The Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) and the European Association of Endoscopic Surgery (EAES) recently released a clinical practice guideline, The Use of FLIP/Impedance Planimetry in the Surgical Work-Up and Management of GERD, Achalasia, and Gastroparesis. FLIP, as a complementary intraoperative and diagnostic and tool in foregut disorders, has shown promise but the lack of standardized protocols limits consistent clinical use. The guideline includes five recommendations based on very low certainties of evidence, due to current limited evidence evaluating FLIP in surgical practice.

Today, we’re spotlighting the recommendations included in the 2026 SAGES/EAES guideline. View the full-text version for the complete look at the recommendations and associated rationale. 

Recommendations From the 2026 SAGES/EAES Guideline:
  • The panel suggests FLIP rather than HRM as a tool to rule out achalasia prior to anti-reflux surgery in adults with proven gastroesophageal reflux disease (GERD). When FLIP is normal, FLIP can avoid the use of HRM.
  • The panel suggests that anti-reflux surgery in adult patients may be performed with or without the use of FLIP.
  • In adults, the panel suggests that FLIP may be added during peroral endoscopic myotomy (POEM) rather than POEM alone in patients undergoing peroral endoscopic myotomy.
  • In pediatrics, the panel suggests that FLIP may be added during esophagomyotomy rather than esophagomyotomy alone in pediatric patients.
  • A subgroup of patients with gastroparesis do not benefit clinically from pylorus-directed therapy, thus investigating FLIP to determine measurements that could help us distinguish these groups is reasonable.

Check out our other gastroenterology content and be sure to sign up for alerts to stay informed on the latest published guidelines and articles.