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Introduction Diagnosing gastro-oesophageal reflux disease (GORD) involves symptom assessment, gastroscopy (OGD) and objective reflux metrics, as defined by the Lyon 2.0 consensus. NHS diagnostic services are under pressure, with prolonged waiting times, emphasising the need for efficient diagnostic pathways. Wireless pH monitoring (Bravo) is done concurrently with OGD and increases diagnostic yield compared with catheter studies, while concurrent EndoFLIP enables assessment of oesophageal physiology. Data on the combined use of these investigations within a single session are limited. We report safety and tolerability outcomes to assess the feasibility of this streamlined diagnostic approach.Methods Adults referred for OGD with symptoms of GORD were offered same session EndoFLIP and Bravo (IRAS 304275). Procedures were performed unsedated, with conscious or propofol sedation. OGD, Bravo and EndoFLIP metrics were collected, alongside tolerability and comfort scores recorded by the endoscopist, nursing staff and patients, using an ordinal Likert-type scale ranging from 0 to 5.Results 108 patients were recruited; mean age 46.9y, 61% female, 25% unsedated, 67% midazolam/fentanyl (mean 1.9mg, 50mcg) and 8% propofol. OGD and EndoFLIP were successfully completed in all. There were no complications or readmissions. Premature Bravo detachment occurred in 4/108 (3 sedated, 1 unsedated).OGD identified hiatus hernia in 34%, oesophagitis in 28% and Barrett’s oesophagus in 5%. GORD was diagnosed in 45% as per Lyon 2.0. EndoFLIP demonstrated normal GOJ opening in 68% and normal motility in 75%.Tolerability was not associated with age, acid exposure time or sedation dose (Spearman, p > 0.05), besides a modest correlation between nurse-reported comfort and midazolam (Spearman p = 0.0087).Conclusions The combined delivery of OGD, Bravo and EndoFLIP in a single session is safe, well tolerated, and feasible, including in unsedated and minimally sedated patients, and provides complementary physiological and reflux assessment. This streamlined, patient centred approach has the potential to reduce repeat procedures and pathway inefficiency in the investigation of suspected GORD.Abstract P135 Table 1Tolerability scoringUnsedated (n=27)Midazolam/Fentanyl sedation (n=72)Propofol (n=9)Kruskal–Wallis p-valueOGD*2 (1-3) [A]2 (1-3) [B]0 (0-0) [B]0.0016EndoFLIP*1.5 (1-2) [A]1 (0-2) [A]0 (0-0) [B]0.0035Bravo*1.5 (1-2)1 (1-2)0 (0-0.25)0.0084 Would you recommend having 3 tests together?£4 (3.25-5) 4 (4-5)5 (4-5)0.6027Endoscopists comfort score$0 (0-1) [A]0 (0-0) [B]0 (0-0) [B]0.0021Nurses comfort score$0 (0-0)0 (0-0)0 (0-0)0.2748Median (IQR)Groups sharing the same letter are not significantly different [Dunn’s multiple comparisons]Scoring:* 0 = none → 5 = unbearable£ 0 = regret → 5 = very happy$ 0 = comfortable → 5 = abandoned