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This review critically analyses a systematic review with a network meta-analysis (NMA) on the effectiveness of endoscopic interventions for gastroparesis by Eckhardt et al. (Eckhardt D, et al. BJS 2025;112. DOI: 10.1093/bjs/znaf183) is critically analysed in the light of the literature. The results show that, by restricting the network exclusively to interventional procedures - G-POEM, pyloroplasty, GES and botulinum toxin injection - drug-based and dietary therapies were not taken into account, even though these constitute first-line treatment in most consensus guidelines; furthermore, the aggregation of heterogeneous outcome measures and the predominance of non-randomised retrospective studies with often inadequately controlled participant selection further undermine confidence in the ultimately proposed ranking of treatment approaches. Due to the complex pathophysiology, patient selection and the differentiation between gastroparesis and functional dyspepsia are essential for the success of endoscopic treatment.