Successful oesophageal pH monitoring with a catheter‐free system

Abstract

SUMMARYBackground: Traditional catheter-based oesophageal pH testing is limited by patient discomfort and the tendency for patients to alter their diet and activities during the study. A catheter-free pH monitoring system (Bravo) designed to avoid these problems has recently become available, but the advantages and limitations of this device have not been fully explored. Aim: To report our initial experience with this new technology. Methods: The records of consecutive patients undergoing Bravo pH monitoring were reviewed. The squamo-columnar junction was localized endoscopically and the pH capsule was placed 6 cm above this junction. All patients were re-endoscoped immediately following placement to document mucosal attachment. Patients were monitored for 24-48 h and then returned the radiotelemetry recording device. Data were subsequently downloaded to a personal computer.

Comparison of esophageal placement of Bravo capsule system under direct endoscopic guidance with conventional placement method

“…Further, the direct method of placing the capsule allows the esophagus to be cleared of air under direct vision, which ensures the successful placement of the device by enhancing the contact between the esophageal wall and the well of the capsule. This is important because early detachment is a well-known complication with the Bravo system, and its incidence could be as high as 2-12% (4), (13).…”

Comparative study of two modes of gastroesophageal reflux measuring: conventional esophageal pH monitoring and wireless pH monitoring

“…However, there was an improvement of this rate when compared to earlier studies that indicate failures from 11% to 13.3% (24,31,33) , due to changes in equipment manufacture and increased time of vacuum suction of the mucosa, which enabled better fixation of the capsule. Early drop of the capsule occurred in the only patient who experienced diffuse esophageal spasm in the manometric study.…”

Wireless Capsules for Esophageal pH Monitoring: Are We Placing Them Correctly?

“…Several endoscopists then withdraw the endoscope to approximately 20 cm from the incisors and intermittently suction while the capsule system is introduced orally and advanced to a distance predetermined by the SCJ measurement [5]. One endoscopist prefers to remove the endoscope and reintroduce it after deployment [1,10]. This difference in technique made no difference in the magnitude of capsule misplacement or the prevention of early capsule detachment.…”

“…Ambulatory esophageal pH testing in patients with suspected gastroesophageal reflux disease (GERD) can be performed with either a transnasal catheter or a wireless capsule system (Bravo™ pH Monitoring System; Medtronic, Inc., Shoreview, Minn., USA) [1,2]. The capsule has two important advantages – patient comfort, resulting in maintenance of normal daily activities and prolonged (>24 h) pH monitoring [3,4,5].…”