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.