Apparatus and methods are provided for achieving prolonged maintenance of gastrointestinal ("GI") tissue folds. The apparatus and methods are adapted to form, secure, approximate and promote healing of tissue folds. Such healing may comprise remodeling the tissue folds along region(s) of opposing tissue contact to facilitate prolonged maintenance of the folds. In one variation, the apparatus and methods may be utilized to achieve gastric reduction. The apparatus may be provided as a system of tools.