A method is provided that involves endoscopically repairing or revising an anastomotic outlet previously formed in a portion of a patient's stomach as part of an earlier bariatric surgical procedure. The method may allow a surgeon to alter gastric functionality, such as gastric emptying or gastric dumping, by revising an existing anastomotic outlet. In this manner, the size of the outlet may be adjusted to change the rate at which contents pass from the stomach through the outlet. A surgical device may be inserted transorally through the patient's mouth, down through the esophagus and into the stomach or gastric pouch where it may be positioned in the vicinity of the anastomotic outlet. The surgical device may then be employed to revise the outlet to achieve a desired outlet configuration. The anastomotic outlet may be revised using an endoscopic fastening device that is configured to place a fastener in tissue. The fastening device may include an endoscopic suturing device to place one or more sutures in tissue in the region of the anastomotic outlet. One or more plications may be formed in the region of the outlet to narrow or reduce the opening of the anastomotic outlet.