A surgical instrument used in an endoscopic fundoplication is disclosed. The instrument may include an elongated tube having a proximal end and a distal end, a distal member coupled proximate the distal end of the tube and configured to fold a fundus of a stomach toward an esophageal wall, and a grasper configured to grasp at least a portion of the fundus or the esophageal wall. The grasper may be coupled to one of the elongated tube and the distal member.