Methods for partial diversion of the intestinal tract

Abstract

Devices and methods are used to modify a metabolic pathway of a digestive system by creating a pathway within the intestinal tract through an anastomosis between a proximal location within the intestinal tract and a distal location within the intestinal tract. In some examples, the small intestine has a first initial length and the created pathway defines a second length of the intestinal tract that is approximately ten to seventy percent of the first initial length of the small intestine.

1 .- 27 . (canceled) 
     
     
         28 . A method of modifying a digestive system defining a first metabolic pathway, the digestive system comprising a stomach and an intestinal tract, wherein the intestinal tract comprises a small intestine, a large intestine, a colon, an ileocecal junction, and a ligament of Trietz, wherein the small intestine comprises a duodenum, a jejunum, an ileum, and a duodenal papilla, the method comprising: creating a second metabolic pathway within the digestive system configured to allow chyme to pass through either the first metabolic pathway or the second metabolic pathway, wherein creating the second metabolic pathway comprises creating an anastomosis by:
 (a) placing a first magnetically attractable device within a first lumen of the digestive system at a first attachment region;   (b) placing a second magnetically attractable device within a second lumen of the digestive system at a second attachment region;   (c) aligning the first magnetically attractable device with the second magnetically attractable device; and   (d) compressing a first wall of the first lumen at the first attachment region and a second wall of the second lumen at the second attachment region between the first and second magnetically attractable devices, wherein the compressed tissue of the first lumen and the second lumen necroses due to ischemia and the necrosed tissue and the first and second magnetically attractable devices separate from the respective first and second attachment regions and pass through the intestinal tract to thereby create and define the anastomosis.   
     
     
         29 . The method of  claim 28 , wherein creating the second metabolic pathway creates a partial jejunal diversion. 
     
     
         30 . The method of  claim 28 , wherein creating the second metabolic pathway creates a complete jejunal diversion. 
     
     
         31 . The method of  claim 28 , wherein the anastomosis is a side-to-side anastomosis. 
     
     
         32 . The method of  claim 28 , wherein placing a select one or both of the first and the second magnetically attractable devices comprises using one or more natural orifices to locate the select one or both of the first and the second magnetically attractable devices at the respective first and second attachment regions within the respective first and second lumens. 
     
     
         33 . The method of  claim 28 , wherein placing a select one or both of the first and the second magnetically attractable devices comprises using a laparoscopic procedure to locate the select one or both of the first and the second magnetically attractable devices at the respective first and second attachment regions within the respective first and second lumens. 
     
     
         34 . The method of  claim 28 , wherein placing the first or second magnetically attractable device comprises making an enterotomy in the respective first or second lumen and placing the first or second magnetically attractable device within the respective first or second lumen via the enterotomy. 
     
     
         35 . The method of  claim 28  wherein placing the first and second magnetically attractable devices comprises making a first enterotomy in the first lumen at the first attachment region, making a second enterotomy in the second lumen at the second attachment region, placing the first magnetically attractable device within the first lumen via the first enterotomy, and placing the second magnetically attractable device within the second lumen via the second enterotomy. 
     
     
         36 . The method of  claim 35 , wherein the first and second enterotomies form the anastomosis. 
     
     
         37 . The method of  claim 28 , wherein creating the second metabolic pathway within the intestinal tract is configured to aid in the treatment of type 2 diabetes. 
     
     
         38 . The method of  claim 37 , wherein the presence of the second metabolic pathway provides for a reduction in A1C level. 
     
     
         39 . The method of  claim 28 , wherein creating the second metabolic pathway within the intestinal tract is configured to improve glucose control. 
     
     
         40 . The method of  claim 28 , wherein creating the second metabolic pathway within the intestinal tract is configured to aid in the treatment for weight loss. 
     
     
         41 . The method of  claim 28 , wherein the second metabolic pathway is reversible such that the intestinal tract can be returned to having only the first metabolic pathway. 
     
     
         42 . The method of  claim 28 , wherein the second metabolic pathway directly couples the duodenum with the ileum such that chyme can bypass an entire length of the jejunum. 
     
     
         43 . The method of  claim 28 , wherein the second metabolic pathway directly couples the stomach and the jejunum such that chyme can bypass the duodenum. 
     
     
         44 . The method of  claim 28 , wherein the anastomosis is located about 100 centimeters distal to the ligament of Treitz. 
     
     
         45 . The method of  claim 28 , wherein the first metabolic pathway remains intact after creation of the second metabolic pathway. 
     
     
         46 . A method of modifying a digestive system defining a first metabolic pathway, the digestive system comprising a stomach and an intestinal tract, wherein the intestinal tract comprises a small intestine, a large intestine, a colon, an ileocecal junction, and a ligament of Trietz, wherein the small intestine comprises a duodenum, a jejunum, an ileum, and a duodenal papilla, the method comprising: creating a second metabolic pathway within the digestive system configured to allow chyme to pass through either the first metabolic pathway or the second metabolic pathway, wherein creating the second metabolic pathway comprises creating an anastomosis by:
 (a) placing a first magnetically attractable device substantially within a first lumen of the digestive system at a first attachment region, wherein the first magnetically attractable device includes a first resilient member configured to engage the first lumen proximate to the first attachment region to maintain the position of the first magnetically attractable device relative to the first attachment region;   (b) placing a second magnetically attractable device substantially within a second lumen of the digestive system at a second attachment region, wherein the second magnetically attractable device includes a second resilient member configured to engage the second lumen proximate to the second attachment region to maintain the position of the second magnetically attractable device relative to the second attachment region;   (c) aligning the first magnetically attractable device with the second magnetically attractable device, wherein aligning results in magnetic elements of each of the first and second magnetically attractable devices to magnetically connect; and   (d) compressing a first wall of the first lumen at the first attachment region and a second wall of the second lumen at the second attachment region between the first and second magnetically attractable devices, wherein the compressed tissue of the first lumen and the second lumen necroses due to ischemia and the necrosed tissue and the first and second magnetically attractable devices separate from the respective first and second attachment regions and pass through the intestinal tract to thereby create and define the anastomosis.   
     
     
         47 . A method of modifying a digestive system having a first metabolic pathway, the digestive system comprising a stomach and an intestinal tract, wherein the intestinal tract comprises a small intestine, a large intestine, a colon, an ileocecal junction, and a ligament of Trietz, wherein the small intestine comprises a duodenum, a jejunum, an ileum, and a duodenal papilla, the method comprising: creating a second metabolic pathway within the intestinal tract configured to allow chyme to pass through either the first metabolic pathway or the second metabolic pathway, wherein the second metabolic pathway defines a length of the intestinal tract between about 10% and about 70% of an initial length of the intestinal tract, wherein creating the second metabolic pathway comprises creating an anastomosis within the intestinal tract by:
 (a) placing a first magnetically attractable device within a first lumen of the digestive system at a proximal location within the intestinal tract, wherein the proximal location is distal to the duodenal papilla;   (b) placing a second magnetically attractable device within a second lumen of the digestive system at a distal location within the intestinal tract;   (c) aligning the first magnetically attractable device with the second magnetically attractable device; and   (d) compressing a first wall of the first lumen at the proximal location and a second wall of the second lumen at the distal location between the first and second magnetically attractable devices, wherein the compressed tissue of the first lumen and the second lumen necroses due to ischemia and the necrosed tissue and the first and second magnetically attractable devices separate from the respective proximal and distal locations and pass through the intestinal tract to thereby create and define the anastomosis within the intestinal tract.