This paper presents an experimental study on two-phase flow patterns and pressure drop of R134a inside a 15.9 mm ID tube containing twisted-tape inserts. Experimental results were obtained in a horizontal test section for twisted-tape ratios of 3, 4, 9 and 14, mass velocities ranging from 75 to 250 kg/m(2) s and saturation temperatures of 5 and 15 degrees C. An unprecedented discussion on two-phase flow patterns inside tubes containing twisted-tape inserts is presented and the flow pattern effects on the frictional pressure drop are carefully discussed. Additionally, a new method to predict the frictional pressure drop during two-phase flow inside tubes containing twisted-tape inserts is proposed. (C) 2012 Elsevier Ltd. All rights reserved.