Methods and devices for manipulating and fastening tissue

A medical device for forming an intersection between the esophagus and the stomach, comprising:

• a shaft and a plurality of vacuum orifices on the shaft for grasping esophageal tissue and a tissue displacing element coupled to the shaft, the shaft defining a longitudinal axis;
• a tissue shaper coupled to the shaft and having a tubular structure open at a first end and a second end and forming a fixed volume cavity that receives and forms a fold of stomach tissue displaced by the tissue displacing element, the tissue shifting element being configured to displace the fold of stomach tissue held by the tissue shaper;
• a flexible elongate element having a tissue engaging element at a distal end of the tissue displacing element;
• and
• a plurality of fasteners for insertion into the fold of stomach tissue.