Procedures

Wireless capsule esophageal pH monitoring

Monitoring esophageal pH can also be performed with Bravo™ pH monitoring which uses a capsule that is attached to the esophageal lining.

How is a Bravo™ pH-monitoring test performed?
The capsule is approximately the size of an eraser on a pencil. The capsule contains an acid sensing probe, a battery, and a transmitter. During an upper endoscopy (EGD), the capsule is introduced into the esophagus on a catheter through the nose or mouth and is attached to the lining of the esophagus with a clip. Then, the catheter is detached from the capsule and removed. The probe monitors the acid in the esophagus and transmits the information to a recorder that is worn by the patient on a belt.

With this method, there is no catheter protruding from the nose for the recording. For this test, the monitoring period is longer, 48 hours (2 days), which allows more symptom events to be captured.

During the recording, the patient goes about his or her usual activities, such as eating, sleeping, and working. Meals, periods of sleep, and symptoms are recorded by the patient in a diary and by pushing buttons on the recorder. This diary helps the doctor to interpret the results.

The patient returns 48 hours after placement when the recorder is attached to a computer so that the data recorded can be downloaded into the computer and can be analyzed.

The capsule will eventually fall off the esophageal lining, usually after five to several days, and is passed in the stool. The capsule is not reusable.

The advantages of the capsule device are related to the absence of a catheter connecting the probe to the recorder and the longer duration of the study. There is greater comfort without a catheter in the back of the throat. As a result, patients are more likely to go to work and participate in more normal activities. One disadvantage of the capsule is that it only measures the pH at one level since it cannot be used in the pharynx or the stomach.  Another disadvantage is the inability to measure impedance via the Bravo™ pH system.

How should I prepare for the test?
An empty stomach is essential for an accurate and safe examination, so you should have nothing to eat or drink, including water, for at least eight hours before the examination.

Can I take my current medications?
Most medications can be continued as usual.  Inform us about medications you're taking, particularly aspirin products, arthritis medications, anticoagulants (blood thinners), insulin or iron products.

What about Aspirin?
Do not stop aspirin, unless instructed by your physician or our staff.  You may have stopped aspirin before a previous upper endoscopy. The latest research and guidelines tell us that it is safe to perform routine upper endoscopy and biopsy while patients continue their aspirin. The data also shows us that the risk of bleeding is very low and when compared with the risk of a stroke or other clotting event, bleeding is relatively easy to control.  Major clotting events, such as stroke can leave irreversible damage.

What about Plavix® (clopidogrel)?
Do not stop Plavix® (clopidogrel), unless instructed to by your physician or our staff.  You may have stopped Plavix® (clopidogrel) before a previous upper endoscopy. The latest research and guidelines tell us that it is safe to perform routine upper endoscopy and biopsy while patients continue their Plavix® (clopidogrel). The data also shows us that the risk of bleeding is very low and when compared with the risk of a stroke or other clotting event, bleeding is relatively easy to control.  Major clotting events, such as stroke can leave irreversible damage.

What about Coumadin®?
Do not stop Coumadin®.  You may have stopped Coumadin® before a previous upper endoscopy. The latest research and guidelines tell us that it is safe to perform routine upper endoscopy and biopsy while patients continue their Coumadin® as long as their INR is in the routine, therapeutic range of between 2 and 3. The data also shows us that the risk of bleeding is very low and when compared with the risk of a stroke or other clotting event, bleeding is relatively easy to control.  Major clotting events, such as stroke can leave irreversible damage. Your doctor will discuss with you if Coumadin® should be stopped.

What about Pradaxa® (dabigatran)?
Please STOP taking Pradaxa® (dabigatran) 36 hours before your upper endoscopy (EGD).  Pradaxa® (dabigatran) has an extremely short half-life, unlike Coumadin®, which means the blood thinning effect is gone after 24-36 hours after stopping the medication.

Will I feel the capsule?
The capsule device may cause a vague sensation in the chest or discomfort when swallowing. This may be due to food tugging on the capsule as the food passes, although discomfort occasionally can be felt when swallowing only saliva. In rare instances, the Bravo™ capsule can cause chest pain requiring removal of the capsule with an endoscopy.

Restrictions after Bravo™ pH monitoring?
Patients cannot have an MRI (Magnetic Resonance Imaging) during the test and for 30 days afterwards.

Some patients cannot have this type of monitoring. Patients with pacemakers, implantable defibrillators or neurostimulators cannot use Bravo™. Patients with a history of bleeding diatheses, strictures, severe esophagitis, varices, obstruction, and prior esophageal resection are not candidates for Bravo™ pH monitoring.

What are the possible complications of Bravo™ pH monitoring?
Although complications are rare, bleeding can occur. If this occurs, it's usually minimal and rarely requires follow-up. Other potential risks include a reaction to the sedative used and a perforation (a tear in the gastrointestinal tract lining). It is important to recognize early signs of possible complications. If you have a fever after the test, trouble swallowing or increasing throat, chest or abdominal pain, contact us immediately.