Devices, systems and methods for diagnosing and delivering therapeutic interventions in the peritoneal cavity

Abstract

A device and system are described that are capable of isolating at least one targeted tissue and forming an anastomosis between two internal body structures though a completely endoscopic procedure. Further, the device and system described generally comprise two tubular members that are capable of moving in a telescopic fashion relative to one another. Additionally, a method is described for using the device and/or system to bypass the duodenum from digestion.

1 . An endoscopic device comprising:
 a outer tubular member for placement within a lumen, the outer tubular member comprising a first vacuum channel, a first compartment, a first end and a second end, the first vacuum channel and the first compartment each comprising an interior and extending to the second end of the outer tubular member; and   a first vacuum port disposed on the outer tubular member, the first vacuum port in communication with the interior of the first vacuum channel and adapted for operative connection with a vacuum source;   wherein the first vacuum channel comprises a first suction port disposed at or near the second end of the outer tubular member, the first suction port adapted to form a reversible seal with a targeted tissue when the vacuum source is operatively connected to the first vacuum port.   
   
   
       2 . The endoscopic device of  claim 1 , wherein the reversible seal is sufficiently strong such that a retracting force applied to the outer tubular member is also applied to the targeted tissue. 
   
   
       3 . The endoscopic device of  claim 1 , further comprising:
 a catheter comprising a first end and a second end, the catheter slidably disposed within the interior of the first compartment, the second end of the catheter adapted to advance and retract through the second end of the outer tubular member.   
   
   
       4 . The endoscopic device of  claim 1 , further comprising:
 a inner tubular member slidably disposed within the interior of the first compartment of the outer tubular member, the inner tubular member comprising a second vacuum channel, a second compartment, a first end and a second end, the second vacuum channel and the second compartment each comprising an interior and extending to the second end of the inner tubular member.   
   
   
       5 . The endoscopic device of  claim 4 , wherein the second end of the inner tubular member is adapted to telescopically advance through the second end of the outer tubular member. 
   
   
       6 . The endoscopic device of  claim 4 , wherein the interior of the second compartment is configured to slidably receive at least one instrument from the first end of the inner tubular member. 
   
   
       7 . The endoscopic device of  claim 6 , further comprising:
 at least one instrument slidably disposed within the interior of the second compartment.   
   
   
       8 . The endoscopic device of  claim 7 , wherein at least one of the at least one instruments comprises a catheter having a first end and a second end, the second end comprising a cutting implement. 
   
   
       9 . The endoscopic device of  claim 7 , wherein at least one of the at least one instruments comprises an optic system instrument. 
   
   
       10 . The endoscopic device of  claim 7 , wherein at least one of the at least one instruments comprises a balloon catheter having a first end, a second end, a balloon positioned proximate to the second end of the balloon catheter, and a needle, wherein the balloon is capable of moving between a deflated position and an inflated position, and wherein the needle is disposed at the second end of the balloon catheter in a straightened configuration such that the needle extends distally from the second end of the balloon catheter. 
   
   
       11 . The endoscopic device of  claim 7 , wherein at least one of the at least one instruments comprises a stent delivery device. 
   
   
       12 - 16 . (canceled) 
   
   
       17 . A system for performing an endoscopic transluminal procedure comprising:
 an outer tubular member for placement in a lumen, the outer tubular member comprising a first vacuum channel, a first compartment, a first end and a second end, the first vacuum channel and the first compartment each comprising an interior extending at least partially between the first end and the second end of the outer tubular member;   an inner tubular member slidably disposed within the interior of the first compartment of the outer tubular member, the inner tubular member comprising a second vacuum channel, a second compartment configured to receive at least one instrument therein, a first end and a second end, the second vacuum channel and the second compartment each comprising an interior extending at least partially between the first end and the second end of the inner tubular member;   a first vacuum port disposed on the outer tubular member at or near the first end thereof, the first vacuum port in communication with the interior of the first vacuum channel and adapted for operative connection with a vacuum source; and   a second vacuum port disposed on the inner tubular member at or near the first end thereof, the second vacuum port in communication with the interior of the second vacuum channel;   wherein the first vacuum channel comprises a first suction port located at or near the second end of the outer tubular member, the first suction port configured to removably attach to a first targeted tissue, and the second vacuum channel further comprises a second suction port located at or near the second end of the inner tubular member, the second suction port configured to removably attach to a second targeted tissue.   
   
   
       18 . The system of  claim 17 , wherein the first suction port of the first vacuum channel is adapted to form a reversible seal with the first targeted tissue when suction is applied through the interior of the first vacuum channel. 
   
   
       19 . The system of  claim 18 , wherein the second suction port of the second vacuum channel is adapted to form a reversible seal with the second targeted tissue when suction is applied through the interior of the second vacuum channel. 
   
   
       20 . The system of  claim 17 , wherein the second end of the inner tubular member is adapted to extend in a telescopic fashion through the second end of the outer tubular member. 
   
   
       21 . (canceled) 
   
   
       22 . The system of  claim 17 , further comprising:
 at least one instrument slidably disposed within the interior of the second compartment of the inner tubular member.   
   
   
       23 . The system of  claim 22 , wherein at least one of the at least one instruments comprises a catheter having a first end and a second end and configured to advance and retract through the second end of the inner tubular member. 
   
   
       24 . The system of  claim 23 , wherein the second end of the catheter comprises a cutting implement. 
   
   
       25 . The system of  claim 23 , further comprising:
 a needle disposed at the second end of the catheter such that the needle extends distally therefrom.   
   
   
       26 . The system of  claim 25 , further comprising a dilation implement disposed at the second end of the catheter. 
   
   
       27 . The system of  claim 23 , wherein the catheter comprises a balloon catheter having a balloon configured to move between a first deflated position and a second inflated position. 
   
   
       28 . (canceled) 
   
   
       29 . The system of  claim 23 , wherein at least one of the at least one instruments comprises a fibroscope configured to facilitate navigation of the second end of the outer tubular member, the second end of the inner tubular member, the second end of the catheter, or at least one of the at least one instruments slidably disposed within the interior of the second compartment. 
   
   
       30 . (canceled) 
   
   
       31 . The system of  claim 17 , wherein the first targeted tissue comprises an interior wall of a stomach and the second targeted tissue comprises an external wall of a jejunum. 
   
   
       32 . The system of  claim 22 , wherein at least one of the at least one instruments comprises a stent delivery system comprising a first end and a second end, the second end of the stent delivery system removably coupled with a stent that is adapted to move between a first compressed position and a second extended position. 
   
   
       33 . The system of  claim 32 , wherein the at least one instrument further comprises an optic system instrument configured to facilitate navigation of the stent delivery system and placement of the stent. 
   
   
       34 . The system of  claim 32 , wherein the stent comprises an autoexpandable cover stent. 
   
   
       35 - 36 . (canceled) 
   
   
       37 . The system of  claim 34 , wherein the stent comprises a ring configuration. 
   
   
       38 . The system of  claim 32 , wherein the stent is adapted to form an anastomosis between the first tissue and the second tissue. 
   
   
       39 . A method for performing an endoscopic procedure, comprising the steps of:
 inserting an endoscopic device through an aperture in the body of a patient, the endoscopic device comprising an outer tubular member having at least one interior and an inner tubular member slidably disposed within an interior of the outer tubular member and having at least one interior;   engaging the endoscopic device with a first targeted tissue;   supplying suction through the at least one interior of the outer tubular member to form a reversible seal between the outer tubular member and the first targeted tissue;   penetrating the first targeted tissue with a catheter slidably disposed within the at least one interior of the inner tubular member such that a first opening is formed in the first targeted tissue;   advancing the inner tubular member through the first opening in the first targeted tissue;   supplying suction through at least one interior of the inner tubular member to form a reversible seal between the inner tubular member and the second targeted tissue;   penetrating the second targeted tissue with the catheter such that a second opening is formed in the second targeted tissue;   positioning a stent at least partially within the first and second openings of the targeted tissues through operation of a stent delivery device slidably disposed within the at least one interior of the inner tubular member; and   forming a sealed anastomosis between the first and second openings by deploying the stent.   
   
   
       40 . The method of  claim 39 , wherein the outer tubular member further comprises a first vacuum port in communication with at least one of the interiors thereof and the inner tubular member further comprises a second vacuum port in communication with at least one of the interiors thereof and the steps of supplying suction through the at least one interior of the outer tubular member and supplying suction through the at least one interior of the inner tubular member further comprise operatively connecting at least one vacuum source to the first and second vacuum ports. 
   
   
       41 . The method of  claim 39 , further comprising the step of:
 manipulating the inner and outer tubular members such that the first opening in the first targeted tissue and second opening in the second targeted tissue are positioned in close proximity and in substantially concentric alignment with one another.   
   
   
       42 . The method of  claim 39 , further comprising the steps of:
 cleaning and sterilizing the first targeted tissue prior to penetrating the first targeted tissue with the catheter, and   cleaning and sterilizing the second targeted tissue prior to penetrating the second targeted tissue with the catheter.   
   
   
       43 . The method of  claim 39 , wherein the first targeted tissue comprises an interior wall of a stomach in a location proximal to the greater curvature of the stomach, and the second targeted tissue comprises an exterior wall of a small intestine in a location proximal to the proximal jejunum. 
   
   
       44 . The method of  claim 43 , further comprising the step of:
 endoscopically inserting a stent into the pylorus of the stomach such that the pyloric portion is occluded and digested matter is prevented from flowing therethrough.   
   
   
       45 . The method of  claim 39 , further comprising:
 an optic system instrument slidably disposed within at least one interior of the inner tubular member and further comprising the step of using the optic system instrument to visually locate the first targeted tissue and the second targeted tissue.   
   
   
       46 . The method of  claim 39 , wherein the catheter further comprises a dilation implement. 
   
   
       47 . The method of  claim 46 , wherein the dilation implement of the catheter comprises a balloon adapted to move between a first deflated position and a second inflated position and further comprising the steps of:
 advancing the balloon in the first deflated position into the first opening of the first targeted tissue;   dilating the balloon into the second inflated position such that the first opening increases in diameter;   deflating and advancing the balloon into the second opening of the second targeted tissue; and   dilating the balloon into the second inflated position such that the second opening increases in diameter.   
   
   
       48 . The method of  claim 46 , wherein the catheter further comprises a needle extending distally from the catheter. 
   
   
       49 . The method of  claim 47 , wherein the first deflated position comprises a first diameter and the second inflated position comprises a second diameter, wherein the first diameter is less than the second diameter. 
   
   
       50 . (canceled) 
   
   
       51 . The method of  claim 39 , further comprising the step of:
 increasing the suction through the at least one interior of the outer tubular member such that the first targeted tissue is temporarily displaced from its normal anatomical position in the body.   
   
   
       52 . A kit comprising:
 an endoscopic device comprising:   an outer tubular member for placement in a gastrointestinal tract, the outer tubular member comprising:
 a first end and a second end; 
 a first vacuum channel extending at least partially between the first end and the second end of the outer tubular member and comprising a first vacuum port, a first suction port, and an interior extending between the first vacuum port and the first suction port, the first vacuum port adapted for operative connection with a vacuum source and the first suction port configured to removably couple with a first targeted tissue; and 
 a first compartment comprising an interior and extending between the first and second ends of the outer tubular member; 
   an inner tubular member slidably disposed within the interior of the first compartment of the outer tubular member, the inner tubular member comprising:
 a first end and a second end; 
 a second vacuum channel extending at least partially between the first and second ends of the inner tubular member and comprising a second vacuum port, a second suction port disposed proximate to the second end of the outer tubular member, and an interior extending between the second vacuum port and the second suction port, the second vacuum port adapted for operative connection with the vacuum source and the second suction port configured to removably couple with a second targeted tissue; and 
 a second compartment comprising an interior and extending between the first and second ends of the inner tubular member; 
 wherein the second end of the inner tubular member is adapted to extend through the second end of the outer tubular member; and 
   a catheter slidably disposed within the interior of the second compartment of the inner tubular member, the catheter comprising a first end and a second end and wherein the second end of the catheter comprises a cutting implement and a dilation implement; and   a stent delivery system adapted to facilitate the delivery of a stent endoscopically.   
   
   
       53 . The kit of  claim 52 , further comprising a stent for forming an anastomosis. 
   
   
       54 . The kit of  claim 52 , further comprising a fibroscope. 
   
   
       55 - 57 . (canceled)