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Introduction Wireless pH monitoring (WPM) is increasingly used to evaluate gastroesophageal reflux disease (GERD), offering improved diagnostic yield and tolerability over 24hr catheters, and Lyon 2.0 recommends extending recordings up to 96hrs to better capture day-to-day variability. AlphaONE™ (Laborie, USA) and Bravo™ (Medtronic, Ireland) capsules are widely used, yet limited data exist directly comparing their real-world performance, and it remains unclear whether deployment suction protocols influence capsule retention or study duration. To address this, a large comparative analysis was undertaken to evaluate study duration, adherence, symptom correlation, and tolerability across alphaONE™ and Bravo™ and four standardised suction protocols.Method Four WPM deployment protocols were prospectively applied during sedated gastroscopy: alphaONE™ 10-second (A10), alphaONE™ 60-second (A60), Bravo™ 60-second (B60) and Bravo™ 120-second (B120). Participants completed a validated tolerability questionnaire. Total recording duration, capsule retention and standard WPM metrics were collected. Statistical analysis (GraphPad Prism, SPSS) was Kaplan–Meier survival, Cox regression, Kruskal–Wallis, Mann–Whitney and Spearman correlation tests.Results 697 patients were included (115–204 per group). Age, sex distribution and acid exposure time (AET) did not differ significantly between groups. Recording duration varied significantly – the proportion of studies achieving >92hr was highest in alphaONE™ groups: A60 90.2%, A10 88.9%, B120 80.6%, B60 75.3%. Time-to-detachment analysis showed longer retention for A60, with earlier detachment in other groups (B60 vs A60 HR 2.99, 95% CI 1.74–5.13, p<0.001; A10 vs A60 HR 1.93, 95% CI 1.07–3.47, p=0.029; B120 vs A60 HR 3.12, 95% CI 1.72–5.63, p<0.001). Endoscopic removal for retention was rare (0.5%) and unrelated to device or suction time. Tolerability scores did not correlate with AET or study duration (p>0.05), besides a very small negative correlation (Spearman r=-0.22, p=0.015), between eating difficulty and duration in B60. No significant group differences (p>0.05) were observed in overall experience, chest discomfort, dysphagia, eating difficulty, throat discomfort, daily activity restriction or willingness to recommend the test. >85% patients preferred WPM over 24hr catheter monitoring.Conclusion All four protocols performed well with high completion rates and excellent tolerability. Tolerability was equivalent across groups and unrelated to study duration or AET. However, alphaONE™, particularly with 60sec suction, demonstrated significantly longer retention, with Bravo™ capsules detaching about three times faster. This represents an additional 5–10 hours of recording time for A60 compared with Bravo™ protocols, a difference that may shift borderline studies into the preferred 96hr range, potentially improving diagnostic yield for GERD.Abstract P389 Figure 1