Purpose:G-POEM is an established intervention for refractory gastroparesis, yet clinical outcomes remain inconsistent, and optimal patient selection is challenging. Symptom severity, pyloric appearance, and response to intrapyloric botulinum toxin are commonly considered in clinical decision-making; a preoperative decision tool is lacking. The present study aimed to develop a preoperative risk score to predict clinical success following G-POEM in patients with post-surgical gastroparesis.Method: A retrospective analysis was performed of consecutive adult patients with refractory post-surgical gastroparesis who underwent G-POEM between 2018 and 2024. Clinical success was defined a priori as a reduction of at least 50% in GCSI total score at 6 to 12 months post-procedure, consistent with published G-POEM literature. A pragmatic, clinically weighted scoring system was developed. The resulting PREDICT-GPOEM score incorporates response to botulinum toxin, pyloric tightness, baseline GCSI severity, age over 60 years, and non-oesophagectomy aetiology. Result:24 patients underwent G-POEM, most frequently following hiatal hernia repair, oesophagectomy, or bariatric surgery. Clinical success was achieved in 75%. Response to botulinum toxin alone demonstrated a positive predictive value of approximately 74%. The PREDICT-GPOEM score stratified patients into low-, intermediate-, and high-risk groups, with clinical success rates of 40%, 65%, and 85%, respectively, demonstrating strong discriminatory ability. The score showed superior performance in non-oesophagectomy patients, consistent with established differences in symptom phenotype and conduit physiology. Conclusion:The PREDICT-GPOEM score effectively stratifies the probability of clinical success following G-POEM in post-surgical gastroparesis, demonstrating robust discrimination and clinically meaningful risk categorization.