Gastroparesis can be simply defined as delayed gastric emptying in the absence of mechanical obstruction. 1 Camilleri M. Parkman H.P. Shafi M.A. et al. Clinical guidelines: management of gastroparesis. Characteristic symptoms include nausea, vomiting, abdominal pain, early satiety, bloating, and weight loss. 1 Camilleri M. Parkman H.P. Shafi M.A. et al. Clinical guidelines: management of gastroparesis. , 2 Vijayvargiya P. Jameie-Oskooei S. Camilleri M. et al. Association between delayed gastric emptying and upper gastrointestinal symptoms: a systemic review and meta-analysis. , 3 Moshiree B. Potter M. Talley N.J. Epidemiology and pathophysiology of gastroparesis. More than 50 causes of gastroparesis have been identified; the most common are long-standing diabetes, prior gastric or esophageal surgery, medications (eg, opioids), or an underlying connective tissue disorder or vascular disorder. 3 Moshiree B. Potter M. Talley N.J. Epidemiology and pathophysiology of gastroparesis. The largest group with gastroparesis, however, is that of patients labeled as having idiopathic gastroparesis. These are more likely to be women than men (4:1 ratio); a prior infectious or inflammatory insult is often the culprit. 1 Camilleri M. Parkman H.P. Shafi M.A. et al. Clinical guidelines: management of gastroparesis. ,3 Moshiree B. Potter M. Talley N.J. Epidemiology and pathophysiology of gastroparesis. Although the definition of gastroparesis is simple, the pathophysiology is complicated. Often thought of as a motor disorder characterized by antral hypomotility (sometimes referred to as an impaired antral “pump”), the complex pathophysiology of gastroparesis includes impaired gastric accommodation, electrical dysrhythmias, antroduodenal dyscoordination, pyloric dysfunction, vagal nerve injury, and abnormal visceral sensation. The symptoms of gastroparesis are generally treated with dietary changes, antiemetic agents, and prokinetic agents. 4 Navas C.M. Patel N.K. Lacy B.E. Gastroparesis: medical and therapeutic advances. Unfortunately, many patients have persistent symptoms despite these interventions, which has spurred researchers to investigate other therapeutic options, including pylorus-directed therapies such as botulinum toxin injection of the pylorus and gastric peroral endoscopic myotomy (G-POEM). 5 Pasricha T.S. Pasricha P.J. Botulinum toxin injection for treatment of gastroparesis. ,6 Abdelfatah M.M. Noll A. Kapil N. et al. Long-term outcome of gastric per-oral endoscopic pyloromyotomy in treatment of gastroparesis.