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

Background/aims: Conventional placement of a wireless esophageal pH monitoring device in the esophagus requires initial endoscopy to determine the distance to the gastroesophageal junction. Blind placement of the capsule by the Bravo delivery system is followed by repeat endoscopy to confirm placement. Alternatively, the capsule can be placed under direct vision during endoscopy. Currently there is no published data comparing the efficiency of one method over the other. The objective of this study was to compare the method of Bravo wireless pH device placement under direct visualization with the conventional method.

Methods: This retrospective study involved 58 patients (29 patients with indirect and 29 patients with direct visualization) who underwent Bravo capsule placement. The physician's endoscopy procedure notes, nurse's notes, post-procedure notes, recovery notes, and pH monitoring results were reviewed. The safety of the procedure, length of the procedure and patient tolerability were evaluated.

Results: None of the 58 patients had early detachment of the device or any immediate procedure-related complications. Overall incidence of complications in both groups was similar. No failures due to the technique were noted in either group. The average amount of time taken for the procedure was similar in the two groups.

Conclusions: The technique of placing Bravo pH device under direct visualization is as safe and effective as the conventional method. In addition, the direct visualization technique has an added advantage of avoiding a second endoscopic intubation. The length of the procedure is similar between the two techniques.