Methods and devices for use in tissue approximation and fixation are described herein. The present invention provides, in part, methods and devices for acquiring tissue folds in a circumferential configuration within a hollow body organ, e.g., a
stomach, positioning the tissue folds for affixing within a fixation zone of the
stomach, preferably to create a pouch or partition below the
esophagus, and fastening the tissue folds such that a tissue ring, or stomas, forms excluding the pouch from the greater
stomach cavity. The present invention further provides devices for performing a transoral, endoscopic hollow organ division, including a
tissue acquisition device capable of acquiring the desired tissue circumferentially, and a fixation mechanism to secure the muscular
layers of the acquired tissue such that the desired healing response is achieved.