Methods and devices for manipulating and fastening tissue

1. 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, a 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.

2. The medical device of claim 1 , wherein the tissue shaper is removably attached to the shaft.

3. The medical device of claim 2 , wherein the tubular structure of the tissue shaper has an open side proximate the esophagus.

4. The medical device of claim 3 , wherein the tissue shaper has a curved cross-sectional shape.

5. The medical device of claim 4 , wherein the curved cross-sectional shape of the tissue shaper forms an arc of at least 180° relative to a longitudinal axis between the first end and the second end.

6. The medical device of claim 5 , further comprising:

a fastener lumen, a fastener applier being slidable within the fastener lumen to different longitudinal positions for insertion of the plurality of fasteners.

7. The medical device of claim 6 , further comprising:

the fastener lumen permitting reorientation of the fastener applier by at least 90 degrees relative to the longitudinal axis of the shaft.

8. The medical device of claim 5 , further comprising:

a fastener cartridge containing the plurality of fasteners.