origin relative to the body of the patient into the cecum of the patient.
  • the distention is achieved by a medical device that transitions from an undeployed state, in which the medical device is introduced into the cecum of the patient, to an expanded state in which the medical device distends the cecum to the pathophysiological size.
  • the expanded device can trigger a colo-gastric brake in the patient, can yield acute inflammation, chronic inflammation, fibrosis and/or wall thickening, and/or can alter the microbiome of the cecum.
  • a colo-gastric brake in the patient can yield acute inflammation, chronic inflammation, fibrosis and/or wall thickening, and/or can alter the microbiome of the cecum.
  • One or more of these phenomena can individually and/or collectively contribute to weight loss in a patient.
  • Other embodiments are also disclosed.
  • FIG. 1 is an elevation view of a colon in a natural or non-distended state
  • FIG. 2 is a cutaway elevation view of a patient showing the bowel of the patient, wherein a stage of an illustrative method for treating obesity of the patient in which an endoscope has been advanced to the cecum of the patient is depicted;
  • FIG. 3 is another cutaway elevation view of the patient such as that of FIG. 2 showing another stage of the method in which a structure has been implanted in the cecum of the patient;
  • FIG. 4 is another elevation view of the colon similar to that of FIG. 1, but depicting a stage of another illustrative method in which a structure that has been introduced into the cecum of a patient to distend the cecum;
  • FIG. 5A is a cross-sectional view of a portion of the colon of a patient during another illustrative method in which an endoscope, shown in perspective, is being advanced toward the cecum of the patient;
  • FIG. 5B depicts another stage of the method in which a catheter is advanced out of a distal end of the endoscope into the cecum;
  • FIG. 5C depicts another stage of the method in which an expandable medical device is being deployed into contact with the cecum via the catheter;
  • FIG. 5D depicts another stage of the method in which the expandable medical device has been deployed to expand the cecum to a pathophysiological size and the catheter has been retracted relative to the endoscope;
  • FIG. 5E depicts another stage of the method in which the expandable medical device is implanted in the cecum and the endoscope has been retracted from the patient;
  • FIG. 6 is a cross sectional view of an embodiment of a system that can be used to implant an embodiment of an expandable medical device within the cecum of a patient;
  • FIG. 7A is a cross-sectional view of a portion of the colon of a patient during another illustrative method in which an expandable medical device, shown in perspective, is being delivered to the cecum of the patient directly from an instrument channel of an endoscope, also shown in perspective;
  • FIG. 7B depicts another stage of the method in which the expandable medical device has been deployed to expand the cecum to a pathophysiological size and the endoscope has been removed from the patient;
  • FIG. 8A is a perspective view of another embodiment of a system that can be used to implant an embodiment of an expandable medical device within the cecum of a patient;
  • FIG. 8B is a perspective view of the expandable medical device in a deployed or expanded state
  • FIG. 9 is a cross-sectional view of a portion of the colon of a patient in which another embodiment of an expandable medical device, shown in perspective, has been delivered;
  • FIG. 10A is a perspective view of another embodiment of a medical device for the treatment of obesity, wherein the medical device is depicted in a contracted or undeployed state;
  • FIG. 10B is another perspective view of the medical device that depicts the device in an expanded or deployed state
  • FIG. 11 is a perspective view of another embodiment of a medical device for the treatment of obesity
  • FIG. 12 is a perspective view of another embodiment of a medical device for the treatment of obesity
  • FIGS. 13A-13G are perspective view of additional embodiments of medical devices for the treatment of obesity;
  • FIG. 14A is a perspective view of another embodiment of a medical device for the treatment of obesity, wherein the medical device is depicted in a contracted or undeployed state;
  • FIG. 14B is another perspective view of the medical device that depicts the device in an expanded or deployed state
  • FIG. 15 is a perspective view of another embodiment of a medical device for the treatment of obesity, wherein the medical device is depicted in an expanded or deployed state;
  • FIG. 16 is a perspective view of another embodiment of a medical device for the treatment of obesity
  • FIG. 17 is a perspective view of another embodiment of a medical device for the treatment of obesity
  • FIG. 18 is a perspective view of another embodiment of a medical device for the treatment of obesity
  • FIG. 19 is a perspective view of another embodiment of a medical device for the treatment of obesity.
  • FIG. 20 is a front elevation view of another embodiment of a medical device for the treatment of obesity
  • FIG. 21 is an elevation view of an embodiment of a kit for the treatment of obesity
  • FIG. 22A is a side elevation view of another embodiment of an expandable medical device that is configured for placement in the cecum of a patient to treat obesity, the medical device being depicted in a contracted or undeployed state;
  • FIG. 22B is a perspective view of the medical device of FIG. 22A in an expanded or deployed state
  • FIG. 23A is a cross-sectional view of a portion of the colon of a patient during another illustrative method in which an endoscope, shown in perspective, is being advanced toward the cecum of the patient;
  • FIG. 23B depicts another stage of the method in which a deployment system is advanced out of a distal end of the endoscope into the cecum;
  • FIG. 23 C depicts another stage of the method in which the expandable medical device of FIGS. 22A, 22B is being deployed within the cecum;
  • FIG. 23D depicts another stage of the method in which the expandable medical device has been deployed to expand the cecum to a pathophysiological size
  • FIG. 23E depicts another stage of the method in which a push rod is being decoupled from the deployed medical device
  • FIG. 23F depicts a further stage of the method just after the push rod has been decoupled from the medical device
  • FIG. 23G depicts a further stage of the method after the push rod has been retracted relative to the endoscope;
  • FIG. 23H depicts a further stage of the method, after the endoscope has been retracted from the patient, at which the cecum naturally expands to a size larger than the pathophysiological size;
  • FIG. 231 depicts a further stage of the method in which an endoscope has been introduced into the bowel of the patient and the push rod (or a different push rod) is coupled to the medical device for purposes of retraction;
  • FIG. 23J depicts a further stage of the method in which a retention sleeve is advanced distally over the medical device to transition the medical device to a retracted configuration
  • FIG. 23K depicts a further stage of the method in which the retention sleeve has been advanced over an entirety of the medical device
  • FIG. 24 depicts another embodiment of a deployment system for deploying an embodiment of a medical device within the cecum, the deployment system including a push rod and a retention sleeve;
  • FIG. 25A depicts an embodiment of a retraction system for retracting the medical device from the cecum, the retraction system including a snare and a retention sleeve;
  • FIG. 25B depicts a further stage of retraction of the medical device from the cecum via the retraction system
  • FIG. 25 C depicts yet a further stage of retraction of the medical device from the cecum via the retraction system
  • FIG. 26 depicts a balloon catheter that may be used to deploy certain embodiments of an expansion medical device within the cecum of a patient
  • FIG. 27 depicts a stage of a method of expanding the cecum of the patient via another embodiment of an expandable medical device using the balloon catheter of FIG. 26;
  • FIG. 28 depicts another embodiment of a deployment system that includes a push rod and a retention filament that selectively maintains the device in the undeployed configuration
  • FIG. 29 is an elevation view of another embodiment of an expansion medical device configured for deployment in the cecum of a patient, the medical device being depicted in a collapsed or undeployed configuration;
  • FIGS. 30A-30G are further views of the medical device of FIG. 29 depicted in an expanded or deployed configuration, with
  • FIG. 30A being a perspective view thereof
  • FIG. 30B being a plan view thereof, with the distal end (from the perspective of the gastrointestinal tract) being in the foreground and the proximal end being in the background;
  • FIG. 30C being an enlarged end-on, substantially plan view of the proximal end thereof;
  • FIG. 30D being an enlarged perspective view of the proximal end thereof
  • FIG. 30E being an enlarged substantially end-on, perspective view of certain strut portions thereof;
  • FIG. 3 OF being an enlarged elevation view of certain of the strut portions;
  • FIG. 30G being an elevation view of a front half thereof, this view including tracings of two force -application lines or regions that each extend about a full periphery of the device;
  • FIG. 31 A is a schematic representation of a region of an illustrative cecum affected by the upper of the two force -application lines of FIG. 30G;
  • FIG. 31B is a schematic representation of a region of the illustrative cecum affected by the lower of the two force -application lines of FIG. 30G;
  • FIG. 32A is a perspective view of another embodiment of an expansion medical device that includes a covering— specifically, a cover attached to a frame— and is configured for deployment in the cecum of a patient, the medical device being depicted in a low-profile, collapsed, or undeployed configuration;
  • FIG. 32B is an elevation view of the expansion medical device of FIG. 32A depicted in an expanded or deployed configuration
  • FIG. 33 A is a perspective view of another embodiment of an expansion medical device that includes a distal end configured to assist in retrieval of the medical device after use and further includes a covering— specifically, a coating applied to a frame, the medical being depicted in a low- profile, collapsed, or undeployed configuration;
  • FIG. 33B is an elevation view of the undeployed medical device of FIG. 33A;
  • FIG. 33C is a plan view of the undeployed medical device of FIG. 33A;
  • FIG. 34A is an elevation view of another embodiment of an expansion medical device shown in a low-profile or undeployed configuration
  • FIG. 34B is a perspective view of the medical device of FIG. 34A in an expanded or deployed configuration
  • FIG. 35A is a cross-sectional view of the medical device of FIG. 34A taken along the view line 35A-35A in FIG. 34A;
  • FIG. 35B is a cross-sectional view, similar to that of FIG. 35A, of another embodiment of an expansion medical device
  • FIG. 35C is a cross-sectional view, similar to that of FIG. 35A, of another embodiment of an expansion medical device
  • FIG. 35D is a cross-sectional view, similar to that of FIG. 35A, of another embodiment of an expansion medical device
  • FIG. 35E is a cross-sectional view, similar to that of FIG. 35A, of another embodiment of an expansion medical device
  • FIG. 36A is a cross-sectional view of a portion of the colon of a patient during another illustrative method in which the expandable medical device of FIGS. 34A and 34B, shown in perspective, is being delivered to the cecum of the patient directly from an instrument channel of an endoscope and naturally or automatically transitions from the low-profile stated to the expanded state within the cecum;
  • FIG. 36B depicts another stage of the illustrative method another illustrative method in which the medical device of FIGS. 34A and 34B is fully deployed within the cecum;
  • FIG. 37 depicts a stage of another illustrative method that involves deployment of the medical device of FIGS. 34A and 34B in which the medical device is attached to the wall of the cecum using one or more fasteners;
  • FIG. 38 depicts another illustrative method in which another embodiment of an expandable medical device has been delivered to the cecum of the patient
  • FIG. 39 depicts another illustrative method in which an embodiment of a pair of expandable medical devices has been delivered to the cecum of the patient;
  • FIG. 40A is a fluoroscopy image of an embodiment of an implant after initial deployment in the cecum of a test patient (in particular, a dog);
  • FIG. 40B is another fluoroscopy image of the implant at seven days after initial deployment
  • FIG. 40C is another fluoroscopy image of the implant at 28 days after initial deployment
  • FIG. 41 is a chart depicting food consumption patterns of test patients (mongrel dogs) in which embodiments of the implant have been implanted at periods prior to implantation, one to 25 days after implantation, and 26 to 90 days after implantation (during which dietary supplements were provided);
  • FIG. 42 is a chart depicting the average food consumption patterns of the test patients.
  • FIG. 43 is a chart depicting body weight of the test patients at various times relative to implantation of the device.
  • Certain embodiments disclosed herein make advantageous use of a natural physiological response to distention of the cecum to treat obesity and illnesses related thereto.
  • certain embodiments mimic the effects of bowel obstruction and bowel distention and/or reproduce the normal physiological“colo-gastric brake,” which is described further below.
  • certain embodiments artificially distend the cecum without causing an actual obstruction (or complete obstruction) of the bowel.
  • various embodiments involve distention of the cecum to trigger a colo-gastric brake and/or a loss or reduction of appetite associated therewith, while permitting normal flow of material through the cecum while the cecum is thus distended.
  • Triggering of the colo-gastric brake and/or a loss or reduction of appetite may be attributable to one or more other or further phenomena as a result of the presence of an inserted or implanted distention device.
  • Bowel obstructions of the colon or small intestine that are either partial or complete, are poorly tolerated by humans (and other animals) and can cause loss of appetite (anorexia), nausea, and/or vomiting. This occurs because, with obstruction of any portion of the bowel (including obstruction of the bile ducts or pancreatic ducts), there can be both local distention of said organs and/or distention of the entire proximal bowel or portions of the more proximal bowel.
  • Bowel distention in any part of the tubular gastrointestinal tract small intestine, colon, etc. drives chemical, hormonal, and neurological signaling that is the direct cause of the loss of appetite, nausea and vomiting, that occurs when any portion of the bowel is obstructed.
  • Various gradations of symptoms can occur depending on exactly where the distention occurs, how distended the bowel becomes, and how rapidly the distention occurs.
  • physiologic, non-obstructing distention of portions of the bowel that can occur as part of normal life can have effects similar to a bowel obstruction.
  • the colon in general, or, for example, the cecum (the most proximal portion of the colon) specifically is distended during or following a meal as part of normal physiologic processes, appetite can be suppressed.
  • a person has constipation, which can yield colon distention with stool, appetite can be suppressed.
  • there can be suppression of appetite and in rare cases, nausea or vomiting.
  • intestinal-gastric brake includes the colo-gastric brake mechanism just described.
  • Certain embodiments disclosed herein thus achieve the advantages of intestinal-gastric (e.g., colo-gastric) braking for obesity treatment— such as, for example, appetite suppression— without triggering one or more of the disadvantageous effects of bowel obstruction.
  • the intestinal -gastric or colo-gastric braking can result specifically from distention of the cecum, and may thus be referred to herein as cecal-gastric braking. Stated otherwise, certain embodiments can give rise to a colo-gastric brake due to alterations to the cecum, which may alternatively be referred to herein as triggering a cecal-gastric brake or as cecal- gastric braking.
  • Intragastric balloons are solid balloons, meaning that they do not define any openings or channels through which materials can pass, that are placed and inflated in the stomach to cause gastric distention and create a sense of fullness and satiety. It should be noted that use of such solid balloons is limited to placement in the stomach only.
  • the stomach is a distensible, and uniquely J-shaped gastrointestinal organ that can accommodate a solid balloon or other structure with limited fear of obstruction.
  • Placement of a solid balloon in more tubular shaped parts of the gastrointestinal tract, such as the small bowel or colon, of a sufficient size to distend the bowel may have a high likelihood of causing an emergency bowel obstruction outside of the stomach.
  • intragastric solid balloons are also not particularly efficacious for weight loss, since the great distensibility of the stomach allows patients to eat significant portions despite the presence of a balloon.
  • Solid gastric balloons also have limited durability. They cannot be spontaneously passed into the more distal tubular bowel for fear of causing an emergency bowel obstruction, hence they need to be removed endoscopically.
  • One proposal for treating obesity and its comorbidities involves placement of one or more devices in the rectum and/or the small intestine to provide outward pressure to these specific regions of the gastrointestinal tract, but without marked distention thereto (i.e., with only minimal distention thereof that is insufficient to distort the normal architecture of these regions and, allegedly, insufficient to cause the patient discomfort), to evoke therapeutically useful responses.
  • the focus of the proposal is to pressurize the small intestine or rectum, with only minimal distention, due to these portions of the gut being less compliant than either the stomach or compliant storage regions of the large intestine (i.e., the cecum).
  • this proposal is based on an observation that the small bowel especially appears to exhibit autoregulation of its diameter, in that distention of local parts is opposed via a localized contractile response.
  • a device is used to impart an expansile or other outward physical/mechanical force upon the rectum or the small intestine.
  • the proposal indicates that it is the outward pressure exerted by the device itself that evokes clinically meaningful responses, but stipulates that the outward pressure of the device should not be so great as to distort the normal architecture of the section of the small intestine (e.g., the duodenum), in which the device may be deployed. This is because expansion of non-compliant regions of the small or large intestine will signal a bowel obstruction and cause intolerable side effects, such as, for example, nausea or vomiting.
  • certain embodiments herein vary significantly from the proposed small-intestinal- or rectum-based devices and methods and, further, overcome complications associated therewith.
  • certain embodiments of the present disclosure are directed to an opposite approach— specifically, marked distention of a specific, highly elastic or expansible segment of the bowel (i.e., the cecum) that, because it is physiologically distensible, may be achieved without significant pressurization.
  • the wall tension of a vessel is directly proportional to the product of the pressure within the vessel and the radius of the vessel.
  • Vessels that are resistant to radial expansion, such as the small intestine thus can be pressurized without significant changes in size.
  • a far different approach is to instead increase the tension in the wall of an expandable vessel (e.g., the cecum) to increase the radius of the vessel, but without significantly altering the internal pressure on the vessel wall.
  • certain embodiments herein can increase cecal wall tension by increasing cecal radius without significantly increasing pressure on the cecal wall (e.g., applying relatively low pressure to the cecal wall) which may maintain intraluminal pressure within a normal range or elevate intraluminal pressure only slightly.
  • Such an approach is far different from purposefully increasing the intraluminal pressure of the small intestine or rectum, while maintaining the radius thereof substantially constant, to thereby increase wall tension.
  • certain embodiments disclosed herein expand the cecum by large amounts, including to a pathophysiological size.
  • Some embodiments e.g., other or further embodiments
  • Other and further embodiments are also disclosed.
  • certain configurations and methods described herein can provide for safer and more efficacious non-surgical means to treat obesity that are minimally invasive and readily and/or relatively cheaply be applied to the majority of obese subjects.
  • the cecum is distended to a pathophysiologic diameter to exaggerate the effects of normal, physiologic post prandial cecum distention without actually causing bowel obstruction or causing the symptoms of obstruction (e.g., pain or nausea).
  • an object or structure is placed within the cecum of a patient so as to distend the cecum.
  • Such distension can trigger a colo-gastric brake (e.g., a cecal-gastric brake) in the patient.
  • the object or structure may include or define one or more passageways through which material can pass.
  • the passageway(s) can be sufficiently large to permit passage therethrough of material (e.g., air, semiliquid, liquid, semisolid, or solid materials) that would otherwise pass through the cecum in the absence of the object or structure.
  • the passageway(s) may permit such passage substantially without obstructing the natural passage of the material, and thus may cause distention of the cecum without obstructing the bowel.
  • the one or more passageways are sized and/or oriented so as to ensure that material that passes through the ileocecal valve can readily pass into the cecum.
  • the structure or object includes a sidewall that at least intermittently contacts the cecum to enlarge the cecum.
  • the structure or object may bear against, abut, apply outward force to, press on, push on, provide an expansion bias to, increase tension in, or otherwise influence the cecal wall to expand the cecum.
  • the sidewall can define a primary passageway that may be aligned with a longitudinal axis of the cecum, and the sidewall can include large secondary passageways (e.g., openings) and/or or narrow struts or other supports or structural features that are configured not to block, or to only minimally block, passage of material into the cecum through the ileocecal valve.
  • large secondary passageways e.g., openings
  • narrow struts or other supports or structural features that are configured not to block, or to only minimally block, passage of material into the cecum through the ileocecal valve.
  • the object or structure includes an expandable structure that is introduced into the cecum in an unexpanded state.
  • the structure is expanded within the cecum to distend the cecum.
  • the structure can define one or more passageways, which can be pathways through the device and/or between portions of the device that may include, or be in fluid communication with, one or more openings, perforations, channels, paths, etc. through which material can enter, pass through or by, and/or exit the structure.
  • the passageway is not entirely enclosed by the structure. Stated otherwise, the structure may define only a portion of the passageway, and may cooperate with the wall of the cecum to define a fully encircled or encompassed pathway through which material passes.
  • the passageway(s) at least partially defined by the structure when in the expanded or deployed state allow gas, semiliquid, liquid, semisolid and/or solid material to pass through, thus avoiding actual obstruction of the bowel.
  • the structure may be secured to the cecum wall.
  • the structure may be placed in tension against the wall, may be anchored to the wall, may be adhered to the wall, may be integrated with or into the wall over time (e.g., via tissue ingrowth), and/or may otherwise be secured to the wall.
  • the structure may be free floating within the cecum.
  • the structure can be sized or otherwise configured to not migrate to more distal regions of the large intestine. Stated otherwise, the structure can be applied to or reside in the cecum.
  • the object or structure includes multiple components that are assembled within the cecum.
  • the structure may be formed of multiple filler components and/or one or more adhesives.
  • the structure may be assembled within the cecum, such as by adhering filler components to the cecum lining and/or to each other. As more and more filler and/or adhesive is applied, the cecum wall can be distended to a variable degree.
  • an adhesive can include a mucosal adhesive that can adhere, or partially adhere, to the inner lining of the bowel and/or may additionally adhere filler components to each other. In other or further instances, an adhesive may be used to adhere the filler components to each other.
  • the components are adhered only to each other without adhering to the cecum.
  • the structure may comprise a conglomerate of the filler components, and the conglomerate can be adhered directly to the lining of the bowel or, in other instances, the conglomerate can be freely mobile in the lumen of the cecum.
  • the conglomerate can be free floating within the cecum.
  • the conglomerate can be sized or otherwise configured to not migrate to more distal regions of the large intestine.
  • FIG. 1 depicts a large intestine or colon 100 in a natural state.
  • the colon 100 includes multiple sections.
  • the most proximal section of the colon 100 is the cecum 110, which receives material from the small intestine (specifically, the ileum).
  • Distal to the cecum 110 is the right or ascending colon 112, the hepatic flexure 113, the transverse colon 114, the splenic flexure 115, the left or descending colon 116, the sigmoid colon 118, and the rectum 120.
  • Stool material or chyme that passes through the colon 100 is substantially in liquid or semiliquid form within the cecum 110 and the ascending colon 112, and progressively solidifies along more distal tracts of the colon 100.
  • FIG. 2 depicts the bowel 200 of a patient 205.
  • the bowel 200 includes the small intestine 210 and the colon 100.
  • FIGS. 2 and 3 depict separate stages of a method for treating obesity of the patient 205.
  • the patient 205 may be suffering not only from obesity, but potentially from other diseases or illnesses caused by, tied to, or otherwise related to obesity (e.g., comorbidities of obesity). For example, amelioration or resolution of the underlying obesity condition could ameliorate or resolve one or more other conditions of the patient 205.
  • the method may be termed as a method for treating the obesity of the patient 205, the method may simultaneously also be a method for treating one or more of the other conditions of the patient 205, such as, for example, diabetes mellitus, nonalcoholic fatty liver disease, nonalcoholic steatohepatitis, etc.
  • a method of treating obesity of the patient 205 may likewise, further, alternatively, or independently be termed as a method of treating diabetes mellitus, a method of treating steatohepatitis, and/or a method of treating some other condition that is treatable by reducing the weight (e.g., the excess weight) of the patient.
  • a method of treating diabetes mellitus a method of treating diabetes mellitus
  • a method of treating steatohepatitis e.g., the excess weight
  • the illustrated method includes the placement of a medical device 300, which may also or alternatively be referred to herein as a structure or object 300, which is of foreign origin relative to the patient 205, within the bowel 200.
  • a medical device 300 which may also or alternatively be referred to herein as a structure or object 300, which is of foreign origin relative to the patient 205, within the bowel 200.
  • the term“of foreign origin relative to the patient” is used herein to describe items, whether naturally occurring or synthetic, that originate externally from the patient.
  • the objects or structures may themselves be naturally occurring items (for example, nutrients; bacteria; natural filler materials, such as natural fibers; etc.) or artificial items (for example, non-naturally occurring or synthetic materials, such as synthetic fibers; stent-like structures, balloons, or cages formed of synthetic materials; etc.), but the items originate external to the patient 205.
  • stool that might distend a portion of the bowel is not an object of foreign origin relative to the patient 205, due to the generation or creation thereof within the patient, whereas a medical device that is introduced into the bowel 200 for distention in any suitable manner is an object of foreign origin relative to the patient.
  • chyme or stool are not objects of foreign origin relative to the body— instead, these materials or compositions are developed within the body as food is digested by the body— whereas the food as originally ingested is an object of foreign origin relative to the body.
  • the object 300 can be introduced into a specified region of the patient 205 by non -natural mechanisms.
  • the mechanisms are separate from physiological processes that are naturally conducted by the body (e.g., material transport through the digestive tract), and may be achieved or controlled by a medical practitioner.
  • placement of the object 300 within the bowel 200 may be achieved via an endoscope, catheter, guidewire, and/or other device that has been advanced into the bowel by a medical practitioner.
  • Other placement methods or mechanisms are also possible.
  • an endoscope 250 is introduced through the rectum 120 of the patient 205 and advanced through the bowel 200 into the cecum 110.
  • the advancement may be termed“proximal” advancement, relative to the patient, as the endoscope 250 is being advanced to regions that are more proximal within the bowel.
  • the advancement may be termed“distal” advancement relative to the practitioner who is performing the procedure, as the distal tip of the endoscope 250 is being advanced away from the practitioner.
  • the terms“proximal” and“distal” are thus used herein in manners that should be clear from the context in which they arise.
  • patient is used herein broadly to mean any subject within whom or within which any of the medical devices described herein are positioned and/or on whom or on which any of the methods described herein are performed.
  • a patient may be an animal subject, such as a mammal (human, canine, etc.).
  • the endoscope 250 may, specifically, be a colonoscope, and may be advanced to the cecum 110 in manners typically employed in colonoscopy procedures.
  • the endoscope 250 may include an internal lumen or instrument channel (see FIG. 5A, lumen 262), which may also be referred to as a working channel, biopsy channel, or tool channel, via which the object 300 can be introduced into the cecum 110.
  • the structure 300 is shown within the cecum 110 after having been advanced through the instrument channel of the endoscope 250 and assembled, expanded, and/or otherwise oriented within the cecum 110 so as to distend the cecum 110.
  • the structure 300 distends the cecum 110 sufficiently to trigger a colo-gastric brake (e.g., a cecal-gastric brake) in the patient 205.
  • the structure 300 may permit passage of material through the cecum 110, such as in manners discussed below.
  • the structure 300 may define one or more passageways through which material passes. Specifically, the one or more passageways permit passage therethrough of material that would otherwise pass through the cecum, in the absence of the structure 300.
  • the structure 300 can distend the cecum 110 without obstructing the natural flow or passage of material through the cecum 110.
  • the structure 300 thus may trigger physiological responses to distention, without triggering one or more physiological responses that might otherwise accompany such distention due to an obstruction of the bowel lumen.
  • the structure 300 is then left in the cecum 110 while distending the cecum 110.
  • the distention may be partial.
  • the structure 300 may contact, abut, bear on or against, push, press, urge, force outwardly, or otherwise provide an expansion bias to, and thus expand, only a portion of a periphery of the cecum 110.
  • the distension may be complete.
  • the structure 300 may contact and provide an expansion bias to an entire periphery of the cecum 110 (e.g., may contact and expand an entire inner circumference of the cecum 110).
  • the distention may be continuous.
  • the structure 300 may distend the cecum 110 by a constant amount, which amount may be sufficient to retain the cecum 110 in the expanded orientation independent of conditions that would otherwise cause natural fluctuations in the size of the cecum 110 over time.
  • the structure 300 is or includes an expandable stent-like device which, when expanded, is placed in tension against an inner wall of the bowel 200.
  • the structure 300 is or includes an expandable cage, ball, balloon, or other similar mechanism, such as described below. Once expanded, the device can maintain a substantially constant size and configuration, and may maintain the cecum 110 in a substantially constant distended state.
  • the device may distend the cecum 110 by a sufficient amount such that if the cecum 110 encounters natural conditions that would cause the cecum 110 to expand, in the absence of the device, the cecum 110 nevertheless does not expand due to the already enlarged configuration imparted to it by the device.
  • the term“stent” may be used herein to describe medical devices that resemble stents in one or more aspects, such as one or more of like materials, similar overall appearance, analogous methods of deployment and/or retraction, etc. Stents, however, are generally used to restore an abnormally constricted, damaged, or otherwise narrowed passageway to a natural size thereof. Stent like devices disclosed herein, however, are configured to enlarge the cecum relative to a natural or relaxed state. Indeed, certain embodiments are specifically configured to transition the cecum from a natural, normal, or relaxed state to an enlarged or expanded state, and indeed, in various embodiments, to a pathophysiological size (as this term is defined below). Accordingly, the term “stent” may be used herein for convenience, but should be interpreted in a manner consistent with the present disclosure.
  • the structure 300 may intermittently distend the cecum 110, such as by permitting fluctuations in the size (e.g., a diameter) of the cecum 110.
  • the structure 300 may distend the cecum 110 to a minimum distended state (i.e., an enlarged state that becomes the new minimum size of the cecum 110), but may permit the cecum 110 to fluctuate naturally to larger distended states when particularly distending conditions arise in the cecum 110.
  • the structure 300 is secured to the wall of the cecum 110 so as to fluctuate in size in tandem with the cecum 110.
  • the structure 300 comprises a stent (e.g., a stent-like device, as previously discussed) that is configured to define a minimum expanded size (e.g., minimum diameter), but can expand beyond the minimum size to larger sizes.
  • the stent may, for example, be a self-expanding and/or or resilient (e.g., elastically resilient) stent that generally contacts and provides an expansion bias to the cecum 110 to achieve a state of equilibrium, at which the cecum 110 is distended.
  • the stent When the cecum 110 expands beyond this distended state due to natural conditions within the cecum 110, such as increased pressure therein, the stent may likewise increase in size due to its resilient outward bias and/or the reduced inward force on the stent from the cecum 110 due to the natural conditions that tend to enlarge the cecum 110.
  • the stent may be delimited to fluctuate to no greater than a maximum size (e.g., a maximum diameter beyond which the stent may extend no further). Accordingly, if the cecum 110 expands beyond this maximum size of the stent, and the stent is not secured to the cecum wall, the stent may temporarily no longer contact or press outwardly against the cecum 110.
  • the maximum size of the stent may be such that even under such natural conditions that tend to enlarge the cecum 110, the stent can maintain contact with and bear against the cecum 110.
  • contact is maintained between the stent and the cecum 110 due to one or more of a resilient outward bias of the device; tissue ingrowth into the device; clips (e.g., hemoclips), sutures and/or any other suitable attachment features that connect the stent to the device; etc.
  • the stent-like device continues to bear outwardly against the cecum 110 throughout such periods of natural distention, the device may be said to provide continuous distention of the cecum 110.
  • the structure 300 may not secured to the wall or lining of the cecum 110 in a manner that would cause the structure 300 to fluctuate in size in tandem with the cecum.
  • the structure 300 may define a substantially constant size as it distends the cecum 110 in the minimum distended state, and may not be capable of expanding beyond (or significantly beyond) this size. Accordingly, as the cecum 110 expands naturally to a more enlarged state, the structure 300 may become free floating within the cecum 110.
  • the structure 300 may, for example, rotate about a longitudinal axis and/or one or more lateral axes and/or may translate longitudinally within the cecum 110.
  • the structure 300 comprises a stent (e.g., stent-like structure), ball, cage, balloon, or other structure that is expandable to a fixed size.
  • a stent e.g., stent-like structure
  • the structure 300 may remain substantially fixed relative to the cecum 110 under normal conditions, such as due to frictional interference between an outer surface of the structure 300 and the lining of the cecum 110.
  • the cecum 110 may naturally distend to a size greater than that caused by the expanded structure 300.
  • the structure 300 may be free to float within the cecum 110 and make intermittent contact therewith.
  • the structure 300 thus may axially and/or laterally rotate, longitudinally and/or laterally translate, “bounce around,” and/or otherwise move within the cecum 110.
  • the structure 300 may be desirably sized and/or otherwise configured (e.g., provided with a tapered end or tapered ends, be sized significantly larger than more distal portions of the large intestine, etc.) that can prevent the structure 300 from migrating from the cecum 110 to more distal portions of the colon 100 under such circumstances. In some instances, at least some portion of the structure 300 substantially always remains in contact with the cecum 110, even during such periods of further enlargement of the cecum 110.
  • the structure 300 may continuously and/or intermittently trigger the colo-gastric brake.
  • the periods of excessive enlargement of the cecum 110 may be relatively infrequent, such that the structure 300 acts to expand the cecum 100 during the majority of the time that it has been implanted or deployed (e.g., greater than 50, 60, 70, 80, 90, or 95 percent of the time it has been implanted or deployed).
  • Distention of the cecum 110 in this manner can reduce an appetite of the patient 205 and/or otherwise reduce a food intake of the patient 205. Over time, the reduced food intake of the patient 205 can result in weight loss for the patient.
  • the structure 300 can remain within the bowel 200 of the patient 205 for a therapeutically effective period.
  • the structure 300 can remain within the bowel 200 for at least a therapeutically effective period. Or stated otherwise, the structure 300 may remain within the patient 205 beyond a therapeutically effective period. For example, in some instances the patient 205 may lose an amount of weight that is effective in treatment of obesity and/or some other related disease, yet the structure 300 may nevertheless remain within the patient. The structure 300 may, in such instances, contribute to further therapeutic weight loss. It may be said that the structure 300 remains in place for an extended therapeutically effective period and/or for an additional therapeutically effective period. In some instances, the structure 300 may substantially ameliorate or even cure a condition, such as obesity (i.e., the patient’s BMI may drop below 30.0), and the structure 300 may nevertheless remain in place thereafter. In some instances, the structure 300 may be implanted or otherwise positioned within the cecum of the patient 205 indefinitely, with no planned removal.
  • the structure 300 may be implanted or otherwise positioned within the cecum of the patient 205 indefinitely, with no planned removal.
  • the term“therapeutically effective period” denotes a period of time over which a therapeutically or clinically significant, or otherwise desired or targeted, amount of weight loss is achieved for the patient 205.
  • the period may be therapeutically effective in the treatment of obesity, generally defined as a body mass index (BMI) of 30.0 or higher, and/or one or more related diseases of the patient due to weight reduction of the patient 205 achieved during its duration.
  • BMI body mass index
  • the therapeutically effective period is an amount of time sufficient to achieve a total weight loss of the patient 205 of no less than 5, 10, 15, 20, 25, 30, 35, 40, 45, or 50 percent.
  • the therapeutically effective period is an amount of time sufficient to achieve an excess weight loss of no less than 10, 15, 20, 25, 30, 35, 40, 50, 60, 70, 80, or 90 percent.
  • excess weight loss refers to a reduction of excess weight, the excess weight being calculated as a difference between the patient’s actual body weight at the time the structure 300 is first introduced into the patient 205 and a target healthy weight of the patient.
  • the target healthy weight of the patient can be determined in any suitable manner.
  • the target healthy weight can be calculated to be the weight necessary to achieve a BMI of 24.9 (i.e., the maximum BMI to be within the normal weight range).
  • the therapeutically effective period is no less than 2, 3, or 4 weeks; no less than 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, or 11 months; or no less than 1, 2, or 3 years.
  • a structure 300 can be positioned within a patient indefinitely.
  • the structure 300 can achieve a desired amount of weight loss, and may, in some instances, act prophylactically to inhibit or prevent a patient from thereafter regaining some or all of the weight that was lost.
  • the structure 300 can be configured to distend the cecum 110 by an amount sufficient to trigger the colo-gastric brake.
  • the structure 300 is configured to trigger the colo-gastric brake by expanding the cecum to a pathophysiological size. Due to variations in cecum size from one patient anatomy to another, natural expansibility of the cecum under both natural and unnatural circumstances, and other properties of the cecum, a discussion of what is intended herein by the term“pathophysiological size” is in order.
  • the cecum 110 is a pouch -like structure that undergoes frequent fluctuations in size.
  • the cecum 110 may at times behave like a sock or other flexible tube through which different media may pass.
  • the various regions of the small intestine are generally resistant to expansion and tend to each maintain a generally constant tubular shape and diameter
  • the cecum is a far more malleable structure that can fluctuate in size depending on the contents therein and/or the pressure of those contents at any given time.
  • the cecum In adult patients, the cecum is typically approximately 6 centimeters in length— due to anatomical variation, however, the cecum is generally no shorter than about 1.5 centimeters and no longer than about 8 centimeters.
  • the cecum generally resides in a collapsed state, but is naturally expansible to a generally open, patent, or non-collapsed state. When in this generally open state, the cecum is typically 4 to 6.5 centimeters in diameter— due to anatomical variation, however, the cecum is generally no smaller than about 1.5 centimeters and no larger than about 9 centimeters when in this non-collapsed state. Accordingly, there can be a significant variation in cecum size from one patient anatomy to another.
  • the cecum is capable of expanding to larger diameters than those just recited without perforating.
  • the cecum can expand to these larger sizes under natural conditions (e.g., in the absence of a pathological even or condition).
  • the cecum may naturally expand to 5, 6, 7, 8, 9, or 10 centimeters at various times during digestion (e.g., due to passage therethrough of gases, chyme, stool, and/or other materials) without perforating, although typically such expansion rarely exceeds 6 centimeters.
  • these larger sizes may, in rare instances, be achieved naturally, it is not natural for the cecum to remain at such enlarged sizes for extended periods. Rather, the cecum returns to a smaller state after the passage of the material that caused the expansion, which passage may take place within a period that is on the order of seconds, minutes, or possibly hours.
  • the term“pathophysiological size,” as applied to the cecum, is meant to denote a relatively enlarged size that (1) is itself irregular, abnormal, or unnatural for the anatomy of a particular patient and/or is generally indicative of an underlying pathological event or condition; (2) can potentially be achieved naturally on an intermittent basis (e.g., on the order of seconds, minutes or hours), but not for a sustained period (e.g., for and/or for at least three days); and/or (3) poses a risk of perforation or other serious medical complication.
  • a pathophysiological size is a size that is indicative of and/or can result in one or more pathological events or conditions if that size is sustained for long periods— i.e., for a significant or abnormally long temporal increment such as, e.g., for up to, for, and/or for at least: 3,4, 5, or 6 days; 1, 2, 3, or 4 weeks; 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, or 11 months; and/or 1, 2, or 3 years), with each of the foregoing temporal increments being considered individually or in any suitable combination (for example, for 3 days; for at least 3 days; for at least 3 days and for up to or for at least 1, 2, or 3 years; etc.).
  • a pathophysiological size is a size that, if achieved within a patient due to biological processes, would be indicative of and/or could result in one or more pathological events or conditions, if that size were to be sustained for long periods.
  • Embodiments disclosed herein may expand the cecum to a pathophysiological size, and may maintain the cecum at such an expanded size for a sustained period (e.g., for up to, for, and/or for at least: 3,4, 5, or 6 days; 1, 2, 3, or 4 weeks; 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, or 11 months; and/or 1, 2, or 3 years), with each of the foregoing temporal increments being considered individually or in any suitable combination.
  • a sustained period e.g., for up to, for, and/or for at least: 3,4, 5, or 6 days; 1, 2, 3, or 4 weeks; 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, or 11 months; and/or 1, 2, or 3 years
  • various embodiments can expand the cecum to an expanded size for a therapeutically effective period or treatment period that exceeds, e.g., three, four, five, or six days; one, two, three, or four weeks; one, two, three, four, five, six, or nine months; or one, two, or three years.
  • some embodiments can be configured to remain within the patient indefinitely beyond such periods, with no planned removal.
  • the cecum when the cecum is expanded to a pathophysiological size, can define a maximum diameter of, for example, no less than about 5, 6, 7, 8, 9, 10, or 11 centimeters, or within a range of from about 5 centimeters to about 6, 7, 8, 9, 10, or 11 centimeters, about 6 centimeters to about 7, 8, 9, 10, or 11 centimeters, about 7 centimeters to about 8, 9, 10, or 11 centimeters, about 8 centimeters to about 9, 10, or 11 centimeters, about 9 centimeters to about 10 or 11 centimeters, or about 10 to about 11 centimeters.
  • an internal volume defined by the cecal wall can be no less than, for example, 0.25, 0.33, or 0.4 liters. Larger sizes are also contemplated, such as for larger anatomies, and smaller sizes are also contemplated, such as for smaller adults, adolescents, or children.
  • a maximum diameter of the cecum increases by no less than 20, 30, 40, 50, 60, 75, or 100 percent.
  • a general shape or configuration of the cecum may be altered as the cecum is transitioned to a pathophysiological size.
  • the cecum may be transitioned from a substantially tubular or substantially cylindrical configuration to an enlarged substantially bulbous configuration, which can include a central or intermediate position at which the cecum defines the maximum diameter.
  • this maximum diameter can be much larger than the maximum diameter when the cecum is in the substantially tubular or substantially cylindrical configuration.
  • Distention of the cecum 110 can be achieved relative to a healthy state of the cecum 110.
  • the structure 300 can be sized or otherwise configured to distend the cecum 110 relative to a normal size of the cecum 110.
  • the purpose of the structure 300 may not, in various instances, be to expand the cecum 110 so as to return it from an abnormally small condition (e.g., due to cancer or other disease) to normal dimensions, but rather, to distend the cecum 110 from a natural size to an enlarged size to trigger the colo-gastric brake and/or otherwise trigger phenomena associated with loss of appetite and/or weight loss.
  • certain structures 300 can be very different from stents or the like whose purpose is to expressly to open or enlarge a vessel or lumen of a patient from a pathologically constricted state to a substantially normal (but not expanded) state, such as merely to maintain patency of the tubular structure.
  • the structure 300 can be eliminated from the cecum 110 and/or, more generally, from the body of the patient 205 in a variety of manners.
  • the structure 300 can be configured to break down within the body of the patient 205 over time.
  • the structure 300 can include a bioresorbable material that degrades over time.
  • the structure 300 may degrade sufficiently such that it no longer distends the cecum 110, and may pass spontaneously or naturally through the remaining portion of the colon 100 and out of the patient 205. It may be desirable for degradation, to the point of discontinued distention and/or natural expulsion of the structure 300 from the patient 205, to occur at some point in time after completion of the therapeutically effective period discussed above.
  • the structure 300 may be actively retrieved from the patient 205.
  • a colonoscopy procedure may be performed to retrieve the structure 300 from the patient 205.
  • standard retrieval techniques may be used, such as by the use of a snare or other device deployed from the colonoscope.
  • Implanting one or more structures 300 in the cecum 110 can be particularly advantageous.
  • material that naturally passes through the intestinal tract e.g., stool or chyme
  • passageways defined by the one or more structures 300 can readily pass the material therethrough.
  • distention of the bowel in this region generally will not give rise to an urge in the patient 205 to defecate, as might occur in more distal portions of the colon (e.g., the rectum, which would rapidly yield an urge to defecate with pressurization and limited distention).
  • positioning device or devices within the cecum 110 can reduce any likelihood of an unintended bowel obstruction, such as in situations where the devices degrade over time and are permitted to pass naturally through the bowel.
  • the cecum 110 is distal to the ileocecal valve, at which such degraded devices, or pieces of such degraded devices, could get caught and give rise to an obstruction. Stated otherwise, certain devices positioned in the small intestine can risk getting caught up in the ileocecal valve, thus giving rise to a small bowel obstruction.
  • FIG. 3 A wide variety of configurations are contemplated for the structure 300, which is schematically depicted in FIG. 3 and discussed in more detail with respect thereto. Illustrative examples of such structures are depicted in FIGS. 4 through 39 and are further discussed in the written descriptions associated with these drawings. Accordingly, the foregoing general discussion with respect to structures 300 are equally and specifically applicable, as appropriate, to the various embodiments depicted in, and discussed with respect to, the drawings.
  • FIG. 4 depicts a stage in another method of treating obesity of the patient 205, in which a medical device, object, or structure 400, has been implanted in the cecum 110 of the patient 205.
  • the structure 400 is formed of a plurality of individual components or particles 410 that have been introduced into the cecum 110.
  • the particles 410 can be assembled within the cecum 110 to form a conglomerate structure, which can partially fill the cecum 110.
  • the particles 410 can be adhered— e.g., via one or more adhesives 420— to the lining of the cecum 110 and/or each other, and in various embodiments, the resultant conglomerate structure 400 can be adhered to the lining, can otherwise be secured to the lining (e.g., may be tensioned against the lining upon formation of a structure with sufficient rigidity to press against the bowel wall), or can be unattached relative to the lining and free floating within the cecum 110.
  • a first amount of adhesive 420 can be applied to the lining, and then further adhesive 420 can be added thereto.
  • the additional adhesive thus can adhere to adhesive material already initially applied in the lumen of the bowel, creating, in essence, a large ball or mass of glue or slime which sticks to itself, but not to the wall of the bowel.
  • the initial adhesive application can cure quickly, preventing attachment to the wall, and then additional adhesive can be applied to the initial adhesive amount. Curing can be of variable time periods.
  • the structure 400 may be formed entirely of one or more adhesives.
  • the adhesive is further combined in various amounts with various amounts of one or more of fiber (e.g., soluble or insoluble fibers of any type), cellulose, hemicellulose, lignans, mucilages, beta-glucans, pectin, guar, polydextrose, starches, dextrins, inulins, psyllium, bran, and/or any other type of natural or artificial fiber or other filler, to create a ball or mass shape of any suitable size, thereby distending the lumen of the bowel to any suitable size or diameter.
  • fiber e.g., soluble or insoluble fibers of any type
  • cellulose e.g., soluble or insoluble fibers of any type
  • hemicellulose hemicellulose
  • lignans mucilages
  • beta-glucans e.g., pectin, guar
  • polydextrose e.g., starches, dextrins, inulins, psyllium
  • the structure 400 includes 100% adhesive, a majority of adhesive, a minority of adhesive, 100% fdler material, a majority of fdler material, a minority of fdler material, or relatively equal amounts of adhesive and fdler material.
  • the final conglomerate structure 400 which may assume a ball shape or other suitable shape, can be adherent to the wall or non adherent to the wall of the bowel.
  • the conglomerate structure 400 can also be degradable over variable periods of time.
  • the adhesive can degrade over a variable period of time, slowly dissolving or degrading, and either be absorbable or pass out of the bowel, naturally like stool. As the adhesive degrades, variable amounts of fdler material are released and pass out of the bowel, similar to stool, thus gradually decreasing the size of the conglomerate structure and gradually reducing the distention effect.
  • the effects of bowel distention achieved by the conglomerate structure 400 can be reversible over a variable period of time, depending on the degradation characteristics of the adhesive and/or fdler material. This can be the case whether the conglomerate structure 400 is adherent or nonadherent to the wall.
  • the conglomerate structure 400 can be positioned in place via adhesion to a variety of different portions of the bowel and, further, at a variety of different locations on the wall of the bowel.
  • the conglomerate structure 400 can be attached and/or formed in a variety of different configurations.
  • the structure 400 can be formed as a series of layers, may be substantially spherical (e.g., ball-shaped), can define an annulus (e.g., circumferentially applied to the wall to ultimately distend the wall about a full periphery thereof), can define a portion of an annulus (e.g., hemi- circumferentially applied), and/or may define other fully or partially obstructing configurations.
  • a non-adherent and freely movable structure 400 may stay in place due to virtue of its size.
  • the structure 400 may define a ball shape of a diameter that is larger than the diameter of the bowel lumen, and may define one or more passages through which material can pass through the bowel.
  • the large diameter of the structure 400 prevents the structure 400 from migrating distally through the bowel. Accordingly, the structure 400 may not be permitted to pass through the distal regions of the bowel and out of the patient 205 until the structure 400 has degraded by a sufficient amount.
  • the substantially ball-shaped structure 400 may be formed with one or more passageways therethrough to permit passage of material therethrough prior to such degradation and spontaneous passage (e.g., defecation) of the structure 400, or portions thereof.
  • Specific adhesives that can be applied to the wall of the bowel include various materials known in the field of tissue adhesives, such as polyethylene glycols, polyethylene glycol copolymers, triglycerides, diglycerides, esters, fatty alcohol esters, polyacids, polyamines, gelatins, chitosans, polyactive esters, isocyonates, anhydrides, cyanoacrylates, methylmethacrolyates, cross-linking adhesives, other tissue adhesives.
  • the adhesives can include materials such as those that bind dentures to teeth, mollusk glues, etc.
  • the adhesives may be used in any suitable combination, cured in any of a variety of manners (e.g., as are known in the art), used with or without added enzymes or preservatives, used with or without added salts, and/or be partially or completely degradable, etc.
  • the adhesives may be used in any suitable amount and may yield any desired orientation and/or configuration.
  • the conglomerate structure 400 can contain one or more varieties of antibiotics and/or anti-microbial material (such as copper or silver) that can have delayed release, which can favorably impact the surrounding microbiome.
  • the conglomerate structure 400 includes one or more of any of a variety of drugs that can affect the microbiome and/or that can directly treat obesity and/or diabetes.
  • the conglomerate structure 400 is attached to native bowel wall mucosa.
  • the mucosa of the bowel wall is purposely damaged or ablated with radio-frequency energy, heat, cryotherapy, or other forms of electromagnetic radiation in order to damage, remove and/or fibrose the mucosa.
  • the structure 400 can better attach to the bowel wall where such ablation has been performed, either by adhering to new fibrotic tissue, or by adhering to deeper layers of the bowel wall, such as the submucosa or deeper muscle layers, or both.
  • such an ablation technique can also be used to sterilize the bowel wall underneath the adhesive.
  • a colonoscope (e.g., such as the endoscope 250 depicted in FIGS. 2 and 3) is advanced into the cecum 110. Thereafter, adhesive 420 and/or filler material 410 is injected through an injectable catheter placed through the biopsy port (i.e., the tool channel) in the endoscope, or may be injected directly through the endoscope. In other instances, rather than injecting the adhesive 420 and/or the filler material 410, some other form of application is employed (brushing, spraying, etc.).
  • the adhesive and/or the filler material is instead advanced into the cecum 110 alongside the endoscope, such as via a channel through a removable or disposable covering over the endoscope.
  • one or more adhesives are first applied to the wall of the cecum 110.
  • one or more particles 410 are applied to the adhesive 410.
  • the one or more particles 410 and the adhesive 420 may be combined (e.g., prior to advancement through the endoscope or within the endoscope) and then applied to the wall of the cecum 110, or otherwise introduced into the cecum 110, via the endoscope.
  • the processes may be repeated until a conglomerate structure 400 of a desired configuration is achieved.
  • the conglomerate structure 400 can distend at least a portion of the cecum 410 in an amount sufficient to trigger a colo-gastric brake.
  • the conglomerate structure 400 can adhere to the mucosa (inner lining) or deeper layers of the cecum 410, such as the submucosal or muscle layers, or fill between the spaces of the bowel wall layers, and fill the bowel wall and/or lumen thus distending said portion to a diameter of a desired size.
  • the new material could adhere to the previous material and pile up in a mass or ball of material of various size and shape, but all to the effect of distending the lumen or wall of said bowel.
  • the conglomerate structure 400 can specifically be positioned within the cecum. In some embodiments, the conglomerate structure 400 is sufficiently large to expand the cecum to a pathophysiological size. The conglomerate structure 400 can be spaced away from the ileocecal valve so as to avoid blocking passage of material therethrough and into the cecum.
  • an implantable object for distending the cecum can be an expandable structure that is delivered directly to an interior of the cecum.
  • the structure can be delivered in an undeployed (e.g., reduced profile, unexpanded, partially expanded) state and can be deployed within the cecum to an expanded state.
  • an expandable medical device can comprise a stent-like device, a cage, a ball, a balloon, or other similar mechanism.
  • the structure can define one or more passageways (e.g., openings, perforations, channels, pathways, or the like) that allow materials (e.g., gasses, semiliquids, liquids, semisolids, and/or solids) to pass through the structure.
  • the structure can be freely movable (e.g., free floating) in the lumen of the bowel, but may be sized and/or otherwise include features that prevent migration (e.g., distal migration) out of the cecum and through the bowel.
  • the structure is at least temporarily or intermittently secured to the cecum wall or inner lining of the cecum.
  • the structure can be continuously and/or fixedly secured to the cecum wall or inner lining of the cecum.
  • the structure can fill, or partially fill, the cecum pouch, and may distend the cecum by a designated, predetermined, or desired amount.
  • the expandable medical device can be configured to expand the cecum to a pathophysiological size. In some instances, the device ensures that the cecum is never collapsed or contracted to a size smaller than the pathophysiological size during treatment via the device.
  • the device can permit the cecum to naturally expand to a larger size that exceeds the pathophysiological size, and in various examples of such instances, the device can be free floating within the cecum, can remain in contact with only a portion of the cecum, or can expand so as to contact and/or remain in contact with, e.g., a full periphery of the cecum during the natural enlargement of the cecum.
  • the device can be free floating within the cecum, can remain in contact with only a portion of the cecum, or can expand so as to contact and/or remain in contact with, e.g., a full periphery of the cecum during the natural enlargement of the cecum.
  • FIGS. 5A-5D depict various stages of an illustrative method of implanting or deploying a medical device 500 (FIGS. 5C and 5D) in the colon 100 of the patient 205.
  • the medical device 500 may also or alternatively be referred to herein as a distention device, distention object, expandable structure, implant, etc.
  • the device 500 is an expandable stent-like device, and in particular, is a balloon-expandable stent-like device. Accordingly, the device 500 may alternatively be referred to herein as a stent (subject to the prior discussion of this terminology), as a stent-like device, or as an expansion device 500.
  • an endoscope 250 is inserted into the colon 100 in the same manner as depicted in FIG. 2.
  • the endoscope 250 is introduced through the rectum 120 of the patient 205 and is advanced proximally through the lumen of the colon 100.
  • a longitudinal axis of the endoscope 250 can be aligned with, parallel to, or may otherwise track or follow a longitudinal axis of the lumen of the colon.
  • FIG. 5A depicts a tip 260 of the endoscope 250 at a proximal end of the ascending colon 112 and nearing the cecum 110.
  • the terms“proximal” and“distal” refer to the direction of passage of material through the gastrointestinal tract of the patient 205.
  • the patient’s mouth is at the proximal end of the gastrointestinal tract and the rectum is at the distal end of the gastrointestinal tract.
  • the endoscope 250 includes a lumen 262, which may be referred to as a tool channel, an instrument channel, or simply as a channel.
  • FIG. 5B depicts a later stage of the method at which the endoscope 250 has been advanced slightly further toward the cecum 110 and held in place.
  • a catheter 510 to which the expansion device 500 is coupled is then inserted proximally through the lumen 262 of the endoscope 250 so as to position the expansion device 500 within the cecum 110.
  • the expansion device 500 is covered with a protective sleeve 520, which may also be referred to as a retention sleeve.
  • the sleeve 520 is removed from the expansion device 500 and retracted through the endoscope 250 prior to deployment of the expansion device 500.
  • the sleeve 520 may retracted via a wire to which it is attached or via any other suitable mechanism.
  • the expansion device 500 is self-expandable, such that removal of the sleeve 520 permits the expansion device 500 to expand outwardly into contact with the walls of the cecum 110 and distend the cecum 110 to an expanded diameter.
  • the expansion device 500 is not self-expanding.
  • a sleeve 520 is not used.
  • the endoscope 250, the catheter 510, and the expansion device 500 may be referred to as a system 540 for treating obesity (or associated illnesses).
  • the system 540, or some or all of the components thereof, may also or alternatively be referred to as a medical device deployment system for distending the cecum.
  • FIG. 5C depicts a later stage of the illustrative method after which the sleeve 520 has been removed.
  • a balloon 530 that is coupled to the catheter 510, and over which expansion device 500 has been positioned, is being inflated via the catheter 510.
  • a proximal end of the catheter i.e., the end that remains external to the patient 205
  • an inflation syringe not shown
  • fluid may be delivered from the inflation syringe, through a lumen of the catheter 510, and into the balloon 530 to expand the balloon 530 and thereby expand the expansion device 500.
  • fluid is used in its ordinary sense and includes materials that have no fixed shape, yield easily to external pressure, or are flowable, such as gases (e.g., air, nitrogen, etc.) and liquids (e.g., saline, deionized water, etc.).
  • gases e.g., air, nitrogen, etc.
  • liquids e.g., saline, deionized water, etc.
  • FIG. 5D depicts yet a later stage of the illustrative method after which the expansion device 500 has been fully deployed into its final expanded configuration via the balloon 530, the balloon 530 has then been deflated (e.g., via retraction of the inflation fluid), and the catheter 510 has been at least partially withdrawn through the lumen 262 of the endoscope 250. After complete or partial withdrawal of the catheter 510, the endoscope 250 (and, in some instances, the catheter 510 if still positioned within the lumen 262) is withdrawn from the patient 205.
  • the cecum 110 can be substantially tubular prior to expansion.
  • the cecum 110 can generally define a cylindrical shape, and the length of the cylinder may be roughly the same as or on about the same order as the diameter thereof.
  • the expansion device 500 when fully deployed, can reorient the cecum 110 into a more bulbous configuration.
  • the expansion device 500 can be bulbous, ovoid, spherical, orb-like, pill-shaped, ball like, etc.
  • the illustrated expansion device 500 is somewhat bulbous, and includes a tapered end corresponding to the distal end of the cecum 110. In other embodiments, the expansion device 500 may expand to a more bulbous state.
  • a maximum diameter defined by the expansion device 500 can exceed a longitudinal length of the device 500 (see, e.g., FIGS. 23G, 23H, 30A).
  • the expansion device 500 can enlarge the cecum 110 to a pathophysiological size.
  • the cecum 110 may be expanded by an amount greater than what is shown in FIG. 5D (e.g., the amount of distension of the cecum 110 may be significantly greater than what is depicted in FIG. 5D).
  • amounts by which the cecum 110 can be expanded are applicable to the present and other embodiments disclosed herein.
  • FIG. 5E depicts a later stage of the illustrative method after the endoscope 250 has been withdrawn from the patient 205.
  • the expansion device 500 remains in its expanded configuration and continues to distend the wall of the cecum 110.
  • the expansion device 500 can continuously or intermittently distend the cecum 110 by an amount sufficient to trigger a colo- gastric brake of the patient 205, which can suppress an appetite of the patient.
  • the expansion device 500 can remain implanted in the patient 205 for a therapeutically effective period over which a weight of the patient is reduced by a desired amount.
  • the expansion device 500 may include any of the dimensions or other features discussed above with respect to the device 300.
  • an outer or maximum diameter of the expansion device 500 is within a range of from about 6 centimeters to about 10 centimeters, or that is no less than about 6, about 7, about 8, about 9, or about 10 centimeters.
  • the expansion device 500 is an example of the device 300 described above, and thus may exhibit some or all of the properties described above with respect thereto.
  • the illustrated embodiment of the expansion device 500 once expanded to the deployed state, defines a substantially constant configuration, or stated otherwise, is not susceptible to fluctuations due to varying physiological conditions experienced within the cecum 110, as might be experienced by more resiliently flexible devices.
  • expansion device 500 thus may achieve continuous distention of the cecum 110 or intermittent distention of the cecum 110, depending on a magnitude of the distention encountered by the cecum 110 (e.g., percentage increase in size) and/or the severity of the physiological conditions encountered within the cecum 110 over the course of implantation.
  • the expansion device 500 is tensioned against the wall of the cecum 110 to achieve distention thereof.
  • the expansion device 500 thus may be secured to the wall of the cecum 110, although, in other or further embodiments, the expansion device 500 may nevertheless, at times, be free floating within the cecum 110.
  • the term“free floating” does not necessarily or solely connote a complete lack of contact with the wall of the cecum 110, although such may be the case on at least some occasions (such as if the cecum 110 expands beyond the distended configuration imparted thereto by the expansion device 500).
  • this term also includes situations where the expansion device 500 contacts only a portion of a periphery of the wall and/or only a portion of a periphery of the expansion device 500 contacts the wall, such as may occur as the expansion device 500 moves around in the cecum 110.
  • the expansion device 500 may be attached to the wall more securely or more permanently, so as to be less susceptible to movement (e.g., rotation) within the cecum 110.
  • one or more anchoring protrusions e.g., hooks or spikes - not shown
  • the body 550 may promote tissue ingrowth that can fix the expansion device 500 in place.
  • tissue ingrowth may occur between and/or over or about individual struts 555 (FIG. 5E).
  • the expansion device 500 may be attached to the wall of the cecum 110 during deployment in any suitable manner.
  • the expansion device 500 is secured about at least a portion of its periphery to the cecal wall via any of the adhesives previously described herein, one or more sutures, one or more clips, one or more mechanical fasteners of any other suitable variety, and/or any other suitable fixation technique, device, or system.
  • the expansion device 500 can include features that inhibit or prevent migration (or premature migration, in the case of stents 500 that are configured to eventually pass through the bowel and out of the patient 205) to more distal regions of the colon 100.
  • the expansion device 500 generally defines a bulbous shape that is similar to, and in some embodiments is enlarged relative to, a bulbous shape that the cecum 110 may naturally achieve.
  • a distal end 551 includes a taper 552 by which a diameter of the expansion device 500 is reduced in the distal direction.
  • This taper 552 can assist in maintaining the expansion device 500 pointed in the distal direction.
  • the narrowing of the expansion device 500 in the distal direction can assist in pointing the expansion device 500 in the same direction that the colon 100 narrows, which is likewise in the distal direction.
  • at least one of the maximum and minimum diameters of the expansion device 500 may be sufficiently large to prevent the expansion device 500 from migrating distally, given that the cecum 110 defines a larger diameter than does at least an immediately adjacent portion of the ascending colon 112.
  • the taper 552 of the distal end which may serve to center or embed the distal end 551 of the expansion device 500 at a distal end of the cecum 110, and/or a length of the expansion device 500, which may exceed a diameter of the expansion device 500 in some embodiments, can prevent or inhibit rotation of the expansion device 500 about axes perpendicular to a longitudinal axis of the expansion device 500 (which can be substantially aligned with a longitudinal axis of the cecum 110).
  • the terms“distal” and“proximal,” as used relative to the expansion device 500 are from the perspective of the digestive tract, rather than from the perspective of the practitioner who may be placing the expansion device 500.
  • the expansion device 500 may include a similar taper at a proximal end 553 thereof. Such a taper may allow the expansion device 500 to more closely conform to the natural, somewhat bulbous shape of the cecum 110.
  • the body 550 of the illustrated expansion device 500 includes a maximum diameter region 560 that extends along a small portion of its length, and is capped by a more conical, parabolic, or rounded shape defined by the taper 552, as previously discussed.
  • the body 550 can be formed in any suitable manner.
  • the body 550 comprises a plurality of wires, struts, connectors, or support members 555, which in the illustrated embodiment cross each other at consistent angles and extend along regularly spaced paths or intervals.
  • the widths of the support members 555 are relatively small, such that the support members 555 define a plurality of large openings 556.
  • the body 550 is substantially hollow, in that it defines a large primary channel or passageway 570.
  • Each of the openings 556 defined by the support members 555 is in fluid communication with the passageway 570, and thus each opening 556 defines an entrance to or exit from the passageway 570.
  • the body 550 defines a proximal opening 571 at an entry to and a distal opening 572 at an exit of the passageway 570.
  • the passageway 570 may be sufficiently large to permit passage of material therethrough without substantially impeding the flow of the material. Stated otherwise, the body 550 of the expansion device 500 can effectively distend the wall of the cecum 110 while the passageway 570 defined by the body 550 can permit substantially unimpeded or unobstructed flow of the material through the body 550. Due to the thinness of the struts 555 and the expanded lumen size provided by the expansion device 500, in some embodiments, the presence of the expansion device 500 actually expand the flow capacity of the cecum 110. In various other embodiments, the expansion device 500 reduces the flow capacity of the cecum 110 by no greater than 5, 10, 15, 20, 25, 30, 40, or 50 percent. In other or further embodiments, the expansion device 500 obstructs no greater than 5 percent of material from passing through the cecum 110.
  • a sidewall region defines a notch 574, which extends the proximal opening 571 longitudinally.
  • the notch 574 can be aligned with the ileocecal valve ICV (FIGS. 5A and 5B) upon implantation of the expansion device 500. Flow material from the ilium thus may pass through or by the notch 574 and into the expansion device 500. The expansion device 500 thus may provide even less impedance to material flow into the cecum 110.
  • the notch 574 may be absent, and in further embodiments, this absence may have little overall effect on flow of material into the passageway 570 due to the size and number of the openings 556.
  • the expansion device 500 would need to have been rotated about a longitudinal axis thereof by approximately 150 degrees in a clockwise direction (as viewed from the proximal or bottom end thereof, as in FIG. 5E).
  • the notch 574 may become misaligned from the ileocecal valve at later times.
  • the expansion device 500 may become free floating within the cecum 110 and may be subject to rotation about a longitudinal axis thereof.
  • the expansion device 500 may be fixedly secured to a portion of the cecal wall to maintain a rotational alignment of the notch 574 with the ileocecal valve. Any suitable attachment technique is contemplated, such as those previously disclosed. For example, a longitudinal length of the expansion device 500 may be fixedly secured to the cecal wall at a position opposite the notch 574.
  • the expansion device 500 may comprise braided filament, such as wire or other material, or may be laser cut from a material. Any suitable material is contemplated, including, for example, metals (e.g., stainless steel), metal alloys (e.g., cobalt-chrome, platinum- chrome), shape-memory alloys (e.g., Nitinol), polymers, bioresorbable material (e.g., magnesium, poly-L-lactide acid, tyrosine polycarbonate, salicylic acid polymers), etc.
  • the expansion devices 500 can be made of any suitable shape and oriented as needed or desired to interface with the anatomy of the patient 205. Illustrative examples of other shapes are depicted, for example, in FIG. 22A through FIG. 30F.
  • the expansion device 500 can be self-expanding.
  • the expansion device 500 may be formed of a heat-setting or elastomeric material.
  • the expansion device 500 can be drug- and/or nutrient-eluting. Stated otherwise, the expansion device 500 can comprise an eluting material that includes one or more drugs, nutrients, hormones, peptides, neurotransmitters, bacteria, and/or other substances that can be released over time.
  • the substances may be appetite suppressants of any suitable variety and/or may otherwise be useful or therapeutic in the treatment of obesity and/or related illnesses.
  • the expansion device 500 may be formed with a metallic scaffold and an elutable substance (drug, nutrient, or otherwise) can be dispersed in a polymer matrix, which may conformally surround the scaffold.
  • the polymers may be primarily biostable to bind the substance to the stent and modulate the elution of the substance into the bowel.
  • substances that the expansion device 500 can elute over time can include peptides, such as cholecystokinin (CCK) for stents 500 configured for implantation in the upper or small intestine, or glucagon-like peptide-l (GLP1) and/or oxyntomodulin for stents 500 configured for implantation in the lower intestine or colon.
  • CCK cholecystokinin
  • GLP1 glucagon-like peptide-l
  • oxyntomodulin for stents 500 configured for implantation in the lower intestine or colon.
  • the expansion device 500 may be formed of a biodegradable or bioresorbable material of any suitable variety.
  • the structural integrity of the material weakens. Accordingly, whereas the expansion device 500 may initially have sufficient structural rigidity to contact and provide an expansion bias to the wall of the cecum to distend the cecum, the expansion device 500 may eventually weaken or break apart to where it is no longer able to distend the cecum. Ultimately, the expansion device 500 may reduce in size to be spontaneously passed through the bowel and out of the patient 205.
  • the expansion device 500 may weaken and/or may break down into multiple separate pieces that may each be sufficiently small to naturally or spontaneously pass through the bowel.
  • the expansion device 500 could last a predetermined amount of time in the applied position (e.g., days, weeks, months, or years).
  • the expansion device 500 is configured to ensure that bioresorption proceeds to the point of terminating distention only after a therapeutically effective period has passed from the time of implantation.
  • the expansion device 500 is configured to be retrievable, such as via an additional colonoscopy procedure.
  • the expansion device 500 can have features that permit a medical practitioner to grab it, collapse it, and retrieve it, such as, for example, via any suitable snaring device and/or a reduced diameter cover into which the snaring device may draw the expansion device 500.
  • FIG. 6 depicts another system 640 that can resemble the system 540 described above in certain respects. Accordingly, like features are designated with like reference numerals, with the leading digits incremented to“6.” Relevant disclosure set forth above regarding similarly identified features thus may not be repeated hereafter.
  • the system 640 can include the endoscope 250 discussed above (which can comprise any suitable endoscope, such as any suitable variety of colonoscope), and can further include a covering 680 or attachment for the endoscope, and a balloon catheter 610 to which an expansion device 600 is coupled.
  • the system 640 can be used to implant the expansion device 600 in a patient 205 in manners such as those discussed above.
  • the catheter 610 is instead inserted through a lumen 682 defined by the attachment or covering 680.
  • the covering 680 may be selectively attachable to and/or detachable from the endoscope 250, and may be disposable.
  • the lumen 682 may be substantially parallel to the instrument channel of the endoscope 250, and likewise may be substantially parallel to a longitudinal axis A L .
  • a longitudinal axis of the instrument channel of the endoscope 250 may be colinear or aligned with the longitudinal axis A L , or may run parallel thereto. Accordingly, in the illustrated embodiment, the expansion device 600 may be introduced into the patient 205 alongside (e.g., exterior to an outer surface of) the endoscope 250.
  • FIGS. 7A and 7B depict stages of an illustrative method for using a system 740 to introduce a medical device or expansion device 700 into the patient 205.
  • the system 740 can include the endoscope 250, the expansion device 700, and a deployment mechanism (not shown) for advancing the expansion device 700 from the channel 262 of the endoscope 250.
  • the method can be substantially the same as that discussed above with respect to FIGS. 5A-5E.
  • the expansion device 700 is self-expanding and may itself be advanced through instrument channel 262 and can be deployed directly from the instrument channel 262.
  • the expansion device 700 may be positioned at the tip of the endoscope 250 prior to insertion of the endoscope 250 into the patient 205.
  • the expansion device 700 can be pushed out of the channel 262 in any suitable manner (e.g., may be pushed by a push rod, wire, or other suitable deployment mechanism) and can expand automatically once no longer restrained within the channel 262.
  • a restriction sleeve may be positioned over or around the expansion device 700 to maintain the expansion device 700 in a collapsed, low-profile, or constricted state, and can be removed from the expansion device 700 prior to or during deployment to permit self-expansion of the expansion device 700.
  • the expansion device 700 may be pushed through a larger portion of the channel 262 (e.g., an entirety thereof) after the tip of the endoscope 250 has been positioned as desired.
  • FIGS. 8 A and 8B depict an illustrative system 840 for implanting an embodiment of a self expanding stent-like expansion device 800.
  • the system 840 includes a catheter 810 to which the expansion device 800 is coupled.
  • the expansion device 800 is instead resiliently biased outward so as to naturally assume an expanded position upon removal of a retention sleeve 820 that is positioned about the expansion device 800.
  • the method for introducing the expansion device 800 into the cecum 110 of the patient 205 can be substantially the same as that discussed above with respect to FIGS. 5A-5E.
  • the catheter 810 is advanced along the guidewire 884.
  • the guidewire 884 may be advanced through the bowel of the patient 205 to the cecum 110 (e.g., via fluoroscopic or other imaging assistance). Once in place, the guidewire 884 may be positioned within an internal or external lumen defined by the catheter 810, and the lumen may be advanced over the guidewire 884 until the catheter is in the desired position.
  • the restrictive sleeve 820 may then be removed, such as by retraction of a wire attached thereto, and the self-expanding expansion device 800 can naturally expand outwardly into contact with the cecum 110 to distend the cecum, as it assumes the deployed or expanded configuration depicted in FIG. 8B.
  • the expansion device 800 can be placed without using an endoscope.
  • the guidewire 884 may be positioned in the patient in the manner just discussed, and then an endoscope can be advanced over the guidewire into position.
  • the guidewire may pass through the instrument channel of the endoscope.
  • the guidewire may then be removed, and the catheter 810 may then be advanced through the instrument channel of the endoscope.
  • the endoscope is advanced into the patient, and the guidewire may be advanced through the endoscope and beyond the distal end thereof to facilitate advancement of the endoscope through the gastrointestinal tract.
  • the guidewire may remain within the endoscope and the expansion device passed thereover through the endoscope, or the guidewire may be removed before advancing the device through the endoscope.
  • visualization for placement of the expansion device 800 may be provided by the endoscope, fluoroscopy, and/or any other suitable imaging technique. Any other suitable techniques for using a guidewire and/or for positioning the expansion device in the patient are also contemplated.
  • FIG. 9 depicts another embodiment of an expansion device 900 implanted in the colon 100 of the patient 205.
  • a bulbous portion at a proximal end of the expansion device 900 is positioned in the cecum 110, and an elongated distal extension 962 of the expansion device 900 extends into the proximal portion of the ascending colon 112.
  • a proximal portion of the expansion device 900 is substantially identical to the expansion device 500.
  • the primary difference between the two expansion devices is the distally directed extension 962, which resides within the ascending colon 112.
  • the expansion device 900 includes a taper 952 that can prevent migration in manners previously discussed.
  • the expansion device 900 can be less prone to rotation about non -longitudinal axis than the expansion device 500.
  • the expansion device 900 can be configured to distend one region of the bowel (i.e., the cecum 110) proportionally more than another portion.
  • the distal extension 962 of the expansion device 900 primarily serves as anchoring leg for the expansion device 900, and may provide the ascending colon 112 with little or no distention, whereas the proximal end of the expansion device 900 may significantly distend the cecum 110, e.g., by a pathophysiological amount or to a pathophysiological size, to trigger a colo-gastric brake.
  • both ends of the expansion device 900 can distend the respective regions of the bowel 200, and may each contribute to the colo-gastric brake.
  • one end of the expansion device 900 expands the bowel by a percentage that is greater than a percentage by which the other end expands the bowel, or in other embodiments, both ends can yield similar distention percentages.
  • FIGS. 10A and 10B depict another embodiment of a medical device 1000, which may also be referred to herein as an expansion device, a stent ball, or a cage.
  • the device 1000 is depicted in an undeployed, contracted, constricted, or unexpanded state in FIG. 10A, and is depicted in a deployed configuration in FIG. 10B.
  • the device 1000 can be expanded and can distend the cecum 110 in manners similar to the stent-like expansion devices previously discussed.
  • the device 1000 may be deployed directly from an endoscope lumen or from a catheter lumen.
  • the device 1000 may be compacted to a smaller profile than what is illustrated in FIG.
  • the struts may bend relative to one another more than is depicted, such that the unexpanded device 1000 is more elongated with a narrower profile than is shown in FIG. 10A.
  • the device 1000 may be formed of any suitable material, whether self-expanding or expandable with, e.g., balloon assistance.
  • self-expanding versions may comprise Nitinol or other shape-memory material to expand from the generally tubular constricted configuration to the generally spherical expanded configuration once within the cecum.
  • the device 1000 can include a body 1050, which may be defined by a series of interconnected stmts 1055, which have a substantially rectangular cross-sectional profile.
  • the stmts 1055 can define a plurality of openings 1071 of a passageway 1071 thorough the device 1000.
  • the illustrated embodiment includes 12 total wedge-shaped openings 1071.
  • the openings 1071 and passageway 1071 are relatively large, and thus are capable of permitting a large flow rate of material to pass through when the device 1000 is implanted.
  • FIG. 11 depicts another embodiment of a device 1100, which can resemble the device 1000 in many respects, and can be a mechanical self-expandable or otherwise expandable cage.
  • the device 1100 may include a plurality of interconnected stmts 1155 that may be formed and connected in any suitable manner.
  • the stmts 1155 are formed as wires or rods with substantially circular cross-sectional profiles.
  • the stmts 1155 define a plurality of openings 1171 of a passageway 1070.
  • the illustrated embodiment includes 44 total wedge-shaped openings 1071. Other numbers and configurations of the openings 1071 are contemplated.
  • the openings 1171 and passageway 1171 are relatively large, and thus are capable of permitting a large flow rate of material to pass through when the device 1100 is implanted.
  • the device 1100 can be made of material that is biodegradable or bioresorbable over time, and thus may eventually naturally pass from the patient 205.
  • the device 1100 may be retrievable from its implantation site.
  • the device 1100 may be readily collapsible via mechanical manipulation.
  • FIG. 12 depicts another embodiment of a medical device 1200 that likewise resembles a cage.
  • the device 1200 includes a frame or body 1250 that is formed from a single rod or wire 1255.
  • the wire 1255 is wound or spiraled in a somewhat spherical shape, or may be termed as a spiral ball.
  • the wire 1255 defines an extended opening 1271 of a passageway 1270 that passes through the ball.
  • the opening 1270 is likewise spiral shaped.
  • the device 1200 can comprise any suitable material, and may be self-expandable or may expand with assistance (e.g., via any suitable mechanical manipulation, such as balloon expansion).
  • suitable materials include metals (e.g., stainless steel) and/or polymeric materials of any suitable variety, nanomaterials, etc.
  • the device 1200 comprises any suitable shape-memory material (e.g., Nitinol).
  • the device 1200 may be introduced through the lumen of a catheter or endoscope.
  • the device 1200 may be in a straightened configuration (e.g., have a substantially linear form) when in an undeployed or unexpanded configuration, and can be advanced through the lumen of the catheter or endoscope in this orientation.
  • the device 1200 may naturally (e.g., if formed of a resilient or shape-memory material) transition (e.g., return) to the space -filling, volume -defining, expanded ball shape depicted in FIG. 12 and distend the cecum.
  • the device 1200 may be formed of a material that is configured to expand due to absorption of material (e.g., water) within the bowel.
  • the device comprises a superabsorbent polymer.
  • the polymer can function the same as or similar to expandable water toys, also known as grow -in-water toys.
  • the device may be sponge-like when in an undeployed state.
  • the device 1200 could be inserted in substantially linear form through the working channel of an endoscope into the bowel in a“dry” (or low moisture content) condition, can assume the spiral shape upon exiting the endoscope, and then can expand when exposed to water or colonic effluent once introduced into the bowel.
  • the device 1200 can expand sufficiently to distend the cecum, such as to a pathophysiological size, as discussed elsewhere herein.
  • a variety of coatings and/or compositions may be applied to the frame of the device 1200.
  • the coating may comprise an eluting material that can prevent or inhibit inflammation of the cecal wall and/or that can prevent or inhibit tissue ingrowth.
  • the device 1200 includes a drug-eluting composition of any suitable variety.
  • the eluted drugs may be, for example, immunosuppressive and/or antiproliferative.
  • the drug-eluting composition may comprise one or more of paclitaxel, sirolimus, or everolimus.
  • a polymer coating bound to the device frame includes the one or more drugs.
  • the coatings and/or compositions applied to the device can elute beneficial substances, such as appetite suppressants.
  • the device 1200 is coated with a polyethylene glycol resin that contains, e.g., a complex carbohydrate or other nutrient source for the patient 205 directly, or contains, e.g., cellulose or some other material that provides nutrients for bacteria that reside in the bowel. Bacteria may eat and derive nutrients from the material over time, and may be sufficient to independently achieve or to assist in achieving satiety for the patient. Items like cellulose may be advantageous, as they need not be preserved (e.g., refrigerated) prior to implantation.
  • the material that may be eluted can comprise nutrients for the patient 205, such as, for example, any suitable complex carbohydrate, simple carbohydrate, fat, or protein.
  • the material that may be eluted can comprise nutrients for bacteria, either including or in exclusively, some materials that are non-nutritive for the patient, such as, for example, cellulose or psyllium.
  • a pouch or other container is positioned at interior of the device 1200.
  • the pouch may comprise a millipore netting or the like that is positioned within the frame or body 1250.
  • the pouch can include nutrients that leach out or are otherwise consumed over time. Nutrients or other materials can be consumed over time and assist in satiating the patient.
  • the body 1250 is independently formed of a separate bioresorbable material that degrades over time and, eventually, spontaneously passes out through the bowel and out of the patient 205.
  • FIGS. 13 A- 13G depict additional embodiments of devices 1300, 1301, 1302, 1303, 1304, 1305, 1306 that can be implanted in the patient 205 to trigger a colo-gastric brake, such as by transitioning from an undeployed or unexpanded state to an expanded state in which the device distends the cecum.
  • the devices 1300-1306 may also be referred to as cages, shells, balls, or balloons.
  • Each device 1300, 1301, 1302, 1303, 1304, 1305, 1306 can include a body 1350 that defines a plurality of openings 1371 that are in fluid communication with a cavity of the body 1350.
  • the cavity is a passageway 1370 through which material can pass.
  • the size, shape, number, pattern (or lack thereof), and/or orientation of the openings 1371 can be varied, depending on, for example, performance preferences.
  • the devices 1300, 1301, 1302, 1303, 1304, 1305, 1306 are illustrative a wide variety of possible options for different sizes, shapes, numbers, patterns, and/or orientations of the openings.
  • the openings 1370 can be any shape or size.
  • the openings 1371 and the passageway 1370 of each device can permit passage of material through the body 1350.
  • the body 1350 is a hollow shell of material.
  • the shell may be relatively thin.
  • the material of which the body 1350 is formed is resiliently flexible or elastomeric.
  • the body 1350 can be compressed or otherwise compacted to a smaller profile to transition the device to the undeployed state. Upon placement in the cecum, the body 1350 can be released from the compressed state and can naturally transition to the deployed or expanded configuration.
  • the body 1350 can define a variety of different shapes or configurations.
  • the bodies 1350 each define a substantially spherical outer surface that is perforated by the various openings 1371.
  • the bodies 1350 are more oblong. In some instances, the oblong shapes may more readily conform the pouch-like configuration of the cecum and/or may be less susceptible to rotation (e.g., rotation about axes other than a longitudinal axis of the body) when retained in the bowel in a free-floating arrangement.
  • the set of openings 1371 and the passageways 1370 with which they communicate can be sufficiently large to permit material that would naturally pass through the portion of the bowel in the absence of the body 1350 to pass through the body 1350 substantially unimpeded.
  • the body 1350 is multi-chambered, and thus may define multiple passageways. All such passageways may desirably provide sufficient flow capacity to permit material that would naturally pass through the portion of the bowel in the absence of the body 1750 to pass through the body 1750 substantially unimpeded.
  • the body 1750 is configured to obstruct no greater than 5, 10, 15, or 20 percent of material from passing through the portion of the bowel within which the body 1750 is positioned. In various embodiments, the body 1750 is configured to reduce a flow capacity through a lumen defined by the portion of the bowel by no greater than 10, 20, 30, 40, or 50 percent.
  • the body 1750 can define an outermost perimeter 1375.
  • the outermost perimeter 1375 contacts the cecum as the body 1750 distends the cecum.
  • the perimeter 1375 of the body 1750 may be fully in contact with an inner surface of the cecum.
  • the body 1750 may contact the cecum about the full perimeter 1375 (or periphery), and a full perimeter of an inner surface of the cecum may contact the perimeter 1375.
  • the device 1300 could be positioned within cecum such that a longitudinal axis of the cecum is substantially aligned with an axis that passes directly through the center of the device 1300 and is perpendicular to the plane of the page of FIG.
  • the body 1370 define a longitudinal axis (e.g., longitudinal relative to its position in the lumen) that is substantially aligned with a direction of material flow through the passageway 1370.
  • the perimeter 1375 of the body 1350 defines a maximum cross- sectional area along a plane that is transverse to the longitudinal axis of the body 1350.
  • this plane is the plane of the page.
  • the passageway 1370 defines a minimum cross-sectional area along a different plane transverse to the longitudinal axis.
  • the passageway 1350 has a minimum area at the opening 1371, which is on a plane that is parallel to the plane of the page.
  • the minimum cross-sectional area defined by the passageway 1370 (e.g., the area of the opening 1371) is smaller than the maximum cross-sectional area defined by the body by no greater than 10, 20, 30, 40, 50, 60, 70, 80, or 90 percent.
  • the lumen size can be substantially the same as the lumen size of the bowel.
  • the minimum size of the passageway 1370 is substantially smaller than the size of the perimeter 1375.
  • the planes of maximum perimeter and minimum passageway size may be coplanar.
  • a summation of the areas defined by the entrance openings 1371 of the passageways is smaller than the maximum cross-sectional area defined by the body 1350, along a plane transverse to the longitudinal axis (e.g., a transverse plane through the bowel lumen when the device is implanted therein) by no greater than 10, 20, 30, 40, or 50 percent.
  • This ratio of areas can be a good indication of the amount of flow reduction that may be caused by the presence of the device 1300, in some instances.
  • FIGS. 14A and 14B depict another embodiment of a medical device 1400 or structure that is formed as a balloon with an integrated channel.
  • the device 1400 can be inflated at the desired location and/or inflated and delivered thereto.
  • the device 1400 includes a body 1450 that defines a channel 1470 when in the expanded state.
  • the structure can be self-sealing, such as via any suitable closure 1480, such as a one-way valve.
  • the closure 1480 includes a one-way valve through which fluid is introduced into the body 1450, and then subsequently maintained in the balloon.
  • the body 1450 can be advanced into the bowel in a deflated or partially deflated state.
  • the body 1450 may, for example, be delivered to a desired site—e.g., the cecum— over a guidewire, over or through an endoscope, or in any other suitable manner.
  • the structure can be applied in a specific segment of the bowel and take 3 -dimensional shape when inflated in order to distend the lumen.
  • the body 1450 is formed of latex, nonlatex, rubber, derivatives of rubber, any rubber-like material or elastomeric material, or any other suitable material.
  • the body 1450 can be expanded with one or more fluids (e.g., air or saline). Once inflated, the body 1450 may be either free floating in the lumen of the bowel or attached or otherwise secured to the wall of the bowel. For example, in some instances, the body 1450 may be attached to the wall by sutures or an adhesive. In other or further embodiments, the body 1450 may be tensioned in place by achieving a suitable pressure of the inflation fluid.
  • the balloon can be expanded to a variety of sizes or shapes, causing a variety of distention amounts of the bowel.
  • At least a portion of the balloon body 1450 comprises a material that is degradable over time (e.g., any suitable bioresorbable material). Degradation can yield leaks in the walls, leading to loss of fluid and size reduction.
  • at least a portion of the closure 1480 comprises a degradable (e.g., bioresorbable) material, which can yield a leak by which the device 1400 is deflated and may eventually spontaneously pass from the patient. Any suitable bioresorbable material is contemplated.
  • the balloon in order to prevent bowel obstruction from the balloon, includes the channel 1470. It may be desirable to orient the balloon such that the channel 1470 is substantially aligned with a longitudinal axis of the bowel lumen. The bowel lumen thus can be simultaneously expanded by the balloon, yet the balloon passageway or channel 1470 can allow air, liquid, semiliquid, semi-solid or solid stool to pass therethrough.
  • the device 1400 comes prepackaged with an inflation catheter. Stated otherwise, when removed from packaging, the device 1400 may already be attached to an inflation catheter.
  • the device 1400 and catheter can be inserted through the working channel of an endoscope.
  • the device 1400 and catheter are advanced through the working channel of the endoscope to position the device 1400 at the distal end of the working channel prior to inserting the endoscope into the patient.
  • the endoscope, catheter, and device 1400 are then advanced together through the bowel of the patient into the cecum.
  • the catheter can be advanced distally relative to the endoscope to move the device 1400 out of the working channel and into the cecum.
  • Any suitable inflation mechanism may be coupled to a proximal end of the catheter, and inflation fluid can thereby be delivered through the catheter into the device 1400 to inflate the device 1400.
  • inflation fluid can then be delivered through the catheter into the device 1400 to inflate the device 1400.
  • the device 1400 As the device 1400 is inflated, it can move into contact with and expand the cecal wall to a pathophysiological size.
  • the catheter can then be decoupled from the device 1400, which can self-seal in manners such as previously disclosed (e.g., via the valve 1480).
  • the catheter and endoscope can then be removed from the patient.
  • FIG. 15 depicts another embodiment of a device 1500 that can include an inflatable balloon body 1550, which may also include a self-sealing closure (such as the valve 1480 previously described).
  • the body 1550 defines a large central passageway 1570.
  • the shape of the body 1550 may assist in ensuring that passageway 1570 remains aligned with the lumen of the bowel.
  • the illustrated embodiment may fit well in the pouch-like cecum, and a length of the body 1550 is such that rotation of the device relative to the bowel in a manner that could close the passageway 1570 would be inhibited.
  • an opening through a sidewall of the balloon structure into the primary passageway 1570 may be provided.
  • the opening can be aligned with the ileocecal valve to ensure the device 1500 does not block the flow of material therefrom.
  • another example structure or medical device 1600 can include a plurality of inflatable structures l655a, l655b that define a body 1650 of the device.
  • the body 1650 defines a passageway 1670 through which material can pass when the device 1600 is implanted.
  • the structures l655a, l655b are each substantially tubular rings that are oriented perpendicularly to each other, such as to form an atom shape.
  • the device 1600 can include two attached or interlocking circular or hemi -circular balloons. Other arrangements are possible, such as discussed further below.
  • the structures l655a, l655b can be oriented relative to each other in a manner to allow wide openings between the individual balloons.
  • each structure l655a, l655b is self-contained. Or stated otherwise, each structure l655a, l655b defines a separate chamber. Thus, the body 1650 is a two- chamber system, with each chamber being separate from the other.
  • each structure 1655a, 1655b contains a self-sealing or auto-closing closure, and each structure 1655a, l655b may be inflated separately.
  • the structures l655a, l655b may be attached to each other in any suitable manner. In some embodiments, the structures l655a, l655b are secured to each other via a bioresorbable material, such as a bioresorbable adhesive.
  • Embodiments can thus include multiple circular or hemi-circular interlocking balloons in any manner or shape that would allow expansion of the balloons but also allow for spaces or openings between the balloons, such as the example structures shown in FIGS. 17-20.
  • configurations other than circular or hemi-circular are used. Any suitable geometric shape in combination with any other shapes are contemplated.
  • the balloon could be partially circular or circular or hemi-circular in combination with any other shape or shapes, so long as there are spaces or perforations between or in the balloon or balloons to allow air or fluid or liquid or semi-liquid or semi-solid stool to pass.
  • the balloons or portions of the balloons could be as thin as ribbons or tubular or any thickness or size.
  • the combination of balloons is essentially limitless as long as there are spaces incorporated within the design to allow passage of air, solid, or liquid.
  • the structures l655a, l655b are connected so as to define a single chamber. Accordingly, the body 1650 can be inflated via a single port.
  • the material of which the body 1650 is formed can degrade which can lead fluid to escape and the body to deflate.
  • the structures l655a, l655b are held together by material that degrades or deflates.
  • a bioresorbable material can hold together the separate structures l655a, l655b prior to degradation, and degradation of the bioresorbable material releases the separate pieces from each other.
  • One or more of the deflated and/or degraded structures l655a, l655b, or individual pieces thereof, can pass through the bowel and be eliminated spontaneously.
  • the body 1650 can be removed endoscopically.
  • connections between various facets of the structure such as connections holding two or more balloons together, or two or more mechanical features together (such as certain of the struts 555 [see FIG. 5E], 1055 [see FIG. 10B], 1155 [see FIG. 11]), could degrade or deflate over time, allowing for separation of the structure and partial or complete elimination of the structure in stool over time.
  • inflatable or expandable structures can define a wide variety of configurations that may be capable of distending the bowel while permitting passage therethrough of material so as not to obstruct the lumen of the bowel.
  • a device 1700 includes a body 1750 formed of three structures l755a, l755b, l755c that are connected to one another at mutually perpendicular orientations.
  • a device 1800 also includes a body 1850 formed of three structures l855a, l855b, l855c that are connected to one another at mutually perpendicular orientations, but in a manner different from that of the device 1700.
  • FIG. 19 depicts a device 1900 that includes a body 1850 formed of a single structure (e.g., a single inflatable balloon, rod, etc.) that forms a netted region substantially without symmetry.
  • FIG. 20 depicts a device 2000 that includes a body 2050 formed of multiple structures (e.g., multiple inflatable balloons, rods, etc.) that form a netted region with multiple planes of symmetry.
  • the device may be removed in any suitable manner.
  • various embodiments ban be partially or completely removed by scraping, dissolving, deflating, collapsing, retracting, snaring, and/or any other suitable means.
  • the implanted medical device may define a space filling or volume -defining structure that may trigger a colo-gastric brake, but may only minimally or nominally distend the bowel wall, or may not distend the wall at all.
  • the device may merely fill the space (without causing partial or complete obstruction) and, potentially, may somewhat slow the flow of material. The presence of the device and/or its slowing of material could independently trigger a colo-gastric brake.
  • FIG. 21 depicts a kit 2100 that can be used in introducing a medical device into a patient.
  • the kit 2100 can include any of the systems (e.g., implantation, deployment, delivery, and/or expansion systems) disclosed herein (i.e., those disclosed previously and/or those disclosed hereafter) and/or components thereof.
  • the kit 2100 can include any of the medical devices disclosed herein (e.g., one or more of the devices 300, 400, 500, 700, 800, 900, 1000, 1100, 1200, 1300, 1301, 1302, 1303, 1304, 1305, 1306, 1400, 1500, 1600, 1700, 1800, 1900, 2000, 2200, 2600, 2800, 2900, 3000, 3100, 3200, 3300, 3400, 3500, 3600, 3800, 3900, 4000, 4200) and/or any one or more of the systems or components thereof or associated therewith to introduce the device into the patient and/or deploy the device within the patient.
  • the medical devices disclosed herein e.g., one or more of the devices 300, 400, 500, 700, 800, 900, 1000, 1100, 1200, 1300, 1301, 1302, 1303, 1304, 1305, 1306, 1400, 1500, 1600, 1700, 1800, 1900, 2000, 2200, 2600, 2800, 2900, 3000, 3100, 3200, 3300, 3
  • the kit 2100 includes the system 840 described above, which includes a guidewire 884 and the medical device 800 coupled with the catheter 810.
  • the medical device 800 may be introduced via an endoscope, or more specifically, a colonoscope (e.g., in manners previously discussed with respect to the system 840).
  • the kit 2100 may include an endoscope and/or accessories therefor, or may be specifically configured for use with a particular endoscope (e.g., a colonoscope).
  • the kit 2100 can include instructions for use 2110, which may provide directions with respect to any of the processes disclosed herein (i.e., any of the methods or steps thereof disclosed previously and/or hereafter). That is, the instructions for use 2110 can include directions to perform any suitable combination of method steps involving the device and/or system included in the kit 2100. For example, in the illustrated embodiment, the instructions for use 2110 can specifically recommend or direct a user to deploy the medical device within the cecum of the patient to distend the cecum for a therapeutically effective period.
  • the kit— and, in particular, the instructions for use thereof— can be approved of or authorized by a regulating body of a particular jurisdiction.
  • the kit, and the instructions for use thereof may be approved of or authorized by the Food and Drug Administration of the United States of America and/or may comply with the regulations of other jurisdictions, such as by qualifying for CE marking in the European Union.
  • FIG. 22A is a side elevation view of another embodiment of an expandable medical device 2200 that is configured for placement in the cecum of a patient to treat obesity, the medical device 2200 being depicted in a contracted, low-profile, or undeployed state.
  • the device 2200 can resemble other devices previously described, including the stent-like devices 500, 600, 700, 800, 900, etc., and can include any suitable feature described with respect thereto.
  • the device 2200 may be constructed in a variety of configurations, including self-expanding configurations, assisted-expansion configurations, etc.; the device 2200 may be constructed of any of a variety of previously disclosed materials and/or can include any of a variety of previously disclosed coatings; etc.
  • the device 2200 includes a highly expandable body 2250, which defines a connection hub 2251 at a proximal end thereof.
  • the body 2250 is substantially cylindrical when the device 2200 is in the contracted state.
  • the device 2200 can define a maximum outer diameter when in the contracted state.
  • the maximum outer diameter of the device 2200 is smaller than an inner diameter of the working channel (which may also be referred to as the instrument channel, tool channel, or biopsy channel) of standard colonoscopes, which can permit delivery of the device 2200 via such a working channel.
  • the maximum diameter of the device 2200 in the contracted state is no greater than 3.7, 3.8, 3.9, or 4.0 millimeters.
  • FIG. 22B is a perspective view of the medical device 2200 in an expanded or deployed state.
  • the body 2250 can be formed in any suitable manner.
  • the body 2250 may be formed from a laser-cut tube of any suitable material, such as, for example, Nitinol or stainless steel.
  • the body 2250 comprises a plurality of wires, struts, connectors, or support members 2255, which in the illustrated embodiment intersect at consistent angles and extend along regularly spaced paths or intervals.
  • the widths of the support members 2255 are relatively small, such that the support members 2255 define a plurality of large openings 2256.
  • the illustrated openings 2256 are substantially diamond-shaped, with the sides thereof being rounded and the tips thereof being pointed, and may be described as being somewhat longitudinally elongated.
  • the openings 2256 may also be referred to as substantially vesica piscis-shaped.
  • the struts 2255 may have relatively sharp edges, which may result from the manner in which the struts 2255 are formed.
  • the struts 2255 may ultimately define substantially rectangular or substantially trapezoidal cross-sections.
  • the comers of such cross-sectional shapes can correspond to relatively sharp edges of the stmts 2255. In some embodiments, these sharp edges can press into the cecal wall as the device 2200 bears outwardly on the cecum.
  • the stmts 2255 may be devoid of sharp edges.
  • one or more coverings may be applied to the stmts 2255. In some embodiments, the one or more coverings can inhibit the stmts 2255 from pressing or digging into the cecal wall (see, e.g., FIGS. 32A-33C and 35C-35E and associated text).
  • the body 2250 is substantially hollow, and defines a large primary channel or passageway 2270.
  • the body 2250 may also be said to encompass, encircle, enclose, circumscribe, or delineate a large volume of space, corresponding to the region internal to the stmt stmcture.
  • Each of the openings 2256 defined by the support members 2255 is in fluid communication with the passageway 2270, and thus each opening 2256 defines an entrance to or exit from the primary passageway 2270.
  • the primary passageway 2270 may be sufficiently large to permit passage of material therethrough without substantially impeding the flow of the material.
  • the body 2250 of the expansion device 2200 can effectively distend the wall of the cecum 110 while the passageway 2270 defined by the body 2250 can permit substantially unimpeded or unobstructed flow of the material through the body 2250.
  • the openings 2256 are sufficiently large and the support members 2255 sufficiently thin to permit the body 2250 to either substantially or completely leave the ileocecal valve unobstructed, depending on the specific orientation of the body 2250.
  • the expanded device 2200 is substantially bulbous.
  • the expanded device 2200 defines a longitudinal length that is smaller than a maximum transverse diameter of the device 2200.
  • the maximum diameter of the expanded device 2200 can be substantially larger than the diameter of the contracted device 2200 due to the highly expansible property of the device 2200.
  • the maximum diameter of the device 2200 when expanded can be no less than 15, 16, 17, 18, 19, 20, 25, 30, 35, or 40 times larger than the diameter thereof when contracted.
  • the maximum diameter of the device 2200 when expanded in various embodiments, can be no less than 7, 8, 9, or 10 centimeters.
  • FIGS. 23A-23K depict various stages of illustrative methods of deploying into, using in, and retracting from the cecum 110 certain embodiments of the device 2200.
  • FIG. 23 A is a cross- sectional view of a portion of the colon of a patient during an illustrative method in which an endoscope 2300 (e.g., a colonoscope), shown in perspective, is being advanced toward the cecum 110 of the patient for delivery of the device 2200.
  • an endoscope 2300 e.g., a colonoscope
  • FIG. 23B depicts another stage of the method in which a deployment system 2310 has been advanced through the working channel of the endoscope 2300 and is advanced out of a distal end of the endoscope 2300 (from the perspective of the practitioner) into the cecum 110.
  • the deployment system 2310 includes a push rod 2312 that is coupled to a distal end (from the perspective of the digestive tract) of the expansion device 2200 and further includes a retention sheath 2314 that maintains or assists in maintaining the expansion device 2200 in the contracted state. In other embodiments, the retention sheath 2314 may not be used.
  • the push rod 2312 can be highly flexible and capable of bending to the contours of an endoscope positioned within the bowel of the patient, yet sufficiently rigid in a longitudinal direction to be capable of advancing the contracted device 2200 through at least a portion of the working channel of the endoscope 2300. Any suitable material is contemplated. In some embodiments, the push rod 2312 further comprises a lubricious coating to facilitate passage through the working channel.
  • FIG. 23 C depicts another stage of the method in which the expandable medical device 2200 is being deployed within the cecum 110.
  • the push rod 2312 having been advanced sufficiently to bring a proximal end (from the perspective of the digestive tract) of the expansion device 2200 into contact with or close proximity to a proximal end of the cecum 110
  • the retention sheath 2314 is withdrawn through the working channel of the endoscope 2300.
  • the expansion device 2200 is self-expandable.
  • the expansion device 2200 is formed of heat-treated nitinol.
  • the device 2200 can be cooled (e.g., via liquid nitrogen) prior to insertion through the endoscope 2300, and can expand when heated to body temperature (and when permitted to expand by removal of the retention sheath 2314). In the illustrated embodiment, expansion of the device 2200 may be gradual as the device is heated within the body. In other embodiments, the expansion device 2200 may be formed of a resiliently flexible material that may self-expand more rapidly and/or immediately upon removal of the retention sheath 2314. Any other suitable configuration is contemplated.
  • FIG. 23D depicts another stage of an illustrative method in which the expandable medical device 2200 has been fully deployed to expand the cecum 110 to a pathophysiological size.
  • the cecum 110 can expand in conformity to an external surface defined by the device 2200.
  • a maximum diameter and/or a volume of the cecum 110 can be significantly enlarged by the expansion device 2200.
  • both the device 2200 and the cecum 110 are substantially bulbous when the device 2200 is in the deployed configuration.
  • FIG. 23E depicts another stage of the method in which the push rod 2312 is being decoupled from the deployed medical device 2200.
  • the medical device 2200 coupled (e.g., in physical contact) with the sidewall of the cecum 110, the medical device 2200 can be resistant to rotation.
  • the device 2200 thus may remain substantially stationary relative to the cecum 110 as the push rod 2312 is rotated to decouple from the medical device 2200.
  • FIG. 23F depicts a further stage of the method just after the push rod 2312 has been decoupled from the medical device 2200.
  • This image depicts the coupling interface 2316 of this particular embodiment via which the push rod 2312 and the device 2200 are selectively coupled to each other.
  • the illustrated coupling interface 2316 comprises external threading 2317 on the push rod 2312 and complementary internal threading 2253 within the connection hub 2251 of the device 2200. Any other suitable connection interface 2316 and selectively releasable and/or selectively couplable/decouplable coupling mechanisms are contemplated.
  • FIG. 23G depicts a further stage of the method after the push rod 2312 has been retracted relative to the endoscope 2300.
  • no attachment mechanism beyond the intrinsic resilience of the expansion device 2200 is provided to affix the expansion device to the cecum.
  • the struts of the expansion device 2200 may push against the cecal wall so as to induce inflammatory and fibrotic responses.
  • Eventual tissue ingrowth can further secure, attach, or embed the expansion device 2200 to or within the cecal wall.
  • one or more attachment mechanisms are introduced through the endoscope 2300 to secure the expansion device 2200 to the cecal wall. Any of the attachment mechanisms discussed above are contemplated.
  • one or more clips such as one or more hemoclips, may be used to secure the expansion device 2200 to the cecal wall.
  • the endoscope 2300 may be removed from the patient, whether separate from or simultaneously with the push rod 2312 or any systems used to further attach the expansion device 2200 to the cecal wall, such as a hemoclip delivery system of any suitable variety. The device 2200 is thus left within the cecum, e.g., for a therapeutically effective period.
  • FIG. 23H depicts a further stage of certain embodiments of the method that can occur after the expansion device 2200 has been deployed in the cecum 110, thus expanding the cecum to define an enlarged maximum diameter (shown in FIG. 23G).
  • the cecum 110 is permitted to naturally expand to a size (e.g., maximum diameter and/or internal volume) larger than the pathophysiological size to which the expansion device 2200 has previously expanded the cecum 110.
  • the natural expansion can be due to natural processes, as previously described.
  • the cecum 110 may naturally expand to the increased volume, in excess of the increased minimum volume achieved via the device 2200 alone, due to passage of one or more of chyme, gas, or stool into the cecum 110.
  • the chyme, gas, or stool may be permitted to pass through the various openings and the passageway of the medical device 2200.
  • the expanded device 2200 does not significantly change shape or size as the cecum 110 undergoes additional expansion. In some instances, such as where the device 2200 is not otherwise connected to the cecal walls, contact between the device 2200 and the cecal wall is reduced or eliminated.
  • the device 2200 can be free floating within the further expanded cecum, and may axially rotate, laterally rotate, longitudinally translate, and/or laterally translate within the cecum while the cecum 110 is in the state of additional enlargement.
  • the medical device 2200 may be solely responsible for triggering a gastric brake in the patient.
  • the medical device 2200 may be only partially responsible or may not significantly contribute, or may not directly contribute, to gastric braking that can result from the enlarged size of the cecum 110 that is due, instead, either partially or entirely, to the natural enlargement of the cecum 110.
  • an operational state such as depicted in FIG. 23H may arise at a time before tissue ingrowth into the medical device 2200 fixedly secures the medical device 2200 to the cecal wall.
  • the medical device 2200 may later be securely fixed to the cecal wall due to such tissue ingrowth.
  • the medical device 2200 may be attached to the cecal wall by any suitable attachment mechanism, such as any suitable adhesive or mechanical fastener (e.g., clips or sutures).
  • the medical device 2200 may be substantially non-expandable beyond its enlarged maximum diameter, such that the medical device 2200 can resist natural expansion of the cecum to any further increased volume, in excess of the increased minimum volume achieved via the device 2200 alone, that might otherwise occur due to natural processes, such as the passage of one or more of chyme, gas, or stool into the cecum 110.
  • the medical device 2200 may be capable of further expansion, such as due to an outward bias that is normally opposed by the cecum 110, such that the medical device 2200 can expand outwardly with the cecum 110 as the cecum naturally expands to a further increased volume, in excess of the increased minimum volume achieved via the device 2200 alone, due to natural processes, such as the passage of one or more of chyme, gas, or stool into the cecum 110.
  • FIG. 231 depicts a further stage of a method in which the endoscope 2300 (or a different endoscope) has been introduced into the bowel of the patient and the push rod 2312 (or a different push rod) is coupled to the medical device 2200 for purposes of retraction.
  • the push rod 2312 can couple with the device 2200 via any suitable connection interface, such as complementary threading.
  • the cecum 110 can again resist rotation of the device 2200 to permit coupling of the device 2200 with the push rod 2312 in this manner. Any other suitable retraction methods are contemplated, such as those previously described.
  • such retraction methods are best suited for situations in which there has been little or no tissue ingrowth relative to the device 2200.
  • the device 2200 may be bioresorbable and may pass naturally through the bowel in manners such as previously described, rather than being affirmatively retracted via a follow-on colonoscopy procedure.
  • FIG. 23J depicts a further stage of the method of FIG. 231, in which the retention sleeve 2314 (or a different retention sleeve) is advanced distally over the medical device 2200 to transition the medical device to a retracted or contracted configuration.
  • FIG. 23K depicts a further stage of the method in which the retention sleeve 2314 has been advanced over an entirety of the medical device 2200.
  • the contracted device 2200 can then be withdrawn through and/or within the endoscope 2300, which may likewise be removed from the patient.
  • the push rod 2312 is advanced distally through the working channel of the endoscope 2300 and coupled with the device 2200 as shown in FIG. 231. Thereafter, the retention sleeve 2314 is advanced distally over the push rod 2312 within the working channel of the endoscope 2300 and into contact with the distal end (from the perspective of the digestive tract) of the device 2200. Relative movement between the push rod 2312 (as attached to the device 2200) and the retention sleeve 2314 can urge the device 2200 to the collapsed or low-profile state.
  • the retention sleeve 2314 can be sufficiently rigid to substantially maintain its shape (e.g., maintain its tubular form with a maximum outer diameter that is less than the inner diameter of the working channel) as it is moved distally relative to the device 2200 and/or as the device is moved proximally relative thereto.
  • the more malleable device 2200 thus can deform or collapse to the low-profile configuration so as to fit within the retention sleeve 2314 and subsequently be withdrawn through the endoscope 2300 while retained in the low-profile orientation within the retention sleeve 2314.
  • the retention sleeve 2314 may be maintained at a fixed longitudinal position while the push rod 2312 and attached device 2200 are withdrawn proximally into the retention sleeve, the retention sleeve 2314 may be advanced distally over the device 2200 as the push rod 2312 and attached device 2200 are maintained at a fixed longitudinal position, and/or any suitable combination thereof.
  • the endoscope 2300, and in particular, the working channel of the endoscope 2300 may be used in a manner such as just described with respect to the retention sleeve 2314, and the retention sleeve 2314 can be omitted.
  • the device 2200 may be drawn directly into the working channel and/or the working channel may be advanced directly over the device 2200.
  • the device may thereby collapse to the low- profile orientation by and be withdrawn directly through the working channel of the endoscope 2300.
  • FIG. 24 depicts another embodiment of a deployment system for deploying an embodiment of a medical device within the cecum, the deployment system including a push rod and a retention sleeve similar to those previously disclosed.
  • the illustrated push rod 2412 may merely abut a distal end of the device 2200 for purposes of pushing the device 2200, rather than forming a more significant temporary connection or attachment therewith.
  • such a deployment system may be used with a different retrieval system, such as that discussed below with respect to FIGS. 25A-25C.
  • the device 2200 may be positioned within the cecum indefinitely without being retrieved.
  • the device 2200 may comprise a bioresorbable material, as previously disclosed, and may weaken over time so as to distend the cecum by progressively smaller amounts and/or may break down or apart, and the pieces thereof may pass through the bowel and out of the patient naturally (e.g., after passage of a therapeutically effective period).
  • the device 2200 may be formed of a more biostable material (e.g., stainless steel, Nitinol, or some other metal allow) and may remain within the cecum, in in further embodiments, can continue expansion of the cecum, for an indefinite period.
  • FIG. 25A depicts an embodiment of a retraction system for retracting the medical device 2200 from the cecum 110, the retraction system including a snare 2418 and a retention sleeve 2414.
  • the snare 2418 can be used to pull the device 2200 into the retention sleeve 2414 to contract the device 2200.
  • the retention sleeve 2414 may be advanced distally (from the perspective of the practitioner) over the device 2200 to assist in the contraction and/or the device 2200 can be drawn proximally into the sleeve 2414 in manners such as previously discussed.
  • the device 2200 may be retracted directly into the endoscope via the snare 2418 in manners such as previously discussed. Any other suitable retrieval method or system is contemplated.
  • FIG. 26 depicts a balloon catheter 2500 that may be used to deploy certain embodiments of an expansion device within the cecum of a patient.
  • the balloon catheter 2500 can include a balloon 2502 that can be used in manners such as previously described to deploy a non-self-expanding device. Any suitable configuration of the balloon catheter 2500 is contemplated.
  • FIG. 27 depicts a stage of a method of expanding the cecum of the patient via another embodiment of an expandable medical device 2600— one that is not self-expanding— using the balloon catheter 2500.
  • the expansion device is preloaded over the balloon 2502, while the balloon 2502 is in a contracted state, and upon proper positioning of the low-profile expansion device within the cecum, the balloon 2502 can be inflated by a desired amount to expand the medical device into its deployed configuration.
  • FIG. 28 depicts another embodiment of a deployment system 2710 that includes a push rod 2712 that defines an internal lumen 2713 and further includes a retention filament 2720 that extends through the internal lumen 2713 of the push rod 2712.
  • the retention filament 2720 can comprise a closed loop suture that can be cut at a proximal end (from the practitioner’s perspective), as shown, and withdrawn through the lumen of the push rod 2712 to permit deployment of a self expanding device 2800.
  • the retention filament 2720 can function similarly to the retention sleeves previously disclosed, and can selectively maintain the device 2800 in the undeployed or low-profile configuration until appropriately positioned within the cecum.
  • FIG. 29 is an elevation view of another embodiment of an expansion device 2900 configured for deployment in the cecum of a patient, the device 2900 being depicted in a low-profile, collapsed, or undeployed orientation, state, or configuration.
  • the device 2900 can resemble certain of the devices discussed above in many respects, such as (among others) the device 2200.
  • Various disclosures regarding the device 2200 and other devices disclosed herein are equally applicable to the device 2900, and might not be repeated, consistent with the disclosure convention previously discussed. Similarly, disclosures hereafter regarding the device 2900 can apply to other devices as well.
  • the device 2900 can include a body 2950 that is configured to transition from the low-profile state to an enlarged or expanded state.
  • the body 2950 can be formed of a tube (e.g., a laser-cut tube) of any suitable material, such as, for example, a metallic (e.g., stainless steel) or metal alloy (e.g., Nitinol) material.
  • the body 2950 can define a maximum length LLP and a maximum width WLP.
  • the maximum width WLP is substantially constant along a full length of the body 2950 and corresponds to an outer diameter l)u of the device 2900.
  • the maximum length L pp can be no less than about 6, 7, 8, 9, 10, 11, 12, 13, 14, or 15 centimeters.
  • the device 2900 can be tightly oriented about a longitudinal axis ALONG defined thereby. Stated otherwise, the device 2900 can be narrow or can define a very low profile so as to be able to be advanced through at least a portion of a working channel of an endoscope, such as a colonoscope.
  • the outer diameter DLP can be smaller than 3.5, 3.6, 3.7, 3.8, 3.9, or 4.0 millimeters.
  • the device 2900 can have a high length-to-width aspect ratio when in the low-profile state. In various embodiments, the maximum length LLP can be larger than the maximum diameter DLP by a factor of no less than 20, 25, 30, 35, or 40.
  • the illustrated device 2900 is substantially cylindrical in the low-profile state.
  • the body 2950 is shaped as a hollow cylindrical tube that defines a central passageway
  • a maximum inner diameter of the tube which corresponds to a maximum outer diameter of the passageway 2970, can be no greater than 3.0, 3.1, 3.2, 3.3, 3.4, 3.5, 3.6, 3.7, or 3.8 millimeters.
  • FIGS. 30A-30G are further views of the medical device 2900 depicted in an expanded or deployed configuration.
  • the device 2900 is shown in a perspective view that is only slightly offset from an elevation view.
  • the body 2950 is substantially bulbous.
  • the body 2950 includes a distal end 2947 (from the perspective of the gastrointestinal tract) and a proximal end 2949.
  • the distal end 2947 of the body 2950 includes a hub 2951 at which a plurality of struts 2955 gather or collect.
  • the hub 2951 can be aligned with the longitudinal axis ALONG of the device 2900.
  • the hub 2951 defines an opening 2972 at the distal end of the primary passageway 2970 of the device 2900.
  • a size or diameter of the opening 2972 can be substantially the same as the size or diameter of the device 2900 when in the low-profile state (FIG. 29).
  • the opening 2972 can be narrow.
  • the hub 2951 with a narrow opening can potentially collect material that naturally passes through the cecum of a patient over time.
  • a larger opening 2972, with or without a hub is contemplated, and may reduce or substantially eliminate significant material collection and/or blockages that may gather thereat.
  • the distal end 2947 of the device 2900 can resemble the distal ends of the devices 500, 700, 800, 900.
  • the proximal end 2949 of the body 2950 defines an opening 2971 at an opposite end of the primary passageway 2970.
  • the opening 2971 is also aligned with the longitudinal axis ALONG.
  • the opening 2971 may also be relatively small, in comparison to a maximum width WEXP of the device 2900 when in the expanded state. In certain embodiments, a small opening
  • 2971 may be less prone to gather material, as compared with a proximal opening 2972 of the same size, as less material may pass thereby or therethrough due to an upstream position of the proximal opening 2972 relative to the ileocecal valve when implanted, as compared with a downstream position of the distal opening 2972.
  • the body 2950 includes the plurality of struts 2955, which can be formed in any suitable manner (such as those disclosed with respect to other embodiments).
  • the struts 2955 extend substantially in a longitudinal direction, but are each angled relative to a longitudinal direction.
  • the longitudinal direction generally refers to lines that run parallel to or are collinear with the longitudinal axis ALONG. Stated otherwise, the longitudinal direction can correspond to the proximal-to-distal orientation.
  • the stmts 2955 are curved convexly outward to define the bulbous shape depicted in FIG. 30A.
  • adjacent stmts 2955 cooperate to define a plurality of windows or openings 2956 into the primary passageway 2970.
  • One of such openings 2956 may desirably be aligned with the ileocecal valve in manners such as previously described.
  • the openings 2956 are shaped substantially as elongated diamonds, with curved sides and pointed ends.
  • the openings 2956 may also be described as substantially vesica piscis-shaped.
  • the body 2950 may be said to define a substantially oblate spheroid or bulbous shape when in the expanded state.
  • the body 2950 may not expand as far outwardly when in the cecum, due to resistance to expansion provided by the cecal wall. This may be seen, for example, in FIGS. 40A-40C (discussed further below), in which the implanted body 2950 defines a substantially prolate spheroid shape.
  • the bulbous or spheroid (whether oblate or prolate) shape defined by the body 2950 in the expanded state can be significantly shorter than the elongated cylindrical shape defined by the body 2950 when in the low-profile state. Stated otherwise, the expanded-state length LEXP of the body 2950 can be substantially shorter than the low-profile-state length Lpp. In contrast, a maximum width WEXP and maximum diameter DEXP of the body 2950 in the expanded state can be substantially larger than the maximum width Wpp and the maximum diameter Dpp of the body 2950 in the low-profile state.
  • the maximum length LEXP of the body 2950 in the expanded state can be no greater than about 4, 5, 6, 7, or 8 centimeters.
  • the maximum width WEXP and/or the maximum diameter DEXP of the body 2950 in the expanded state can be no less than about 5, 6, 7, 8, 9, 10, 11, or 12 centimeters. It may be said that the device 2900 has a low length-to-width aspect ratio when in the expanded state.
  • the maximum length LEXP can be larger than the maximum diameter DEXP by a factor of no greater than 0.75, 1.25,
  • the maximum length Lpp of the body 2950, or of the three- dimensional shape defined thereby, when in the low-profile state is no less than 1.25, 1.5, 1.75, 2.0,
  • the maximum diameter DEXP of the three-dimensional shape or region defined or otherwise bounded by the body 2950 when the body 2950 in the expanded state is no less than 10, 15, 20, 25, or 30 times larger than the maximum diameter Dpp of the three-dimensional shape or region defined or otherwise bounded by the body 2950 when the body 2950 is in the low-profile state
  • FIG. 30B is a top plan view of the device 2900 in the expanded state.
  • the illustrated device 2900 includes 9 substantially symmetrical lobes defined by the struts 2955. Due to the uneven symmetry that results, the maximum diameter DEXP, which passes through a center of the device 2900, is slightly smaller than the maximum width WEXP of the device 2900.
  • the hub 2951 at the distal end of the device 2900 can define an opening that is substantially smaller than the opening 2971 at the proximal end of the device 2900. In other embodiments, the opening at the distal end is larger than that at the proximal end.
  • the device 2900 includes what may be termed a“closed” distal end and an open proximal end (from the perspective of the digestive tract of the patient). That is, although the distal end includes large openings or windows 2956, the struts 2955 meet together in a narrow cluster near a longitudinal axis of the device 2900. In some instances, this narrow cluster or hub 2951 can block material from moving through the cecum.
  • solid waste may pass into the primary passageway of the device 2900 through the ileocecal valve, may proceed toward the distal end of the device through the passageway of the device 2900, and may and catch on the hub.
  • the distal end can be open, such as in a manner identical or similar to the proximal end of the device 2900.
  • the struts 2955 can be gently sloped to assist in distributing forces at the strut/wall interface in a manner that reduces trauma to the wall.
  • the slopes at the apices may be even flatter than those shown in FIG. 30B.
  • the struts 2955 can include notched, narrowed, necked, or tapered regions 2959— i.e., regions of reduced thickness— in the proximity of the hub 2951. In some instances, such regions of reduced thickness allow for greater flexure of the struts 2955 in this region. This can assist in achieving the oblate spheroid shape depicted in FIGS. 30A and 30G.
  • the struts 2955 define three discrete rows of interlocked or interdigitated windows 2956. Each row of windows 2956 extends about a full periphery of the device 2900.
  • the medical device 2900 may closely resemble the device 2200 discussed above, and may be deployed via a method similar to those described with respect to FIGS. 23A-23K and 24.
  • the medical device 2900 is advanced through the working channel of an endoscope while in a contracted or low-profile state (FIG. 29) and delivered from the distal end (relative to the practitioner) of the endoscope into the cecum, where the medical device 2900 is permitted to self- expand.
  • the device 2900 may be preloaded in the endoscope so as to be positioned at the distal end of the scope, the scope is then advanced into the bowel to the cecum, and then the device 2900 is delivered into the cecum.
  • the medical device 2900 is so delivered from the distal end of the endoscope via a push rod, such as discussed above with respect to FIG. 24.
  • the medical device 2900 expands the cecum to a pathophysiological size.
  • the medical device 2900 may push on, press outwardly against, or bear against discrete or specific regions of the cecal wall, which can expand the cecum.
  • outward forces exerted by the strut structure of the medical device 2900 can press on a relatively small portion of the cecal wall (e.g., narrow contact bands) where the struts contact and bear against the wall.
  • those regions of the medical device 2900 that bear against the narrow contact regions (e.g., narrow lines of contact) with the cecal wall can provide pressures within a range of from about 1 to about 10; about 2 to about 6; about 3 to about 5; no less than 1, 2, 3, 4, 5, 6, 7, 8, 9, or 10; or no greater than about 1, 2, 3, 4, 5, 6, 7, 8, 9, 10 psi.
  • At least a portion of the medical device 2900 presses outwardly against abutting portions of the cecal wall at a pressure of about 1, 2, 3, 4, or 5 psi.
  • the medical device 2900 may press outwardly at lower pressures.
  • smoother and/or wider struts may be used, which may distribute outwardly directed forces over a greater area and thereby reduce pressures applied at contact regions of the cecal wall.
  • the medical device 2900 is then securely attached to the cecum.
  • clips are used to secure the medical device 2900 to the cecum.
  • the portions of the medical device 2900 that press against the cecal wall can induce acute and chronic inflammation of the wall.
  • the chronic inflammation can be accompanied by fibrosis.
  • the struts may include relatively sharp or angular edges that dig into the cecal wall. The sharp edges may result, for example, from manufacturing processes, such as laser cutting.
  • the fibrosis may occur along the regions of the cecal wall to which force is imparted from the struts of the medical device 2900. The fibrosis can thicken the cecal wall in these contact regions.
  • tissue ingrowth between, over, or around the struts can maintain the medical device 2900 securely fastened to the cecum and may, in some instances, inhibit explanting of the medical device 2900. More generally, outward forces provided to the cecal wall by the medical device 2900 can result in thickening of certain portions of the cecal wall.
  • Implantation of the medical device 2900 can further result in alteration of the microbiome of the patient, e.g., within the cecum.
  • a composition of the microbiome may change in a way that alters metabolic capabilities of the patient. That is, the microbiome may change from an “obese” microbiome (i.e., a microbiome associated with a physiological state of obesity) to or toward a“lean” microbiome (i.e., a microbiome associated with a physiological state of leanness).
  • Obese microbiomes may, for example, be associated with phylum-level changes in the microbiota, reduced bacterial diversity, and altered representation of bacterial genes and metabolic pathways, as compared with lean microbiomes.
  • one or more of a number of phenomena that may result from the enlargement of the cecum due to expansion of the medical device 2900 therein can individually cause and/or collectively contribute to subsequent weight loss for the patient.
  • One of these phenomena is the signaling of a colo-gastric brake that can result directly from distention of the cecum due to expansion of the medical device 2900. This may be the sole phenomena responsible for weight loss due to the medical device 2900, may be one of multiple factors, or may not be present at all.
  • One or more of the foregoing phenomena may be interrelated.
  • a number of entities are brought to the inflammation site, such as white blood cells (e.g., neutrophils).
  • other entities are brought to the inflammation site, such as lymphocytes and plasma cells.
  • the presence of these entities or cells can alter the microbiome of the cecum.
  • fibrosis can be interrelated with chronic inflammation of the cecum.
  • fibrosis of the cecum may individually cause and/or contribute to weight loss due to interruption of pacemaker currents or signals or other effects on pacemaker activity in the cecum.
  • the strut pattern of the device 2900 can yield a complementary pattern of fibrosis in the cecum.
  • the illustrative strut patterns 2992, 2994 outlined in FIG. 30G can result in complementary fibrosis regions, patterns, or lines 2996, 2998 of the cecum, which are schematically depicted in FIGS. 31A and 31B.
  • These complementary patterns (strut pattem/fibrosis pattern) can extend about a full periphery or circumference of each of the device 2900 and the cecum, respectively.
  • a number of generally transversely directed, continuous wavy lines that follow the strut pattern can extend about an entirety (e.g., a full periphery) of the device 2900.
  • These lines 2992, 2994 may also be referred to as force -application lines or regions.
  • the resultant lines or regions of fibrosis 2996, 2998 (FIGS. 31A and 31B) likewise can extend about a full periphery of the cecum.
  • One or more of the substantially continuous lines of fibrosis 2996, 2998 may interrupt pacemaker signals of the gut, similar to interruption of pacemaker signals that result from scarring or ablation patterns in various Cox-maze procedures for treatment of atrial fibrillation in the heart.
  • the lines of fibrosis 2996, 2998 need not extend about a full periphery of the cecum to adequately disrupt the pacemaker signaling to achieve weight loss. In other instances, extension of the fibrotic lines about a full periphery of the cecum yields proper disruption of pacemaker signaling to achieve weight loss.
  • FIGS. 32A and 32B depict another embodiment of an expandable medical device 3000 similar to other devices disclosed herein.
  • the device 3000 is self-expanding, whereas in others, the device 3000 is not self-expanding and may instead be expanded with a balloon catheter or in any other suitable manner.
  • the medical device 3000 can include a body 3050 that includes a plurality of interconnected struts 3055.
  • the struts 3055 may form a pattern similar to that of the device 2900, or with slight modifications, as shown.
  • a distal end 3010 of the device 3000 may be closed in a manner to the device 2900, with the struts meeting together at a narrow hub.
  • a proximal end 3012 is open when the device 3000 is in an expanded state.
  • the distal end 3010 is open and the proximal end 3012 is closed, and in still other embodiments, both the distal and proximal ends 3010, 3012 are open.
  • the medical device 3000 can further include a covering 3080 of any suitable variety.
  • the covering 3080 comprises a cover 3082 that extends about an outer periphery of the body 3050.
  • the cover 3082 can be attached to the body 3050 in any suitable manner, including those known in the art and those yet to be devised.
  • the cover 3082 may be sutured or otherwise fastened to the body 3050.
  • the cover 3082 may be molded over or otherwise secured to the body struts 3055.
  • the medical device 3000 may be referred to as a covered stent (consistent with the manner in which the term“stent” is used herein).
  • the cover 3082 may resemble coverings used in biliary stents.
  • the cover 3082 may comprise one or more of polycarbonate, polyurethane, silicone, polytetrafluoroethylene (ePTFE), fluorinated ethylene propylene (FEP), polytetrafluroethylene (PTEF), or PermalumeTM. Any other suitable material is contemplated.
  • the presence of the cover 3082 can reduce inflammation and fibrosis of the cecum and can prevent or inhibit tissue ingrowth.
  • the mid or central region of the device 3000 applies a greater amount of force to the cecal wall than do the proximal and distal ends of the device 3000. This can result from the geometry of the device.
  • the substantially oblate spheroid or bulbous shapes previously disclosed expand the cecum most in the central region.
  • the illustrated device 3000 defines a rounded substantially bicone shape, with an enlarged diameter in the mid region. The device 3000 thus may likewise press most firmly against the cecal wall in this intermediate region.
  • Regions such as these which may provide the greatest expansion to the cecum, may correspond to the regions of the cecum that experience the greatest inflammation, fibrosis, and ingrowth.
  • the cover 3082 can be applied to at least this middle region, such as in the illustrated embodiment, thereby significantly reducing, minimizing, or eliminating these phenomena.
  • the cover 3082 can facilitate retrieval of the device 3000 after the device has expanded the stent for a desired amount of time. Retrieval processes such as those disclosed elsewhere herein are contemplated.
  • the cover 3082 may be substantially open to permit passage thereby of material that naturally works its way through the cecum.
  • the cover 3082 extends about a medial region of the device 3000, but does not extend over the distal ends of the struts 3050, which gather together toward a narrow hub region. This may facilitate passage of material through the distal end of the device 3000.
  • the body 3050 may define a large open end.
  • the cover 3082 may fully extend to the distal end of the body 3050.
  • the cover 3082 may include an opening (not shown) therethrough to ensure the ileocecal valve remains unobstructed. During deployment of the device 3000, the practitioner may align the opening with the ileocecal valve, and material can pass from the ileocecal valve into an interior of the device 3000.
  • the cover 3082 is shown substantially fully at an exterior of the body 3050 when the device 3000 is in the low-profile or collapsed state. In other embodiments, at least a portion of the cover 3082 may be positioned at an interior of the body 3050 in this collapsed state. In various embodiments, the cover 3082 may be thin and/or highly expansible to readily transition from the collapsed state to the expanded state. In other of further embodiments, the covering 3080 may additionally or alternatively include a coating applied directly to the body 3050, such as any suitable coating described elsewhere herein.
  • FIGS. 33A-33C are various views of another embodiment of an expansion medical device 3100, which can closely resemble other devices disclosed herein in many respects.
  • the device 3100 is shown in a low-profile state in FIGS. 33A-33C, and can be configured to transition to an expanded state resembling that of other devices herein, such as, for example, any of the devices 2200, 2900, 3000.
  • the device 3100 includes a body 3150 to which is applied a covering 3180 that can inhibit or prevent inflammation, fibrosis, and/or tissue ingrowth.
  • the covering 3180 comprises a coating 3184 applied directly to the body 3150.
  • the coating may comprise an eluting material, such as for example, a drug-eluting composition of any suitable variety, including those described elsewhere herein.
  • the coating 3184 may be applied to the body 3150 in any suitable manner, including those known in the art and those yet to be devised.
  • the coating 3184 is restricted to an intermediate region between the proximal and distal ends of the body 3150, similar to the region of the body 3050 covered by the covering 3080 (see FIGS. 32A and 32B). In other embodiments, the coating 3184 may cover more of the body 3150. For example, in various embodiments, the coating 3184 covers no less than 50, 60, 70, 80, 90, or 95 percent of a surface area of the body 3150.
  • the device 3100 can be configured for retrieval, such as after passage of a therapeutically effective period.
  • the covering 3180 can facilitate removal of the device 3100 from the cecum.
  • the device 3100 includes a distal end 3110 that facilitates or assists in collapsing of the device 3100 from an expanded state to a low-profile state, as described further hereafter.
  • each distal strut 3155 at one side of the body 3150 can slope or curve toward the other side of the body 3150, and all of the struts 3155 can gather toward a distal tip 3186 that is offset to one side of a longitudinal axis ALONG defined by the body 3150.
  • each distal strut 3155 can define an angle relative to the longitudinal axis ALONG within a fist plane (i.e., the plane of the drawing sheet) that is no greater than the acute angle a.
  • a fist plane i.e., the plane of the drawing sheet
  • each distal strut 3155 can define an angle relative to the longitudinal axis ALONG within a second plane that is orthogonal to the first plane (i.e., the plane of the drawing sheet) that is no greater than the acute angle b.
  • first plane i.e., the plane of the drawing sheet
  • each of the uppermost and lowermost struts define the greatest (in magnitude) angle, ⁇ b, relative to the longitudinal axis ALONG, the inner or intermediate struts define progressively smaller (in magnitude) angles relative to the longitudinal axis ALONG, and the center strut is substantially parallel to the longitudinal axis ALONG.
  • the angles a and b may be equal, or one may be larger than the other.
  • one or more of the distal struts may define a maximum acute angle relative to the longitudinal axis ALONG, and each distal strut can define an angle relative to the longitudinal axis ALONG that is less than or equal to that maximum angle.
  • the maximum acute angle is no greater than 5, 10, 15, 20, 25, 30, or 35 degrees.
  • each of the distal struts may be circumscribed by a cone having a vertex centered at the distal tip 3186, and an apex angle of the cone may be acute.
  • the apex angle of the cone is no greater than 10, 20, 30, 40, 45, or 50 degrees.
  • the distal tip 3186 is offset relative to the longitudinal axis ALONG. Likewise, each of the struts 3155 at the distal end of the body is positioned exclusively at one side of a plane that passes through the central longitudinal axis of the body when the body is in the low-profile state.
  • the distal tip 3186 includes a connection hub 3151 or connector to selectively attach to a retrieval device, such as a threaded push rod or pull rod such as previously disclosed.
  • the connection hub 3151 comprises an internally threaded tube. Other retrieval mechanisms are contemplated.
  • the device 3100 may be connected to a pull rod and drawn directly into the working channel of an endoscope or may be drawn into a retention or retrieval sheath.
  • an opening or leading edge of the working channel or retention sheath can be a substantially fixed or rigid shape, such as a circle.
  • the angled distal end 3110 of the device 3100 can be configured to facilitate entry of the device 3100 through the opening and/or collapse of the device 3100 as it is advanced into a lumen of the working channel or retrieval sheath. For example, as the angled distal struts 3155 are pressed against the leading edge of the channel or sheath, the forces applied to the distal struts 3155 work to collapse the body 3150 to the low-profile state.
  • FIGS. 34A and 34B depict another embodiment of an expansion device 3200 configured for deployment in the cecum of a patient, the device 3200 being depicted in a low-profile, collapsed, or undeployed orientation, state, or configuration in FIG. 34A and being depicted in an expanded, enlarged, or deployed configuration in FIG. 34B.
  • the device 3200 can resemble certain of the devices discussed above in many respects, such as (among others) the device 1200.
  • Various disclosures regarding the device 1200 and other devices disclosed herein are equally applicable to the device 3200, and might not be repeated, consistent with the disclosure convention previously discussed. Similarly, disclosures hereafter regarding the device 3200 can apply to other devices as well.
  • the device 3200 can include a body 3250 that is configured to transition from the low-profile state to the expanded state.
  • the body 3250 can be formed of any suitable material, such as, for example, any metallic (e.g., stainless steel), shape- memory alloy (e.g., Nitinol), resilient polymer, superabsorbent polymer, or other material. Other suitable materials are contemplated, including without limitation those discussed above with respect to the device 1200.
  • the material is a resiliently flexible material that is capable of being retained in the low-profile state, such as when retained within a tubular structure (e.g., the working channel of an endoscope) or otherwise retained in a substantially linear profile, and automatically transitioning to the expanded state to define a three-dimensional profile upon and/or after having been advanced out of the tubular structure.
  • the body 3250 is formed as a single elongated element, such as a rod or wire.
  • the illustrated wire defines a substantially circular cross-section. Other cross-sectional shapes are contemplated (oval, rectangular, diamond, etc.)
  • the term“linear” does not necessarily connote rectilinearity, but rather, connotes a relatively straight line and/or a configuration in which the body 3250 is constrained to follow the contour of an elongated member (such as, e.g., a guidewire, guide tube, or endoscope), and thus does not independently delineate a three-dimensional volume.
  • the body 3250 may be said to be substantially collinear with a working channel or retention tube within which the body 3250 is restrained, contained, or otherwise loaded, and thus may also be termed as being in a collinear or in-line configuration.
  • linear “linear,”“in-line,” and“collinear” are sufficiently broad to include deviations from rectilinearity, such as in circumstances in which the body 3250 is loaded within the working channel of an endoscope that is bent within the bowel of a patient.
  • the body 3250 may also be said to be in a constrained or confined state when in the low- profile state, such as when loaded within a working channel or a retention tube.
  • the body 3250 can define a maximum length LLP and a maximum width WLP.
  • the maximum length LLP can be no less than about 10, 15, 20, 25, 30, 35, 40, 45, 50, 55, 60, 65, 70, 75, 80, 85, 90, 95, or 100 centimeters.
  • the maximum length LLP can be significantly longer than for embodiments such as the device 2900, as a single elongated element is reconfigured from a linear profile to form a three-dimensional shape upon transition from the low-profile to the high-profile or expanded state.
  • the device 2900 in contrast, transitions from a three-dimensional tubular shape having a cylindrical profile, which is defined by a plurality of struts, to a three-dimensional tubular shape having a bulbous profile, as defined by the same plurality of struts (see FIGS. 29-30G).
  • the maximum width WLP is substantially constant along a full length of the body 3250 and corresponds to an outer diameter D pp of the body 3250.
  • the body 3250 can be tightly oriented about a longitudinal axis ALONG defined thereby. Stated otherwise, the device 3250 can be narrow or can define a very low profile so as to be able to be advanced through at least a portion of a working channel of an endoscope, such as a colonoscope.
  • the outer diameter DLP can be smaller than 3.5, 3.6, 3.7, 3.8, 3.9, or 4.0 millimeters
  • the body 3250 is substantially solid. Accordingly, the outer diameter DLP may be said to extend exclusively through an internal region of the body 3250. This is in contrast, for example, to the device 2900 when in the low-profile state. There, the outer diameter DLP extends through the primary passageway 2970 defined by the tubular body 2950. Stated otherwise, the tubular body 2950 of the device 2900 defines a hollow, substantially cylindrical region (which may also be referred to as a three-dimensional region or as a tubular region), and the outer diameter DLP extends through both the body 2950 and through the open lumen, hollow interior, or open space defined by the body 2950.
  • the device 3200 can have a high length-to-width aspect ratio when in the low-profile state.
  • the maximum length LLP can be larger than the maximum diameter DLP by a factor of no less than 20, 25, 30, 35, 40, 45, 50, 60, 70, 80, 90, 100, 125, 150, 175, 200, or 225.
  • the body 3250 may be said to define a substantially spiraled or helical shape or profile when in the expanded state. Whereas the body 3250 defines a substantially linear profile when in the low-profile state, the body 3250 demarcates, defines, or otherwise bounds a three-dimensional shape or region.
  • the helical shape substantially corresponds to a cylinder having a maximum length LEXP and a maximum width WEXP, which directly corresponds to a maximum diameter DEXP.
  • the cylindrical shape defined by the body 3250 in the expanded state can be significantly shorter than the linear profile of the body 3250 when in the low-profile state. Stated otherwise, the expanded-state length LEXP of the body 3250 can be substantially shorter than the low-profile-state length LLP. In contrast, a maximum width WEXP and maximum diameter DEXP of the body 3250 in the expanded state can be substantially larger than the maximum width Wp p and the maximum diameter Dp p of the body 3250 in the low-profile state.
  • the maximum length LEXP of the body 3250 in the expanded state can be no greater than about 4, 5, 6, 7, or 8 centimeters.
  • the maximum width WEXP and/or the maximum diameter DEXP of the body 3250 in the expanded state can be no less than about 5, 6, 7, 8, 9, 10, 11, or 12 centimeters. It may be said that the device 3200, or a three-dimensional shape defined thereby, has a low length-to-width aspect ratio when in the expanded state.
  • the maximum length LEXP can be larger than the maximum diameter ⁇ EXP by a factor of no greater than 0.75, 1.25, 1.5, 1.75, 2, 2.25, 2.5, 2.75, 3.0, or 3.5.
  • the maximum length LLP of the body 3250, or of the linear shape defined thereby, when in the low-profile state is no less than 1.25, 1.5, 1.75, 2.0, 2.5, 3.0, 3.5, 4.0, 4.5, 5, 6, 7, 8, 9, 10, 15, 20, 25, or 30 times larger than the maximum length LEXP of the three-dimensional shape or region defined or otherwise bounded by the body 3250 when in the expanded state.
  • the maximum diameter DEXP of the three-dimensional shape or region defined or otherwise bounded by the body 3250 when the body 3250 in the expanded state is no less than 10, 15, 20, 25, or 30 times larger than the maximum diameter DLP of the body 3250 when in the low-profile state.
  • the body 3250 does not define a passageway when in the low-profile state, but does define a passageway 3270 when in the expanded state.
  • the device 3200 further defines an extended opening 3271 or window into the passageway 3270.
  • the opening 3271 is defined by adjacent portions of the body 3250 and spirals around the substantially cylindrical shape demarcated by the body 3250.
  • any suitable variations of the device 3200 are contemplated. For example, different numbers and/or arrangements of loops or turns are contemplated. Other three-dimensional shapes or configurations than substantially cylindrical are also contemplated. For example, in other embodiments, a shape generally demarcated by the device 3200 in the expanded state, such as by spiral contours defined thereby, may be substantially bulbous (see FIG. 38).
  • the body 3250 of the illustrated device 3200 can comprise an elongate wire or rod 3255.
  • the rod 3255 When deployed, the rod 3255 may come into direct contact with the sidewall of the cecum.
  • the rod 3255 may be placed within the cecum via an endoscope, catheter, or in any other suitable manner.
  • FIG. 35B depicts another embodiment of a device 3300 that is substantially the same as the device 3200.
  • the device 3200 includes an elongated body 3350 such as the body 3250 shown in FIGS. 34A and 34B.
  • the body 3250 is formed of an elongated tube 3355 (of any suitable material disclosed herein) that defines a channel or lumen 3377.
  • the lumen 3377 is sized to pass over a guidewire.
  • the guidewire may constrain the body 3250 to the linear profile.
  • the device 3300 may be introduced into the cecum via an endoscope and/or the guidewire.
  • the device 3300 may be introduced into the cecum over a guidewire, whether in conjunction with or independently from an endoscope.
  • Visualization other than that provided by an endoscope e.g., fluoroscopy
  • fluoroscopy may be employed in certain of such methodologies.
  • FIG. 35C depicts another embodiment of a device 3400 that includes a body 3450 which is substantially the same as the device 3200.
  • the body 3450 includes a rod 3455 such as the rod 3255.
  • the device 3400 further includes a covering 3480, such as a layer of material or coating 3486. Any suitable covering, layer, or coating is contemplated, as are any suitable method for applying the same to the rod 3455 (for example, dipping, spraying, overmolding, etc.).
  • the covering 3480 or coating 3486 may be said to encapsulate, encompass, enclose, envelop, wrap, sheathe, or cover at least a portion of the body 3450.
  • the covering 3480 comprises an eluting composition.
  • the covering 3480 comprises a polymeric material, such as, for example, silicone.
  • the covering 3480 may, for example, inhibit inflammation, fibrosis, and/or tissue ingrowth.
  • the covering 3480 may render the device 3400 more suitable for long-term placement within the patient.
  • the cecum may better tolerate the device 3400 due to the covering 3480. This may, in some instances, permit the device 3400 to remain within the patient indefinitely and/or in other or further instances, may facilitate removal of the device 3400 if and when desired.
  • FIG. 35D depicts another embodiment of a device 3500, which includes a body 3550 formed as a tube 3555, similar to the body 3350 of FIG. 35B.
  • the device 3500 further includes a covering 3580, such as a coating or layer 3586, which can resemble the covering 3480.
  • the foregoing relevant disclosures thus apply to the device 3500.
  • the device 3500 can further define a lumen 3577, such that the device 3500 may suitably be used with a guidewire in manners such as previously disclosed.
  • FIG. 35E depicts another embodiment of a device 3600, which includes a body 3650 formed as a rod 3655, similar to the body 3250 of FIG. 35A.
  • the rod 3655 may function in manners such as the rod 3255.
  • the device 3600 further includes a covering 3680, which is formed as tube 3686.
  • the tube 3686 may be polymeric and/or may include, for example, any of the other materials previously described with respect to coverings.
  • the rod 3655 is embedded within a sidewall of the tube 3686.
  • the tube 3686 defines a lumen 3677 that may suitably be used with a guidewire in manners such as previously disclosed.
  • any of the devices 3300, 3400, 3500, 3600 may generally function in manners such as described with respect to the device 3200.
  • the devices 3300, 3400, 3500, 3600 are configured to transition from a low-profile configuration, such as that depicted in FIG. 34A, to an expanded configuration, such as that depicted in FIG. 34B.
  • FIGS. 36A and 36B depict stages of an illustrative method of expanding the cecum 110 of a patient using the device 3200.
  • the device 3200 is loaded into the working channel 262 of an endoscope 250 in a low-profile state, such as by advancing the device 3200 distally through the working channel 262.
  • the endoscope 250 is then inserted through the bowel of the patient into the cecum 110.
  • a practitioner may position the distal end (from the practitioner’s perspective) of the endoscope 250 at the proximal end (relative to the gastrointestinal tract) of the cecum 110.
  • the device 3200 is then advanced out of the endoscope 250 and into the cecum 110.
  • the device 3200 may be pushed through the working channel 262 via a push rod or the like.
  • exiting the working channel 262 frees the device 3200 from being constrained to a linear profile, and the device 3200 naturally or automatically transitions to the expanded state.
  • the device 3200 comprises a resilient material that naturally coils into a spiraled configuration, such as the illustrated helix, as the device 3200 is advanced out of the channel 262.
  • the coiling occurs immediately upon exiting the channel 262, whereas in others (such as in certain shape-memory embodiments), there may be a delay before coiling occurs.
  • the practitioner may visualize the ileocecal valve ICV and positioning of the body 3250 during deployment of the device 3200 to ensure that the ileocecal valve ICV remains unobstructed. Stated otherwise, the practitioner may visualize positioning of the body 3255 against the cecal wall to ensure that the side window 3271 is aligned with the ileocecal valve ICV.
  • FIG. 36B depicts a stage at which the device 3200 has been fully deployed within the cecum 3200. In some embodiments, no further attachment of device 3200 to the cecum 110 is performed.
  • the endoscope 250 may be retracted from the patient and the device 3200 left in place for a therapeutically effective period. As previously discussed, in various methods and for various different embodiments, the device 3200 may be retracted via a subsequent colonoscopy (such as, e.g., by snaring the device 3200 into the working channel 262), may be left to degrade through bioresorption and may ultimately pass naturally through the colon, or may be left in place indefinitely.
  • a subsequent colonoscopy such as, e.g., by snaring the device 3200 into the working channel 262
  • FIG. 37 depicts a stage of an additional illustrative method.
  • the initial stages may proceed in manners such as discussed with respect to FIGS. 36A and 36B.
  • one or more mechanical fasteners 3710 may then be used to secure the device 3200 to the cecum 110.
  • one mechanical fastener 3710 specifically a hemoclip 3712, has been used to attach the body 3255 to the cecal wall. This can be accomplished by advancing a hemoclip delivery device 3700 through the endoscope 250 in manners known in the art. Any suitable number of hemoclips and/or other fasteners may be used. In the illustrated method, more hemoclips will subsequently be used to secure the body 3255 in place.
  • FIG. 38 depicts a stage of another illustrative method, similar to that depicted in FIG. 36B, in which another embodiment of an expandable medical device 3800 has been delivered to the cecum of the patient via an endoscope 250.
  • the medical device 3800 substantially resembles the device 3200, but forms a bulbous shape, rather than a cylindrical shape, when fully deployed. Like the device 3200, the device 3800 assumes a spiraled form when fully deployed. Other configurations are also contemplated.
  • FIG. 39 depicts a stage of another illustrative method in which multiple devices are deployed within the cecum.
  • a first spiraled device 3900 is deployed into contact with the cecum in manners such as previously disclosed.
  • the device 3900 may define a longitudinal axis A .
  • a second device 4000 is inserted into an interior of the first deployed device 3900 in manners such as previously disclosed, such as by advancing the device 4000 out of the working channel of an endoscope at a position internal to the device 3900.
  • the second device 4000 may be permitted to self-expand and come into contact with the cecal wall and/or the first device 3900.
  • the second device 4000 can define a second longitudinal axis A .
  • the axes A , A may be an angle g relative to each other. Such an arrangement can allow for more distributed forces to expand the cecal wall.
  • the angle g is no less than about 45, 60, 75, or 90 degrees. In the illustrated embodiment, the angle is substantially 90 degrees.
  • the target implant location for all animals was the cecum, although a colonoscopy at implant and a gross necropsy analysis revealed that a portion of one of the stents was deployed in the ascending colon.
  • Cecal implantation of the stent was successful for the remaining two animals. Hemoclips were applied endoscopically to appose each stent to the bowel.
  • FIGS. 40A, 40B, and 40C are fluoroscopy images 4102, 4104, 4106 of an expansible device 4200 implanted within the cecum of one of the test subjects at the day of implant, 7 days post-implant, and 28-days post-implant, respectively.
  • High protein/calorie supplements were started on study day 26 in order to support animal health, welfare, and humane body condition due to the rapid weight loss of the animals.
  • the supplements included hamburgers, eggs, whey, and Ensure.
  • high protein/calorie supplements in addition to their standard dry food, the animals still showed marked weight loss from baseline, as discussed further below.
  • FIG. 41 is a bar graph 4300 comparing the food intake activity of the three test subjects during three discrete time increments: pre -implant; days 1-25 post-implant; and days 26-90 post implant.
  • the test subjects in which the expansible device was accurately deployed in the cecum are represented by the shading identified at 4302 and 4304.
  • the test subject in which the expansible device was partially deployed in the ascending colon is represented by the shading identified at 4306.
  • FIG. 42 is a plot 4400 showing the averaged food intake activity of all three test subjects.
  • Veterinarian checks for body condition are performed when an animal appears too thin. Weight loss and/or appearing thin prompted veterinarian checks for all animals on study days 19, 25, and about 39. The veterinarian check at day 25 prompted commencement of supplementation on study day 26 for all animals.
  • FIG. 43 is a plot 4500 showing subject weight over time for each of the test subjects.
  • the lines 4502, 4504 correspond to the test subjects in which the expansible device was accurately deployed in the cecum; the line 4506 corresponds to the test subject in which the expansible device was partially deployed in the ascending colon.
  • the host cellular response to the strut wires was most pronounced at the strut/mucosa and strut/submucosa interfaces where there was associated mucosal ulceration, strut tract debris accumulation (cellular and digesta), and variable bacterial colonization.
  • the host cellular response was mixed and generally chronic-active, composed of neutrophils, macrophages and lymphocytes. Cellular aggregates were also associated with multiple deeper strut locations (subserosa, muscular tunic) and it is speculated these cellular infiltrates represent continuing inflammation along the wire tract within the intestinal wall.
  • Device implant was associated with decreased food intake and weight loss in all animals, however once weight loss became greater than about 10% of initial baseline weight, more dramatic declines in feed intake were observed, which were correlated with further, exacerbated weight loss.
  • supplementation with high calorie/protein food commenced, and this was successful at maintaining body condition and weight in all animals for the duration of the study.
  • diarrhea/soft-stool were seen throughout the post implant period, this was not associated with any adverse clinical events or pathology.
  • the marked weight loss, recurrent soft-stool, and strut fracture in 2 out of 3 animals all animals remained generally healthy for the duration of the study.
  • test devices maintained their approximate positioning in the bowel throughout the study duration, and performed as expected in that they were observed to expand radially outward after deployment.
  • fluoroscopy revealed strut fractures in two out of three devices within one week of implant, and this was confirmed upon gross examination. No bowel perforation was observed in this canine animal model.
  • any of the methods described in this disclosure and/or the following claims may be used with any applicable medical device and/or system described in this disclosure and/or the following claims, as appropriate.
  • any of the kits disclosed herein and/or in the claims that follow can include instructions for carrying out any of the methods recited in this disclosure and/or in the claims that follow, as appropriate. This disclosure includes all permutations of the independent claims with their dependent claims.

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Abstract

L'invention concerne divers dispositifs, systèmes et méthodes qui peuvent être utilisés dans le traitement de l'obésité et de maladies associées. Dans certains cas, le cæcum d'un patient obèse est distendu à une taille pathophysiologique durant une période thérapeutiquement efficace. La distension peut être obtenue par l'introduction d'un objet qui est d'origine étrangère par rapport au corps du patient dans le cæcum du patient. Dans certains cas, la distension est réalisée par un dispositif médical qui passe d'un état non déployé, dans lequel le dispositif médical est introduit dans le cæcum du patient, à un état déployé dans lequel le dispositif médical distend le cæcum de façon suffisante pour déclencher un frein colo-gastrique chez le patient.
PCT/US2019/039575 2018-06-27 2019-06-27 Dispositifs, systèmes et méthodes de traitement de l'obésité WO2020006279A1 (fr)

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US10596021B2 (en) 2016-12-23 2020-03-24 Ganz Brake, Llc Obesity treatment devices, systems, and methods
US11464660B2 (en) 2016-12-23 2022-10-11 Ganz Brake, Llc Obesity treatment devices, systems, and methods

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