Cold and Hot Snare Endoscopic Techniques for Removal of the Bravo pH Monitoring Capsule

Abstract

Background: Currently, use of the Bravo capsule is a very common method for evaluating the gastroesophageal reflux because it has the advantage of being an intraesophageal catheter-free system. However, endoscopic removal of the capsule is necessary when technical problems or severe discomfort are present. Most frequently, endoscopists solve this problem by nudging the device with the tip of the endoscope to dislodge it; others have used a cold snare to produce traction on the capsule, and then tear the probe off. These techniques however are not free of complications. We report here the cold and hot snare techniques used in 4 of our patients, which resulted in the successful removal of the capsule without complications. Methods: The polypectomy cold snare procedure is a typical polypectomy method. The cold snare loops the mucosal pedicle and tightly closes it until sectioning is achieved. In the hot snare technique, a monopolar coagulating current is added to the previous procedure, making the resection more feasible when the cold snare is not sufficient. Finally, in both situations, the probe is removed from the esophagus with the same snare. Conclusions: The cold and hot snare techniques are safe and simple endoscopic procedures when the removal of the Bravo capsule is required. We recommend the cold snare method as a first option and the hot snare method in case the former fails.

Endoscopic removal of an over-the-scope-clip (“bear claw”)

“…4 In another report, Bravo capsules were removed The authors speculate local immune dysfunction within sarcoid lymph nodes as a possible explanation for the apparent higher rate of infection after EUS-FNA. First, local dislodgement was possible with the use of submucosal saline solution injection and a cold "polypectomy" technique.…”

Gastric perforation following endoscopic removal of a Bravo pH capsule in a cat

“…Infrequently, Bravo pH capsules are placed at an incorrect location, experience premature transmission failure or result in patient discomfort in humans, necessitating their removal. [6][7][8] The use of a cold polypectomy snare is one of the techniques that has been used at our institution (four healthy cats and two dogs) and others for removal of Bravo pH capsules. 7,8 This is the first report of gastric perforation secondary to removal of a Bravo pH capsule.…”

“…[6][7][8] The use of a cold polypectomy snare is one of the techniques that has been used at our institution (four healthy cats and two dogs) and others for removal of Bravo pH capsules. 7,8 This is the first report of gastric perforation secondary to removal of a Bravo pH capsule. Bravo capsules have been successfully removed from the stomachs of normal Journal of Feline Medicine and Surgery 17 (6) cats without complication.…”

Mediastinal abscess formation after EUS-guided FNA in patients with sarcoidosis

“…4 Inasmuch as hospital cholecystectomy volume has not been associated with the severity of pancreatitis, it has no effect on the increase in readmissions. In this case, treatment selection bias may occur because patients with less severe pancreatitis and thus in better condition are more likely to undergo cholecystectomy and, in turn, are less likely to undergo readmission.…”