Pathogenesis and endoscopic treatment of gastroparesis

Gastroparesis is a common functional disorder characterized by chronic upper gastrointestinal symptoms and objective evidence of non-mechanically obstructive delayed gastric emptying. Oxidative stress and inflammation are the core mechanisms of gastroparesis, and it has pathological changes such as loss of Interstitial Cajal Cell (ICC), decreased innervation, immune infiltration, and myofibrosis. In recent years, there has been innovation and development in endoscopic treatment of gastroparesis, among which G-POEM has shown good clinical efficacy. Other endoscopic treatments, such as gastric electrical stimulation, intra-pyloric botulinum toxin injection, pyloric stenting, gastrostomy or anastomosis, also contribute to improving delayed gastric emptying and alleviating symptoms of gastroparesis. This article reviews the physiological changes and pathological mechanisms of gastroparesis and the latest progress in treatment. The review aims to evaluate the effectiveness of current endoscopic therapies and explore possible improvements in the treatment of gastroparesis.