Disclosed are implantable medical devices for connecting tissue layers to create an anastomosis. The anastomosis devices include a tubular structure having a plurality of first and second apposition portions (502, 504) interconnected by a central region (206). The central region includes a framework of elongate elements and one or more axial adjustment members (218). The methods of using the devices include endoscopic deployment, and the devices may include self-expanding frameworks that facilitate a secure connection between the tissue structures.
