The present invention generally relates to devices for treating gastroesophageal reflux disease. The present invention more particularly relates to such devices which are flexible enough for passage into the stomach while being capable of being made selectively rigid for forming a gastroesophageal flap.
Gastroesophageal reflux disease (GERD) is a chronic condition caused by the failure of the anti-reflux barrier located at the gastroesophageal junction to keep the contents of the stomach from splashing into the esophagus. The splashing is known as gastroesophageal reflux. The stomach acid is designed to digest meat, and will digest esophageal tissue when persistently splashed into the esophagus.
A principal reason for regurgitation associated with GERD is the mechanical failure of a deteriorated gastroesophageal flap to close and seal against high pressure in the stomach. Due to reasons including lifestyle, a Grade I normal gastroesophageal flap may deteriorate into a malfunctioning Grade III or absent valve Grade IV gastroesophageal flap. With a deteriorated gastroesophageal flap, the stomach contents are more likely to be regurgitated into the esophagus, the mouth, and even the lungs. The regurgitation is referred to as “heartburn” because the most common symptom is a burning discomfort in the chest under the breastbone. Burning discomfort in the chest and regurgitation (burping up) of sour-tasting gastric juice into the mouth are classic symptoms of gastroesophageal reflux disease (GERD). When stomach acid is regurgitated into the esophagus, it is usually cleared quickly by esophageal contractions. Heartburn (backwashing of stomach acid and bile onto the esophagus) results when stomach acid is frequently regurgitated into the esophagus and the esophageal wall is inflamed.
Complications develop for some people who have GERD. Esophagitis (inflammation of the esophagus) with erosions and ulcerations (breaks in the lining of the esophagus) can occur from repeated and prolonged acid exposure. If these breaks are deep, bleeding or scarring of the esophagus with formation of a stricture (narrowing of the esophagus) can occur. If the esophagus narrows significantly, then food sticks in the esophagus and the symptom is known as dysphagia. GERD has been shown to be one of the most important risk factors for the development of esophageal adenocarcinoma. In a subset of people who have severe GERD, if acid exposure continues, the injured squamous lining is replaced by a precancerous lining (called Barrett's Esophagus) in which a cancerous esophageal adenocarcinoma can develop.
Other complications of GERD may not appear to be related to esophageal disease at all. Some people with GERD may develop recurrent pneumonia (lung infection), asthma (wheezing), or a chronic cough from acid backing up into the esophagus and all the way up through the upper esophageal sphincter into the lungs. In many instances, this occurs at night, while the person is in a supine position and sleeping. Occasionally, a person with severe GERD will be awakened from sleep with a choking sensation. Hoarseness can also occur due to acid reaching the vocal cords, causing a chronic inflammation or injury.
GERD never improves without intervention. Life style changes combined with both medical and surgical treatments exist for GERD. Medical therapies include antacids and proton pump inhibitors. However, the medical therapies only mask the reflux. Patients still get reflux and perhaps emphysema because of particles refluxed into the lungs. Barrett's esophagus results in about 10% of the GERD cases. The esophageal epithelium changes into tissue that tends to become cancerous from repeated acid washing despite the medication.
Several open laparotomy and laproscopic surgical procedures are available for treating GERD. One surgical approach is the Nissen fundoplication. The Nissen approach typically involves a 360° wrap of the fundus around the gastroesophageal junction. The procedure has a high incidence of postoperative complications. The Nissen approach creates a 360° moveable flap without a fixed portion. Hence, Nissen does not restore the normal movable flap. The patient cannot burp because the fundus was used to make the repair, and may frequently experience dysphagia. Another surgical approach to treating GERD is the Belsey Mark IV (Belsey) fundoplication. The Belsey procedure involves creating a valve by suturing a portion of the stomach to an anterior surface of the esophagus. It reduces some of the postoperative complications encountered with the Nissen fundoplication, but still does not restore the normal movable flap. None of these procedures fully restores the normal anatomical anatomy or produces a normally functioning gastroesophageal junction. Another surgical approach is the Hill repair. In the Hill repair, the gastroesophageal junction is anchored to the posterior abdominal areas, and a 180° valve is created by a system of sutures. The Hill procedure restores the moveable flap, the cardiac notch and the Angle of His. However, all of these surgical procedures are very invasive, regardless of whether done as a laproscopic or an open procedure.
New, less surgically invasive approaches to treating GERD involve transoral endoscopic procedures. One procedure contemplates a machine device with robotic arms that is inserted transorally into the stomach. While observing through an endoscope, an endoscopist guides the machine within the stomach to engage a portion of the fundus with a corkscrew-like device on one arm. The arm then pulls on the engaged portion to create a fold of tissue or radial plication at the gastroesophageal junction. Another arm of the machine pinches the excess tissue together and fastens the excess tissue with one pre-tied implant. This procedure does not restore normal anatomy. The fold created does not have anything in common with a valve. In fact, the direction of the radial fold prevents the fold or plication from acting as a flap of a valve.
Another transoral procedure contemplates making a fold of fundus tissue near the deteriorated gastroesophageal flap to recreate the lower esophageal sphincter (LES). The procedure requires placing multiple U-shaped tissue clips around the folded fundus to hold it in shape and in place.
This and the previously discussed procedure are both highly dependent on the skill, experience, aggressiveness, and courage of the endoscopist. In addition, these and other procedures may involve esophageal tissue in the repair. Esophageal tissue is fragile and weak. Involvement of esophageal tissue in the repair of a gastroesophageal flap valve poses unnecessary risks to the patient.
A new and improved device and method for restoration of a gastroesophageal flap valve is fully disclosed in U.S. Pat. No. 6,790,214, issued Sep. 14, 2004, for TRANSORAL ENDOSCOPIC GASTROESOPHAGEAL FLAP VALVE RESTORATION DEVICE, ASSEMBLY, SYSTEM AND METHOD, which patent is assigned to the assignee of this invention, and is incorporated herein by reference. That apparatus and method provides transoral endoscopic gastroesophageal flap valve restoration. A longitudinal member arranged for transoral placement into a stomach carries a tissue shaper that non-invasively grips and shapes stomach tissue. A tissue fixation device is then deployed to maintain the shaped stomach tissue in a shape approximating a gastroesophageal flap.
Whenever stomach tissue is to be transorally shaped as, for example, by the improved device last mentioned above, it is necessary to feed the device down the esophageal passage including the mouth, throat, and esophagus and into the stomach. Unfortunately, the throat and esophagus are capable of expanding to only a diameter of about two centimeters (2 cm) without damage. Further, the back of throat defines a radius of approximately only 4.4 cm in the average adult. Hence, for any kind of device to be guided down into the stomach, the device must have a maximum perimeter of no more than about 6.28 cm (2 cm×π) and be flexible enough to bend through the radius of 4.4 cm defined by the back of the throat. While being flexible enough to travel down the throat and esophagus, the device must also be rigid enough to shape the stomach tissue necessary to form the gastroesophageal flap. The present invention addresses these issues.
The invention provides a transoral gastroesophageal flap valve restoration device comprising a first member, and a second member hingedly coupled to the first member. The first and second members are arranged for esophageal passage into a stomach to receive stomach tissue there between and to form a flap of a gastroesophageal flap valve. The first and second members are configured to flex in a direction to follow the esophageal path into the stomach and to be substantially rigid when receiving the stomach tissue there between to form the flap of the gastroesophageal flap valve.
The invention further provides an assembly for restoring a gastroesophageal flap valve comprising a longitudinal member having an end arranged for placement in a stomach, and a transoral gastroesophageal flap valve restoration device carried at the end of the longitudinal member including a first member and a second member hingedly coupled to the first member. The first and second members are arranged for esophageal passage into a stomach to receive stomach tissue there between and to form a flap of a gastroesophageal flap valve. The first and second members are also configured to flex in a direction to follow the esophageal path into the stomach but to also be substantially rigid when receiving the stomach tissue there between and forming the flap of the gastroesophageal flap valve.
According to another embodiment, the invention provides a transoral gastroesophageal flap valve restoration device that is selectively flexible during mouth, throat, and esophagus passage into a stomach, and selectively comparatively rigid during folding of stomach tissue into a restored gastroesophageal flap.
The invention further provides a method of restoring a gastroesophageal flap valve. The method comprises providing a transoral gastroesophageal flap valve restoration device comprising a first member and a second member hingedly coupled to the first member, the first and second members being flexible for esophageal passage into a stomach and substantially rigid to receive stomach tissue there between to form a flap of a gastroesophageal flap valve when in a second orientation. The method further comprises feeding the device down the esophagus into the stomach with the device in a flexible condition, rendering the device substantially rigid, and pulling stomach tissue between the first and second members to form the flap of the gastroesophageal flap valve.
The invention still further provides a method of restoring a gastroesophageal flap valve comprising the steps of providing a transoral gastroesophageal flap valve restoration device arranged for esophageal passage into a stomach when in a substantially flexible condition and to receive stomach tissue to form a flap of a gastroesophageal flap valve when in a substantially rigid condition. The method further comprises feeding the device down the esophagus into the stomach with the device in the substantially flexible condition, rendering the device into the substantially rigid condition, and pulling stomach tissue into the device to form the flap of the gastroesophageal flap valve.
The features of the present invention which are believed to be novel are set forth with particularity in the appended claims. The invention, together with further objects and advantages thereof, may best be understood by making reference to the following description taken in conjunction with the accompanying drawings, in the several figures of which like referenced numerals identify like elements, and wherein:
The esophageal tract is controlled by an upper esophageal sphincter (UES)in the neck near the mouth for swallowing, and by the LES 48 and the GEFV 49 at the stomach. The normal anti-reflux barrier is primarily formed by the LES 48 and the GEFV 49 acting in concert to allow food and liquid to enter the stomach, and to considerably resist reflux of stomach contents into the esophagus 41 past the gastroesophageal tissue junction 52. Tissue aboral of the gastroesophageal tissue junction 52 is generally considered part of the stomach because the tissue protected from stomach acid by its own protective mechanisms. Tissue oral of the gastroesophageal junction 52 is generally considered part of the esophagus and it is not protected from injury by prolonged exposure to stomach acid. At the gastroesophageal junction 52, the juncture of the stomach and esophageal tissues form a zigzag line, which is sometimes referred to as the “Z-line.” For the purposes of these specifications, including the claims, “stomach” means the tissue aboral of the gastroesophageal junction 52.
Referring now to
In addition to the restraints on the maximum transverse perimeter, the device must be able to negotiate the 90° turn in the back of the throat. Still further, in order to restore a gastroesophageal flap valve, the flap must be of sufficient length so as to close the esophagus. Hence, the fold is preferably, for example, 3 cm in length or greater. In order to form a fold of 3 cm or greater, a device having a length of 6 cm or greater would be required. Obviously, a rigid device 6 cm in length would have a difficult time in negotiating the 90° turn in the back of the throat.
Accordingly, the gastroesophageal flap valve restoration devices disclosed herein representing various embodiments of the present invention are capable of navigating the 90° turn in the back of the throat without damaging mouth, throat, or esophageal tissue. As will be seen here in each of the embodiments, the devices are dimensioned to follow the esophageal path and configured to flex in a direction to follow the esophageal path while also being configured to be substantially rigid when necessary in forming a restored flap of a gastroesophageal flap valve.
The device 100 according to one embodiment of the present invention is shown in
The arm 118 is hingedly coupled to the body 116 by a pulley 120. As a result, the arm 118 is arranged for reciprocal movement with respect to the body 116. When the device 100 is being fed down the esophageal passage, the arm 118 may be rendered to be substantially inline with the body 116 as may be seen in
To render the body 116 flexible for bending around the 90° turn in the back of the throat as illustrated in
To lend further flexibility to the device 100, the arm 118 is also rendered flexible during the passage down the esophageal passageway. To that end, it will be noted in
Referring now to
While forming the flap 70 in the stomach tissue 43, the device 100 is rendered substantially rigid. The rigidity of the device is provided by rigidity in both the body 116 and the arm 118. More specifically, because the second set of slots 124 are relatively narrow, they will close when the body 116 is straightened by forces applied to it by the stomach tissue folding process and by a compression assembly to be described hereinafter.
As will also be described hereinafter, the pulley 120 is a single pulley of sufficient diameter to provide a mechanical advantage enclosing arm 118 on the body 116 to enable the stomach tissue 43 to be folded into the flap 70. A pulley of such dimension is rendered possible by a single hinged connection of the arm 118 to the body 116 by the pulley 120. This will be seen more particularly hereinafter.
Referring now to
Referring now to
Similarly, link 164 is hingedly coupled to link 162 by another hinge 167. It also includes a pin 169 which limits the pivotal movement between the link 164 and the link 162.
When the device 150 is in the process of forming a restored gastroesophageal flap valve, the links 160, 162, and 164 are locked so as to be substantially inline as shown in
As will also be noted in
Referring now to
When a force 198 is imparted to the control cable 182 to pivot arm 118 pivots for forming the stomach tissue flap. The arm 118 is coupled to the body 116 by a single hinge 123 formed by the pulley 120.
Referring now to
When the device is fed down the esophageal passageway, the body 116 is flexible and non-compressed. However, when the device 100B is within the stomach aboral of the Z-line and ready to be used for forming a restored gastroesophageal flap valve, the device is rendered substantially rigid. When a force 198 is imparted to the control cable 180 to pivot arm 118 for forming the stomach tissue fold, the body 116 of the device 100 is also placed under compression from the pulley 120 to the stops 196 to ensure closing of the narrow slots 124 and promote rigidity of the body 116 of the device 100B.
As also may be noted in
As may be seen in
As may be further noted in
The foregoing structure allows the connection of the arm 118 and the body 116 to be dismantled if necessary. The dismantling of the connection between the arm 118 and the body 116 may be effected by simply pulling the locking pin 220.
Referring now to
Also illustrated in
To provide a sufficient mechanical advantage the pulley 120 may have a diameter greater than about 7 mm. Preferably, the pulley has a diameter of about 10 mm.
Referring now to
The arm 218 is configured to be flexible during esophageal passage into the stomach of the device 100 and rigid during restoration of a gastroesophageal flap valve. To that end, it will be noted that the arm 218 comprises a plurality of links 260, 262, and 264. Link 260 may be hingedly coupled to the body 116 at the pulley 120, and is also hingedly coupled to link 262 by a hinge 261. The hinge 261 includes a pin 263. Similarly, link 264 is hingedly coupled to link 262 by another hinge 267. It also includes a pin 269.
When the device 100 is fed down the esophageal passage, the hinges 261, and 267, and the pulley 120, permit the arm 218 to be flexible and bent as shown in
With further reference to
In view of the widened nature of the distal end 270 of the arm 218, the distal end 270 is preferably comprised of a flexible material which is preformed in a somewhat closed arcuate configuration to reduce the distal end cross-section for passage through the esophageal passage. However, due to the flexible nature of the material used to form the arm 218, and the central slit 276, the wings 278 and 280 formed by the slit 276 will readily fan out and make broad contact with the tissue when the tissue is contacted for forming the gastroesophageal flap.
While particular embodiments of the present invention have been shown and described, modifications may be made, and it is therefore intended in the appended claims to cover all such changes and modifications which fall within the true spirit and scope of the invention.
This Preliminary Amendment is being filed concurrently with an application that is a division of U.S. Ser. No. 12/873,233 filed Aug. 31, 2010, which is a continuation of U.S. Ser. No. 11/893,549 filed Aug. 15, 2007, now abandoned, which is a continuation of U.S. Ser. No.11/001,666 filed Nov. 30, 2004, now abandoned, the entirety of each of which are incorporated herein by reference.
Number | Name | Date | Kind |
---|---|---|---|
2753870 | Muffly | Jul 1956 | A |
3875928 | Angelchik | Apr 1975 | A |
4006747 | Kronenthal | Feb 1977 | A |
4271828 | Angelchik | Jun 1981 | A |
4576772 | Carpenter et al. | Mar 1986 | A |
4595007 | Mericle | Jun 1986 | A |
4669473 | Richards et al. | Jun 1987 | A |
4696300 | Anderson | Sep 1987 | A |
4846836 | Reich | Jul 1989 | A |
4895148 | Bays et al. | Jan 1990 | A |
4921479 | Grayzel | May 1990 | A |
5006106 | Angelchik et al. | Apr 1991 | A |
5041129 | Hayhurst et al. | Aug 1991 | A |
5080543 | Murphy | Jan 1992 | A |
5088979 | Filipi et al. | Feb 1992 | A |
5254126 | Filipi et al. | Oct 1993 | A |
5312023 | Green | May 1994 | A |
5314473 | Godin | May 1994 | A |
5403326 | Harrison et al. | Apr 1995 | A |
5411508 | Bessler et al. | May 1995 | A |
5411520 | Nash et al. | May 1995 | A |
5549621 | Bessler et al. | Aug 1996 | A |
5571074 | Buckman et al. | Nov 1996 | A |
5571116 | Bolanos et al. | Nov 1996 | A |
5626614 | Hart | May 1997 | A |
5676674 | Bolanos et al. | Oct 1997 | A |
5713903 | Sander et al. | Feb 1998 | A |
5759151 | Sturges | Jun 1998 | A |
5810882 | Bolduc et al. | Sep 1998 | A |
5814054 | Kortenbach et al. | Sep 1998 | A |
5861036 | Godin | Jan 1999 | A |
5879372 | Bartlett et al. | Mar 1999 | A |
5887594 | LoCicero | Mar 1999 | A |
5897562 | Bolanos et al. | Apr 1999 | A |
5938668 | Scirica et al. | Aug 1999 | A |
6086600 | Kortenbach | Jul 2000 | A |
6098629 | Johnson et al. | Aug 2000 | A |
6113609 | Adams | Sep 2000 | A |
6113611 | Allen et al. | Sep 2000 | A |
6142957 | Diamond et al. | Nov 2000 | A |
6254642 | Taylor | Jul 2001 | B1 |
6264700 | Kilcoyne et al. | Jul 2001 | B1 |
6302311 | Adams et al. | Oct 2001 | B1 |
6302917 | Dua et al. | Oct 2001 | B1 |
6312437 | Kortenbach | Nov 2001 | B1 |
6315789 | Cragg | Nov 2001 | B1 |
6419669 | Frazier et al. | Jul 2002 | B1 |
6428548 | Durgin et al. | Aug 2002 | B1 |
6447524 | Knodel et al. | Sep 2002 | B1 |
6743239 | Kuehn et al. | Jun 2004 | B1 |
6773440 | Gannoe et al. | Aug 2004 | B2 |
6773441 | Laufer et al. | Aug 2004 | B1 |
6790214 | Kraemer et al. | Sep 2004 | B2 |
6835200 | Laufer et al. | Dec 2004 | B2 |
6916332 | Adams | Jul 2005 | B2 |
6921361 | Suzuki et al. | Jul 2005 | B2 |
7022118 | Ariura et al. | Apr 2006 | B2 |
7037344 | Kagan et al. | May 2006 | B2 |
7074229 | Adams et al. | Jul 2006 | B2 |
7083630 | DeVries et al. | Aug 2006 | B2 |
7220266 | Gambale | May 2007 | B2 |
7347863 | Rothe et al. | Mar 2008 | B2 |
7618426 | Ewers et al. | Nov 2009 | B2 |
7632287 | Baker et al. | Dec 2009 | B2 |
7678123 | Chanduszko | Mar 2010 | B2 |
7713277 | Laufer et al. | May 2010 | B2 |
7776057 | Laufer et al. | Aug 2010 | B2 |
7850704 | Burnett et al. | Dec 2010 | B2 |
7857184 | Viola | Dec 2010 | B2 |
7857823 | Laufer et al. | Dec 2010 | B2 |
7866526 | Green et al. | Jan 2011 | B2 |
7942887 | Kraemer et al. | May 2011 | B2 |
7951157 | Gambale | May 2011 | B2 |
7954687 | Zemlok et al. | Jun 2011 | B2 |
7955340 | Michlitsch et al. | Jun 2011 | B2 |
8057494 | Laufer et al. | Nov 2011 | B2 |
8252009 | Weller et al. | Aug 2012 | B2 |
8277468 | Laufer et al. | Oct 2012 | B2 |
8308765 | Saadat et al. | Nov 2012 | B2 |
8343175 | Ewers et al. | Jan 2013 | B2 |
8574243 | Saadat et al. | Nov 2013 | B2 |
9526500 | Carter | Dec 2016 | B2 |
20010056282 | Sonnenschein | Dec 2001 | A1 |
20020022853 | Swanson et al. | Feb 2002 | A1 |
20020035370 | Kortenbach | Mar 2002 | A1 |
20020040226 | Laufer et al. | Apr 2002 | A1 |
20020055772 | McGuckin, Jr. et al. | May 2002 | A1 |
20020072761 | Abrams et al. | Jun 2002 | A1 |
20020078967 | Sixto, Jr. et al. | Jun 2002 | A1 |
20020082621 | Schurr et al. | Jun 2002 | A1 |
20020143349 | Gifford, III et al. | Oct 2002 | A1 |
20020183765 | Adams | Dec 2002 | A1 |
20020198541 | Smith et al. | Dec 2002 | A1 |
20030023230 | Lewis et al. | Jan 2003 | A1 |
20030055442 | Laufer et al. | Mar 2003 | A1 |
20030065359 | Weller et al. | Apr 2003 | A1 |
20030093117 | Saadat | May 2003 | A1 |
20030120289 | McGuckin, Jr. et al. | Jun 2003 | A1 |
20030120292 | Park et al. | Jun 2003 | A1 |
20030171760 | Gambale | Sep 2003 | A1 |
20030187465 | Bailly et al. | Oct 2003 | A1 |
20030191497 | Cope | Oct 2003 | A1 |
20030216613 | Suzuki et al. | Nov 2003 | A1 |
20030216754 | Kraemer et al. | Nov 2003 | A1 |
20030220657 | Adams | Nov 2003 | A1 |
20040044304 | Hill et al. | Mar 2004 | A1 |
20040044364 | DeVries et al. | Mar 2004 | A1 |
20040087976 | DeVries et al. | May 2004 | A1 |
20040093024 | Lousararian et al. | May 2004 | A1 |
20040116949 | Ewers et al. | Jun 2004 | A1 |
20040133236 | Chanduszko | Jul 2004 | A1 |
20040138529 | Wiltshire et al. | Jul 2004 | A1 |
20040147958 | Lam et al. | Jul 2004 | A1 |
20040148034 | Kagan et al. | Jul 2004 | A1 |
20040153102 | Therin et al. | Aug 2004 | A1 |
20040153103 | Schwartz et al. | Aug 2004 | A1 |
20040162568 | Saadat et al. | Aug 2004 | A1 |
20040215216 | Gannoe et al. | Oct 2004 | A1 |
20040236357 | Kraemer et al. | Nov 2004 | A1 |
20040243223 | Kraemer et al. | Dec 2004 | A1 |
20050004575 | Sgro et al. | Jan 2005 | A1 |
20050017781 | Honda | Jan 2005 | A1 |
20050043759 | Chanduszko | Feb 2005 | A1 |
20050075653 | Saadat et al. | Apr 2005 | A1 |
20050085829 | Kraemer et al. | Apr 2005 | A1 |
20050154405 | Kraemer et al. | Jul 2005 | A1 |
20050177176 | Gerbi et al. | Aug 2005 | A1 |
20050187565 | Baker et al. | Aug 2005 | A1 |
20050203547 | Weller et al. | Sep 2005 | A1 |
20050216040 | Gertner et al. | Sep 2005 | A1 |
20050228413 | Binmoeller et al. | Oct 2005 | A1 |
20050247320 | Stack et al. | Nov 2005 | A1 |
20050251176 | Swanstrom et al. | Nov 2005 | A1 |
20060009789 | Gambale | Jan 2006 | A1 |
20060190018 | Baker et al. | Aug 2006 | A1 |
20060253130 | Wolniewicz | Nov 2006 | A1 |
20060253142 | Bjerken | Nov 2006 | A1 |
20070021756 | Kortenbach | Jan 2007 | A1 |
20070021760 | Kelleher | Jan 2007 | A1 |
20070112363 | Adams | May 2007 | A1 |
20070129738 | Kraemer et al. | Jun 2007 | A1 |
20070191870 | Baker et al. | Aug 2007 | A1 |
20070191871 | Baker et al. | Aug 2007 | A1 |
20070219566 | Gambale | Sep 2007 | A1 |
20070276409 | Ortiz et al. | Nov 2007 | A1 |
20080015618 | Sonnenschein et al. | Jan 2008 | A1 |
20080287966 | Kraemer et al. | Nov 2008 | A1 |
20080294179 | Balbierz et al. | Nov 2008 | A1 |
20090177214 | Adams | Jul 2009 | A1 |
20090198254 | Laufer et al. | Aug 2009 | A1 |
20090236388 | Cole et al. | Sep 2009 | A1 |
20100241139 | Harshman | Sep 2010 | A1 |
20110196391 | Forsell | Aug 2011 | A1 |
20110213390 | Kraemer et al. | Sep 2011 | A1 |
Number | Date | Country |
---|---|---|
252607 | Sep 1992 | EP |
1999022649 | May 1999 | WO |
1999060931 | Dec 1999 | WO |
2000053102 | Sep 2000 | WO |
2000078227 | Dec 2000 | WO |
2001032084 | May 2001 | WO |
2001035834 | May 2001 | WO |
2001064964 | Sep 2001 | WO |
2001067964 | Sep 2001 | WO |
2001085034 | Nov 2001 | WO |
2001089391 | Nov 2001 | WO |
2002024058 | Mar 2002 | WO |
2002024080 | Mar 2002 | WO |
2002028289 | Apr 2002 | WO |
2002082621 | Oct 2002 | WO |
2002096327 | Dec 2002 | WO |
2003061480 | Jul 2003 | WO |
2003099140 | Dec 2003 | WO |
2004019787 | Mar 2004 | WO |
2004019788 | Mar 2004 | WO |
2004049982 | Jun 2004 | WO |
2004069055 | Aug 2004 | WO |
2005065412 | Jul 2005 | WO |
2005081817 | Sep 2005 | WO |
2006023764 | Mar 2006 | WO |
2006034484 | Mar 2006 | WO |
2006081368 | Aug 2006 | WO |
2007002817 | Jan 2007 | WO |
2007064713 | Jun 2007 | WO |
2010087756 | Aug 2010 | WO |
Entry |
---|
The gastroesophageal flap valve: in vitro and in vivo observations; Lucius D. Hill et al.; Gastrointestinal Endoscopy; vol. 44, No. 5, 1996; pp. 541-547; abstract. |
Reappraisal of the flap valve mechanism in the gastroesophageal junction: A study of a new valvuloplasty procedure in cadavers; KjellB.A. Thor et al.; Acta Chir Scand 153:25-28, 1987; abstract. |
The Plicator Procedure; 1 page; abstract. |
Chuttani, MD. et al., “A novel endoscopic full-thickness plicator for treatment of GERD: an animal model study”. Gastrointestinal Endoscopy, vol. 56, No. 1, 2002, pp. 116-122; abstract. |
Jobe, et al., “Endoscopic Appraisal of the Gastroesophageal Valve After Antireflux Surgery”, American Journal of Gastroenterology, ISSN 0002-9270; abstract. |
International Search Report for PCT/US2012/054328. |
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20170100146 A1 | Apr 2017 | US |
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Parent | 12873233 | Aug 2010 | US |
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Parent | 11893549 | Aug 2007 | US |
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