Endoscopic treatment of gastroparesis

Table 1 Summary of endoscopic therapies for refractory gastroparesis

Endoscopic therapies	Technique/mechanism	Advantages	Disadvantages
Intrapyloric botulinum toxin injection	Radial or direct injection of 100-200 U of toxin around the pylorus	Safe and well tolerated	No clear benefit in RCTs
	Toxin binds to cholinergic receptors resulting in decreased acetylcholine release	Easy to perform	Need for repeat treatments
		Observational studies report high response rate
Gastric electric stimulation	Miniature wireless device placed through over-tube and secured to the gastric mucosa with endoclips	Proof of concept design with proven benefit	Lack of human studies
	Device stimulates gastric muscle resulting in more regular, constant amplitudes	Currently used prior to definitive surgical placement	No comparative data to surgically placed gastric pacers
		Less invasive compared to surgical placement
Transpyloric stenting	Through-the-scope self-expandable metal stents placed across the pyloric channel	Small case series demonstrating a proven benefit in symptoms	Limited data
			Potential for stent migration
Endoscopic pyloromyotomy	Submucosal dissection and tunneling with full separation of the pyloric ring (myotomy)	Less invasive alternative to traditional surgical pyloromyotomy	Limited data
			Technically challenging with limited expertise
			Potential for complications:
Endoscopic decompression or bypass	Percutaneous endoscopic jejunostomy (PEJ) and direct PEJ	Safe and effective	Limited success
	Direct post-pyloric enteral nutritional support		Technical difficulty
endoscopic ultrasound-guided gastrojejunostomy	Transluminal anastomosis using self-expanding, lumen-apposing metal stents	Decreased morbidity and mortality compared to surgical approach	Lack of human trials Unknown long-term safety and patency issues