Inclusion Criteria:  All patients aged 18+ diagnosed with refractory gastroparesis as defined earlier in this document, no age limit Patients already consented to undergo G-POEM  Exclusion Criteria:  Patients who are pregnant(at Northwestern, all female patients have urine pregnancy tests on day of endoscopy), vulnerable populations such as prisoners, Life expectancy < 1 year based on concurrent comorbidities based on study team assessment, Coagulopathy with INR > 1.5 that cannot be reversed, Thrombocytopenia with platelets < 50,000 that cannot be corrected with blood products, Unable to safely undergo elective endoscopy due to current comorbidities, and inability to pass standard endoscope. Patients with history of gastric surgery and Active narcotic use at time of G-POEM evaluation within four weeks. Tobacco use is not an exclusion criterion