Approach to Esophageal Symptoms: Optimizing Index Endoscopy.

We propose a novel algorithm integrating Clinical Achalasia Risk Score (CARS) scoring, functional lumen imaging probe (FLIP) panometry, and wireless pH monitoring to streamline esophageal symptom evaluation during index endoscopy. This approach reduces diagnostic delays and reliance on manometry, diagnosing 50% to 70% of patients without overt findings. CARS scoring assesses achalasia likelihood, guiding and informing FLIP panometry to evaluate esophagogastric junction opening and motility, yielding more accurate classifications, and wireless pH monitoring enhances gastroesophageal reflux disease diagnosis by measuring acid exposure over 48 to 96 hours. This method can diagnose up to 75% of patients within a week.