Letters To The Editor
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Endosc. May 16, 2015; 7(5): 573-574
Published online May 16, 2015. doi: 10.4253/wjge.v7.i5.573
Unreported complication of Bravo pH capsule dislodged into the pyriform sinus
Akash Kumar, Elisabeth Kramer, Sita Chokhavatia
Akash Kumar, Department of Medicine, the Mount Sinai Medical Center, New York, NY 10029, United States
Elisabeth Kramer, Division of Gastroenterology and Nutrition, Memorial Sloan-Kettering Cancer Center, New York, NY 10065, United States
Sita Chokhavatia, Division of Gastroenterology and Hepatology, Robert Wood Johnson University Hospital, New Brunswick, NJ 08901, United States
Author contributions: Kumar A and Kramer E were involved in literature review; Chokhavatia S performed the EGD on the patient described in the manuscript; Kumar A, Kramer E and Chokhavatia S were involved in manuscript preparation.
Conflict-of-interest: As stated in the cover letter, we do not have any conflicts of interest.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by 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 different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Akash Kumar, MD, Department of Medicine, the Mount Sinai Medical Center, 1249 Park Avenue, Apt 12H, New York, NY 10029, United States. akash.kumar@mssm.edu
Telephone: +1-914-844-6975
Received: October 8, 2014
Peer-review started: October 8, 2014
First decision: November 14, 2014
Revised: January 3, 2015
Accepted: February 10, 2015
Article in press: February 12, 2015
Published online: May 16, 2015
Processing time: 222 Days and 6.1 Hours
Abstract

We report an unexpected, previously unreported complication of Bravo pH capsule dislodgement. During Bravo pH testing of a 44-year-old man with gastroesophageal reflux disease, we were unable to endoscopically visualize the capsule attached to the esophageal wall after deployment. After multiple attempts to detect the capsule, it was visualized in the left pyriform sinus. As there was significant risk for pulmonary dislodgement, ENT and pulmonary physicians were immediately consulted to review options for safe removal. Ultimately, ENT successfully retrieved the capsule with a foreign body removal forceps. The Bravo pH test is generally a well-tolerated diagnostic tool used to confirm the presence of abnormal esophageal acid reflux. While few complications have been reported, technical difficulties can occur, including poor data reception, misplacement, and early dislodgement. Rarely, more serious complications can occur, ranging from esophageal wall trauma to capsule aspiration. Gastroenterologists performing this procedure should be aware of the low, but non-trivial, risk of complications.

Keywords: Gastroesophageal reflux disease; Esophageal pH monitoring; Bravo capsule; Dislodgement; Esophagogastroduodenoscopy

Core tip: We report an unexpected, and so far unreported, complication of a Bravo pH capsule dislodgment. While Bravo probe placement is generally a well-tolerated procedure, dislodgment into the pyriform sinus in this case necessitated immediate action by an interdisciplinary team. Complications of Bravo capsule use range from technical difficulties, such as poor data reception and non-deployment, to more serious events such as esophageal wall trauma and capsule aspiration. Gastroenterologists performing this procedure should be aware of the risk of potential complications.