S856 Patient Tolerance of Unsedated Endoluminal Functional Lumen Imaging Probe and High-Resolution Manometry in a Tertiary Care Center in Canada

Introduction: The endoluminal functional lumen imaging probe (FLIP) is a transoral catheter-based tool used to aid in the diagnosis of esophageal motility disorders. The standard of care is performing FLIP at time of sedated endoscopy. This can pose challenges in a resource constrained setting. Esophageal manometry (HRM), involving the transnasal placement of a catheter in an unsedated patient, has a success rate of >99%. In our center, we perform FLIP in unsedated patients in the motility lab. Our study aimed to compare the tolerability and overall success of esophageal manometry and unsedated esophageal FLIP. Methods: We conducted a prospective cross-sectional study of patients that underwent HRM or unsedated esophageal FLIP between August 2023 and April 2025. Patients were provided a questionnaire following the procedure to track adverse events during catheter insertion and recording. Data on tolerability was collected, as were other demographic- and outcome-related parameters. The incidence of patient-reported adverse effects was compared with Chi-squared tests and the intensity of pain on a 10-point visual analogue scale and overall experience were compared with Mann-Whitney U. Results: A total of 88 patients (62 [70.5%] women, median age 58.5 years) underwent HRM (61 [69.3%]) or FLIP (27 [30.7%]) and were included in this analysis. There was no significant difference between reported adverse events occurring during FLIP versus HRM except for ‘other,’ reported in 37% FLIP and 11% HRM (P = .007) during insertion. Gagging was reported by 30% and pain/pressure by 7% FLIP patients and gagging by 11% HRM patients. During recording, vomiting was reported by 16% HRM patients vs 0% FLIP (P = .029). In terms of overall experience, global distress was statistically different with a median score of 3 for FLIP and 2 for HRM (P = .017). There was no difference in global symptoms between age <65 and age >65, or sex. There was no difference in overall success between FLIP and HRM with technical success seen in 93% FLIP and 95% HRM (P = 0.49). Conclusion: There are no significant differences between adverse events associated with FLIP versus HRM, except for gagging at time of insertion, which was higher in FLIP patients. However, there was no difference in overall success between both procedures suggesting that unsedated FLIP is well tolerated and safe to perform in the motility lab.