Abstract
Gastroparesis is a severe diabetic complication, caused by a progressive multifactorial enteric neuropathy. To make an early diagnosis in patients at risk of diabetic gastroparesis is crucial for slow down its progression towards full-blown disease source of further complications and requesting effective, but unsafe, drugs as well as invasive surgical treatments. This aim can be achieved by detecting its first signal represented by the gastric emptying (GE) delay, by using, among the tests to measure GE, the simple, safe, reliable, and easily available one, that is real-time ultrasonography, possibly done annually. Once the GE delay has been identified, it is necessary to evaluate with endoluminal functional lumen imaging probe or manometry whether it depends on pylorospasm, which should be treated by means of non-surgical endoscopic therapies. If, instead, it depends on initial gastropathy, detected by electrogastrograhic body surface gastric mapping, it should be treated with the safest prokinetic drugs and with the newly emerging treatments, thus distancing heavy medical and surgical treatments, while waiting for future solutions.