Gastroparesis is a complex and often debilitating condition that is challenging for even the experienced provider to treat. In this chapter, we discuss important aspects of patient history, clinical evaluation, and diagnostic studies that are best used to identify and assess this disease process. In many cases, management can be successful using just lifestyle interventions and medications. However, this is not always the case. In the refractory gastroparesis patient, consideration for surgical treatment is crucial. Over the past decades, multiple alternative interventions have been developed, both endoscopically and surgically, for these refractory patients. We examine these interventions, discussing considerations that must be made when deciding upon a multidisciplinary treatment approach.