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Background Both gastric electrical stimulation (GES) and gastric‐peroral endoscopic myotomy (G‐POEM) can be offered to patients with gastroparesis and predominant nausea and vomiting. The study's aim was to compare GES and G‐POEM efficacy on nausea and vomiting scores in patients with gastroparesis. Methods Two multicenter cohorts of patients with medically refractory gastroparesis with predominant nausea and vomiting (defined as a score >2 on nausea and vomiting subscale that varied from 0 to 4) were treated either with GES (n = 34) or G‐POEM (n = 30) and were followed for 24 months (M). Clinical response was defined as a decrease of ≥1 point in nausea and vomiting subscale without premature exclusion due to switch from one to the other technique before M24. Changes in symptomatic scales and quality of life were also monitored. Key Results Patients from both groups were comparable although the mean score of nausea and vomiting subscale was higher in GES (3.0) compared to G‐POEM group (2.6; p = 0.01). At M24, clinical response was achieved in 21/34 (61.7%) patients with GES and in 21/30 (70.0%; p = 0.60) patients with G‐POEM. Mean scores of nausea and vomiting subscale decreased at M24 in both GES (from 3.0 to 1.6; p < 0.001) and G‐POEM (from 2.6 to 1.2; p < 0.001) groups, although there was no difference between groups (difference adjusted from baseline: −0.28 [−0.77; 0.19]; p = 0.24). Likewise, symptomatic and quality of life scores improved at M24 in both groups, without difference according to treatment group. Conclusions and Inferences At M24, we did not observe significant difference in efficacy of GES and G‐POEM in medically refractory gastroparesis with predominant nausea and vomiting.

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