EndoFLIP-guided foregut surgery: toward a new era of intraoperative physiology

The endoluminal functional lumen imaging probe (EndoFLIP) has emerged as a transformative tool in the operative and perioperative management of foregut disorders, including achalasia, gastroesophageal reflux disease (GERD), and esophagogastric junction outflow obstruction. Unlike traditional modalities such as high-resolution manometry and barium swallow studies, EndoFLIP provides real-time, intraoperative assessment of distensibility, compliance, and luminal geometry at the esophagogastric junction. As such, EndoFLIP may augment surgical precision in procedures such as Heller myotomy, fundoplication, and peroral endoscopic myotomy (POEM) by enabling physiologic calibration rather than reliance on static anatomical correction. We further discuss its evolving role in risk stratification, postoperative surveillance, and personalized foregut surgical planning. As the field moves toward functional and minimally invasive solutions, EndoFLIP may offer a data-driven framework to optimize patient outcomes through physiology-informed decision-making in real time.