Pitfalls in Wireless Esophageal pH Monitoring

Abstract

Purpose: The Bravo pH monitoring system is a catheter-free pH capsule that is attached to the esophageal mucosa. Studies have compared it to conventional pH monitors, and demonstrated patient tolerability with minimal complications. There has been one case report describing an esophageal perforation that occurred during placement of the Bravo pH catheter.1 Another more recent study reported that the Bravo capsule frequently causes hypertensive contractions in the distal esophagus, and these contractions are commonly associated with chest pain.2 The aim of our study is to report our experience with wireless Esophageal pH monitoring. Methods: Medical records of consecutive patients undergoing Bravo pH monitoring at our institution were reviewed. 160 patients underwent wireless 48 hr pH monitoring between 7/1/2003 to 6/1/2006. Indications for the study included the typical reflux symptoms, heartburn and regurgitation, as well as atypical symptoms such as non-cardiac chest pain, chronic cough, asthma, laryngitis, hoarseness, and globus. Results: 160 patients underwent Bravo pH monitoring between 7/2003 and 6/2006. In 23 (14%) patients, complications were noted. Data was not retrievable due to computer malfunction in 9 patients (5.6%). In 6 patients (3.8%) the capsule either failed to deploy, attach, or fell off within the first 24 hours. Eight patients (5%) reported a foreign body sensation, chest pain or globus, which required repeat EGD for removal of the capsule. Adequate diagnostic data was obtained in the remaining 137 patients (85%). Conclusions: 1. The majority of complications were related to technical difficulties, but overall the BRAVO capsule was well tolerated. 2. Five percent of our patient population experienced somatic complaints requiring endoscopic removal of the capsule 3. Bravo pH monitoring is an effective method of quantifying esophageal acid exposure. 4. Recognition of the potential technical issues and patient intolerability compared to the standard 24 hour ambulatory pH monitor is crucial for the appropriate use of this diagnostic modality.