Endoluminal treatment devices and methods are provided. Generally, the devices and methods can allow an endoluminal device to be introduced into a lumen of a patient and engage a wall of lumen with an implant device, which can be a drug delivery device or medical device. In one embodiment, an endoluminal treatment method is provided that includes forming an incision in body tissue, attaching first and second pledgets to the body tissue near the incision, attaching a manipulation line to body tissue near the incision by attaching a first free end of the manipulation line to the first pledget, introducing a surgical tool through the incision in the body tissue, attaching a second free end of the manipulation line to the surgical tool such that the manipulation line extends between the first pledget and the surgical tool, and manipulating the surgical tool to perform a medical treatment procedure.