what to do if bravo capsule doesnt fall off
World J Gastrointest Endosc. 2015 May 16; seven(5): 573–574.
Unreported complication of Bravo pH capsule dislodged into the pyriform sinus
Received 2014 October 8; Revised 2015 January three; Accepted 2015 Feb ten.
Abstract
We report an unexpected, previously unreported complexity of Bravo pH sheathing dislodgement. During Bravo pH testing of a 44-yr-former human being with gastroesophageal reflux disease, we were unable to endoscopically visualize the capsule attached to the esophageal wall later deployment. Later on multiple attempts to detect the capsule, information technology was visualized in the left pyriform sinus. As at that place was significant risk for pulmonary dislodgement, ENT and pulmonary physicians were immediately consulted to review options for condom removal. Ultimately, ENT successfully retrieved the sheathing with a foreign body removal forceps. The Bravo pH examination is generally a well-tolerated diagnostic tool used to confirm the presence of abnormal esophageal acid reflux. While few complications accept been reported, technical difficulties tin can occur, including poor information reception, misplacement, and early on dislodgement. Rarely, more serious complications can occur, ranging from esophageal wall trauma to sheathing aspiration. Gastroenterologists performing this procedure should be aware of the low, but non-little, gamble of complications.
Keywords: Gastroesophageal reflux disease, Esophageal pH monitoring, Bravo sheathing, Dislodgement, Esophagogastroduodenoscopy
Core tip: We report an unexpected, and so far unreported, complication of a Bravo pH sheathing dislodgment. While Bravo probe placement is mostly a well-tolerated procedure, dislodgment into the pyriform sinus in this case necessitated immediate action past an interdisciplinary squad. Complications of Bravo sheathing use range from technical difficulties, such equally poor data reception and non-deployment, to more serious events such every bit esophageal wall trauma and capsule aspiration. Gastroenterologists performing this procedure should be aware of the run a risk of potential complications.
LETTER TO THE EDITOR
We report an unanticipated, previously undocumented complication of Bravo capsule dislodgement. A forty-five year old patient with gastroesophageal reflux disease (GERD), not-compliant with medical therapy, presented with increasing cough, hoarseness, and other acid reflux symptoms. To verify presence of acrid reflux, he underwent upper endoscopy and Bravo pH testing at our infirmary. The gastroesophageal junction (Z line) was visualized at a altitude of 40.0 cm from dentition. The Bravo device was deployed at 34.0 cm from dentition (6 cm above the Z line). When the sheathing was non endoscopically visualized to exist adherent to the esophageal wall, the endoscope was advanced beyond 34.0 cm to appraise for possible device motion to the distal esophagus or stomach. When the capsule was not visualized at these locations, the endoscope was withdrawn. When the telescopic was withdrawn from the upper esophageal sphincter, the device was seen in the left pyriform sinus (Figure ane). The nonadherent capsule likely was either pulled up by the endoscope during withdrawal or coughed upward by the patient. ENT and pulmonary physicians were immediately consulted for assistance in ensuring safe removal of the capsule from this precarious location, as there was pregnant hazard for pulmonary dislodgement. After the anesthesiologist performed endotracheal intubation, ENT successfully retrieved the capsule with a strange body removal forceps without farther complications.
Bravo pH sheathing in left pyriform sinus.
The Bravo pH test is more often than not a well-tolerated diagnostic tool that tin verify the presence of aberrant esophageal acrid reflux and determine if treatment refractory symptoms are due to persistent acid reflux in patients with GERD. Equally the deployment of the Bravo pH device is typically a innocuous procedure[1], very few complications have been reported. Technical difficulties virtually usually include non-deployment, non-attachment, misplacement, premature dislodgement, and insufficient information reception. Infrequently, patients develop significant chest pain after capsule placement[ii], necessitating removal. Rarely, more serious complications tin occur in less than 2% and include esophageal wall trauma, excessive bleeding, and capsule aspiration[3]. In one reported instance, the patient aspirated the sheathing into the bronchus immediately subsequently deployment, causing retching, heavy cough, and desaturation to 74%[4]. After initial pushing into stomach with a transnasal video-endoscope, this sheathing was removed with grasping forceps.
Gastroenterologists using the Bravo pH test should exist cognizant of the low but not-trivial adventure of complications, ranging from technical difficulties to aspiration of a dislodged capsule. Providers can utilise reports of documented complications to troubleshoot and resolve difficulties that may arise during deployment of Bravo pH capsules.
Footnotes
Disharmonize-of-interest: Equally stated in the cover letter, nosotros exercise not have whatever conflicts of interest.
Open-Access: This article is an open-admission article which was selected by an in-house editor and fully peer-reviewed past external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on dissimilar terms, provided the original work is properly cited and the use is non-commercial. Meet: http://creativecommons.org/licenses/by-nc/4.0/
Peer-review started: October viii, 2014
First decision: November 14, 2014
Article in press: February 12, 2015
P- Reviewer: Amornyotin Due south, Rabago L S- Editor: Tian YL 50- Editor: A E- Editor: Wu HL
References
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Source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4436927/
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