INTRODUCTION: Clinically relevant esophagogastric junction metrics on functional lumen imaging probe (FLIP) in postfundoplication patients remain unclear.

METHODS: Sixty-three symptomatic postfundoplication patients underwent FLIP, barium esophagram, and high-resolution manometry. Logistic regressions and receiver-operating characteristic curves for distensibility index (DI) at 60 mL and maximal diameter were generated to predict impaired clearance.

RESULTS: Maximal diameter (odds ratio: 0.77, confidence interval: 0.62-0.96, P = 0.02, area under receiver-operating characteristic curve = 0.73), but not DI, independently predicted impaired clearance. Diameter >16.5 mm achieved >90% sensitivity for normal clearance; DI < 2.0 mm 2 /mm Hg and diameter <8 mm were >90% specific for impaired clearance.

DISCUSSION: Maximal diameter on postfundoplication FLIP predicts impaired clearance and discriminates better than DI.