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Recent studies highlight that the EndoFLIP technique could be used as an intra-operative quality tool during either anti-reflux or achalasia surgery.8,9 Teitelbaum et al10 described that the EndoFLIP technique is able to guide laparoscopic Heller myotomy and peroral esophageal myotomy to obtain an ideal postoperative EGJ distensibility with regard to both postoperative achalasia and reflux symptoms. In addition, Perretta et al8 provided observational data about the change in EGJ distensibility and diameter during different stages of laparoscopic Nissen fundoplication. In the future, the EndoFLIP method could potentially be used during laparoscopic fundoplication to prevent creation of a hypercompetent valve with associated [http://www.selleckchem.com/products/Bosutinib.html Bosutinib nmr] postoperative symptoms (eg, dysphagia or gas bloating).8 It therefore appears that the EndoFLIP technique has considerable potential as an intra-operative tool. On the other hand, currently available methodologies limit its role with regards to the assessment of EGJ distensibility in the preoperative diagnostic work-up or in post-procedure evaluation of patients undergoing endoluminal GERD surgery like TIF. Additional research is necessary [http://www.selleckchem.com/products/byl719.html Alpelisib supplier] to define the role of the EndoFLIP technique for both the preoperative work-up and tool for intraoperative calibration. Footnotes Conflicts of interest: None.""TO THE EDITOR: I read with interest the study by Smeets et al,1 who evaluated the association between pre-operative distensibility measurements and objective and clinical outcomes after transoral incisionless fundoplication (TIF) surgery. The study concluded that distensibility measurements have no added value in the pre-operative diagnostic work-up or in the post-procedure evaluation of endoluminal anti-reflux therapy. This study adds to a growing body of literature,2�C9 which in general suggests that there is little benefit in the use of any of the standard gastrodiagnostic methods to predict post-surgical outcomes in gastroesophageal [https://en.wikipedia.org/wiki/Dabigatran Dabigatran] reflux disease (GERD) surgery. The outcomes of such functional surgery are operator and technique dependent, producing highly variable gastroesophageal junction (GEJ) constructs.10 It is therefore questionable whether the geometry of the GEJ pre-surgery alone could be reasonably expected to predict how the GEJ will perform post-surgically. However the authors, in my view, have made an important contribution in addressing a question of significant clinical importance, namely as to whether a pre-operative measurement can help stratify patients who might reasonably benefit from a lower risk transoral GERD procedure versus, for example, a laparoscopic fundoplication. Using criteria of a distensibility cut-off value of 2.3 mm2/mmHg (measured at 30 mL distension volume) combined with acid exposure time