Gastroparesis is an incompletely understood disorder characterized by vomiting, nausea, abdominal pain, and related symptoms amongst evidence of delayed gastric emptying often refractory to medical therapy. Gastric electrical stimulation (GES), using higher than physiologic frequency and low energy, has been shown to be effective in many patients with refractory symptoms and received Humanitarian Use Device approval in 2000. A meta-analysis suggests GES is effective for symptom control and favorable in gastric emptying, nutritional status, and quality of life analysis. Recent work with endoscopically placed, temporary GES indicates trial stimulation is important in the evaluation of stimulation devices. In addition, approximately 50 % of patients responded to standard settings [4, Neurogastroenterol Motil 18(4):334–338, 2006] while other patients require higher energy settings for optimal response. These recent studies offer the potential for personalization of stimulation parameters in a given patient. For GES to be accepted and adopted on more widespread basis, further evaluation of individual responses to simulation must be determined and then correlated with individual histologic, electrophysiological and biochemical findings to optimally help patients. This chapter will discuss the historical development of current GES therapy.