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Introduction High-resolution oesophageal manometry (HRM) is the gold standard for assessing oesophageal motility disorders, but up to 10% of patients may be intolerant due to discomfort or anatomical factors (Hengehold et al, Neurogastroenterol Motil 2022), and may yield inconclusive results (Roman et al, Clin Gastroenterol Hepatol 2011), in which cases EndoFLIP (Endoluminal Functional Lumen Imaging Probe) may offer an alternative. To date there is minimal data on its use in the NHS, so this study aims to assess EndoFLIP in patients with incomplete/inconclusive HRM.Methods A retrospective review was conducted of adult patients at a single tertiary centre who were unable to tolerate HRM or had inconclusive HRM results and subsequently underwent EndoFLIP between 2022 and 2025. Electronic clinical records were reviewed to determine referral indications, reasons for HRM failure, and EndoFLIP findings. Descriptive statistics were used to summarise patient demographics, HRM intolerance rates and EndoFLIP outcomes.Results Between 2022-2025, 1785 patients underwent HRM, of whom 75 (4.2%) were unable to tolerate the procedure. Forty patients underwent EndoFLIP following failed (75%) or inconclusive (25%) HRM, outcomes outlined in table 1.Reason for HRM failure included: inability to tolerate nasal intubation (73%), withdrawal of consent after intubation (20%), failure due to nasal anatomy (3%). 58% were female, median age of 49. EndoFLIP was successfully completed in all patients. EndoFLIP findings were defined according to the Dallas Consensus 2.0. Normal esophagogastric junction (EGJ) opening/contractility was found in 53%. 9 out of 10 patients referred for consideration of anti-reflux surgery had normal EGJ opening and normal contractile response and were deemed suitable for surgery. Reduced EGJ opening was found in 40%, of which 23% had a therapeutic dilation performed in the same sitting. 8% had indeterminate findings i.e. borderline EGJ opening.Conclusions EndoFLIP provides clinically meaningful diagnostic information and can directly influence management decisions in patients with failed or inconclusive HRM. These findings demonstrate the clinical applicability of EndoFLIP in an NHS setting for patients with failed/inconclusive HRM.Abstract P394 Table 1EndoFLIP outcomesEndoFLIP outcomesn (%)Normal EGJ opening, normal contractile response21 (53)Suitable for anti-reflux surgery9 (23)Reduced EGJ opening16 (40)Diagnosis of achalasia9 (23)Therapeutic dilatation performed7 (18)Borderline EGJ Opening3 (8)