Applicability of the Dallas Consensus as a framework to interpret paediatric EndoFLIP panometry

Background/aims Endoluminal Functional Lumen Image Probe (EndoFLIP) panometry is increasingly considered as an adjunct tool to assess oesophageal motility in children and adults. The Dallas Consensus was recently introduced to standardise performing and interpreting FLIP panometry in adults. There is no agreed consensus in paediatric practice and FLIP values in children differ from adults. We aimed to assess whether the Dallas Consensus can be used as a framework to interpret FLIP panometry in children. Methods Retrospective review of all complete FLIP panometry performed at Evelina London Children’s Hospital between February 2022 and November 2025. EndoFLIP V.2.0 and EF-322N (16 cm) catheters were used. Oesophageal manometry was reported according to the Chicago classification. Results 22 children were included (median age 10.5 years (IQR 5.5–14.3); 41.7% female). Dysphagia and achalasia were the most common referral indications. A balloon volume of 40 mL represented the earliest volume at which FLIP metrics were interpretable in the majority of children, allowing application of a Dallas-like structure. Oesophagogastric junction (OGJ) diameter and Distensibility index values were lower than adult values, and age was not associated with any FLIP parameters. Patterns of OGJ opening and contractile response demonstrated concordance with manometry. Conclusion The Dallas Consensus can be applied as a framework for interpreting paediatric FLIP panometry using the same categories of OGJ opening and contractile response; however, adult threshold values, particularly for diameter and intrabag pressure, are not directly applicable to children. Paediatric-specific normative values are required, and OGJ assessment should be individualised according to tolerated balloon volume rather than fixed thresholds.