Nonendoscopic transnasal placement of a wireless capsule for esophageal pH monitoring: Feasibility, safety, and efficacy of a manometry-guided procedure

Background and study aims: The aim of the study was to evaluate the safety, feasibility, and efficacy of transnasal placement of the Medtronic Bravo capsule for wireless esophageal pH monitoring. Patients and methods: Forty patients with symptomatic gastroesophageal reflux disease were prospectively evaluated. All patients underwent upper gastrointestinal endoscopy and esophageal manometry. The Bravo capsule was then introduced transnasally and released 5 cm above the upper margin of the lower esophageal sphincter. Serial radiographs were performed weekly until capsule release. Results: Of the 40 patients who were evaluated, 38 (95%) were eligible to undergo the procedure. Transnasal placement proved impossible in one patient (2.5%). Overall, a total of 39 procedures were performed in 38 patients (the procedure was repeated in one patient because of accidental intragastric fixation). Esophageal placement was successful in 36/39 procedures (92.3%). The mean duration of the procedure was 10 minutes (range 5-16 minutes). Adverse events were noted in five of the 39 procedures (12.8%), mild epistaxis in two patients (5.1%) and pharyngeal irritation in three patients (7.7%). After the procedure, a slight "foreign body" sensation was reported by 20 of the 36 patients (55.5%) who had undergone successful esophageal placement; two patients (5.5%) experienced severe retrosternal pain necessitating endoscopic removal of the capsule. At the end of the study, 34 of the 38 patients (89.5%) stated that they would be willing to undergo the test again if necessary. Conclusions: Transnasal placement of the Bravo pH capsule is safe, well tolerated, does not require sedation, and avoids endoscopy and its complications. © Georg Thieme Verlag KG Stuttgart.