Methods and devices for folding and securing tissue

A method of creating a tissue fold comprising:

• inserting an endoscope and a grasper-overtube through an esophagus and at least partially into a stomach cavity, the grasper-overtube including a tube, disposed radially outward and around the endoscope, and an arm movably mounted relative to the tube;
• positioning the arm of the grasper-overtube at a first position radially outward from the tube, forming a first angle between the arm of the grasper-overtube and the tube;
• establishing native tissue between the arm of the grasper-overtube and a portion of the tube;
• and
• positioning the arm of the grasper-overtube at a second position radially outward from the tube, forming a second angle between the arm of the grasper-overtube and the tube, the second angle being smaller than the first angle;
• grasping the native tissue and forming the tissue fold;
• inserting a tissue fastener through a lumen of the tube and an opening at a distal end of the tube, the tissue fastener having a first arm and a second arm coupled to the first arm of the tissue fastener;
• and
• securing the tissue fold with the tissue fastener, the first arm of the tissue fastener engaging a first outer surface of the tissue fold and having a free end positioned on a first side of the tissue fold, and the second arm of the tissue fastener engaging a second outer surface of the tissue fold and having a free end positioned on a second side of the tissue fold opposite the first side of the tissue fold.