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Introduction High-resolution manometry (HRM) is the gold-standard for oesophageal motility and gastro-oesophageal junction (GOJ) assessment (Yadlapati et al., Neurogastroenterol Motil 2021). EndoFLIP provides intraprocedural assessment of GOJ distensibility (DI) and contractile response, standardised in recent consensus guidance (Carlson et al., Gastroenterology 2025). The role of EndoFLIP in assessing patients with GORD symptoms remains incompletely understood. We compared EndoFLIP and HRM parameters in adults investigated for gastro-oesophageal reflux disease (GORD).Methods A retrospective review was done of HRM in adults who had undergone EndoFLIP as part of a research study (IRAS 304275). EndoFLIP distensibility index (DI) was measured at 60 ml in minimum (closed) and maximum (open) states and compared with HRM lower oesophageal sphincter pressure (LESp) and integrated relaxation pressure (IRP). Correlation, discrimination and agreement were assessed using Spearman’s rank, linear regression, receiver operating characteristic (ROC) analysis, intraclass correlation coefficients (ICC), Bland–Altman analysis, and Cohen’s/Fleiss’ κ.Results 38 patients underwent paired EndoFLIP and HRM assessment. Minimum (closed) DI showed a moderate inverse correlation with LESp (r = –0.34, p = 0.039), while maximum DI demonstrated a strong inverse correlation with IRP (r = –0.62, p = 0.0002). DI metrics showed limited ability to discriminate low or high LES pressure on ROC analysis (AUCs <0.75). Whether the GOJ opened or not was not associated with LESp, IRP, acid exposure time or GORD diagnosis (all p > 0.05). Agreement for hiatus hernia (HH) length was greatest between OGD and HRM, with poorer agreement between EndoFLIP and either modality. Motility classification showed poor agreement between EndoFLIP and HRM using both four-category (normal, reduced, hyper-contractile, absent) and binary (normal, abnormal) classification (figure 1).Conclusions EndoFLIP demonstrates physiologically plausible correlations with HRM for GOJ dynamics but shows poor agreement for motility classification and HH assessment. EndoFLIP provides complementary intraprocedural physiological information independent of manometric findings. Further studies are needed to define how EndoFLIP metrics should be integrated alongside HRM in patient pathways.Abstract P423 Table 1Key correlations and agreement between EndoFLIP and HRM metricsComparisonStatisticsInterpretationMinimum DI vs LESpr = –0.34, p = 0.039Moderate inverse correlationMaximum DI vs IRPr = –0.62, p = 0.0002Strong inverse correlationDI vs LES pressure thresholdsROC AUC 0.58–0.72Poor discriminationHH length: OGD vs HRMICC = 0.61; κ = 0.62Best agreementHH length: HRM vs EndoFLIPICC = 0.13; κ = 0.14Poor agreementMotility classificationκ = 0.14–0.28Poor agreement