a gastric reduction system and method provides for transesophageal formation of a gastric reduction pouch of the stomach . the system includes an expandable structure , which may be placed in a stomach and expanded to occupy a fractional volume of the stomach . an evacuator is then fed through the expandable structure and utilized to deflate the stomach and draw the stomach to and around the expandable structure to form the gastric reduction pouch . a self - deploying fastener is then deployed to maintain the gastric reduction pouch .