Introduction: Gastroparesis is a debilitating disease of insufficient gastric emptying and visceral hypersensitivity characterized by nausea, vomiting, early satiety and bloating. Gastric emptying scintigraphy (GES), in combination with typical symptoms and normal esophagogastroduodenoscopy, is used to diagnose the disease. Gastric per-oral endoscopic pyloromyotomy (G-POEM or POP) has emerged as a novel technique for treating gastroparesis with up to 80% success rate. This procedure involves a myotomy of the distal stomach. We hypothesize that responders to this therapy are characterized by more distal dysmotility when compared with non-responders, as defined by GES retention patterns. Methods: We use regional gastric emptying measurements from diagnostic GES to determine proximal or distal predominance of disease for each patient. We then compare treatment response and symptoms in each patient to total gastric half-emptying time, proximal gastric half-emptying time and a ratio comparing the two values. Results: 47 patients underwent G-POEM during the study period. A significant difference (P<0.01) was found in proximal:total half-emptying time ratio between responders and non-responders. A significant difference between pre- and post-procedural proximal:total half-emptying time ratios were identified for each patient. No correlations were identified between motility patterns and symptoms or in motility patterns among the different etiologies of the disease. Conclusion: Proximal:total half-emptying time ratio may represent an important patient selection factor for G-POEM versus other treatment modalities going forwards. Local retention patterns in GES may not inform symptom profile in gastroparesis. Copyright © 2019 by the Society of Nuclear Medicine and Molecular Imaging, Inc.