[Show abstract][Hide abstract]ABSTRACT: Wireless pH monitoring is one of the recent technologies that focus on improving the diagnosis of gastroesophageal reflux disease (GERD). The capsule, which is fixed within the esophagus, transmits data via telemetry to an external receiver. The capsule is usually inserted 6 cm above the squamocolumnar junction during an upper endoscopy. The standard recording duration is 48 hours but this can be extended to 96 hours. The wireless capsule has been shown to be at least as accurate as the conventional catheter for the monitoring of esophageal pH. Normal pH values have been established in three different series. The use of a wireless capsule provides an increased diagnostic yield for GERD compared with the conventional catheter. The increased yield is the result of higher sensitivity to detect both abnormal acid esophageal exposure and positive symptom-reflux association. This may be related both to the prolonged recording duration and to fewer dietary modifications and restrictions on activities. Several studies have shown that the pH capsule was better tolerated by patients than the conventional pH catheter. Mild-to-moderate chest pain represents the main side effect of the pH capsule: severe chest pain requiring endoscopic removal of the capsule is rare. The main indication for wireless capsule application is monitoring of distal esophageal pH for diagnostic purpose, particularly in patients with a normal endoscopic examination. The capsule technique has some limitations: costs are higher than conventional pH monitoring, misplacement may occur, and the sampling rate is lower. Finally, compared with pH-impedance monitoring, only acid reflux events can be evaluated.
[Show abstract][Hide abstract]ABSTRACT: Currently, the use of esophageal pH-monitoring is rather limited mainly due to technical difficulties. In addition a nasal electrode for 24 h is often responsible of limitation of activities and reduces the diagnostic value of the test. Telemetric wireless pH-monitoring is now available, avoiding these limitations and offering the advantage of prolonged recordings for 48 h or even 96 h. Consequently diagnostic value is increased, especially due to the more frequent occurrence of symptoms during monitoring. This pH-metric capsule should not be used in patients with increased hemorrhagic risk or in those with pacemaker devices. Inserting the wireless pH capsule during an upper GI endoscopic examination is possible thus reducing hospital visits. Several studies have established the reliability of the technique; in addition the inserted capsule on the esophageal wall makes impossible intragastric migration of the probe sometimes observed with conventional electrodes. Tolerance is good with sometimes some transient chest pain. Overall patients feel more comfortable in their daily activities than with conventional wire electrodes. Finally prolonged wireless pH monitoring makes possible in a unique session both diagnostic and therapeutic characterizations by administering an antisecretory agent at mid recording. Consequently wireless pH monitoring is a valuable alternative to conventional pH-monitoring, especially in patients with intermittent and/or atypical symptoms suggestive of reflux.
[Show abstract][Hide abstract]ABSTRACT: La pH-métrie œsophagienne par capsule télémétrique (système Bravo®) permet un enregistrement plus prolongé et dans des conditions
plus physiologiques. Le but de ce travail était d’évaluer, sur une cohorte rétrospective, si les résultats obtenus étaient
différents selon le mode d’implantation de la capsule. Une pH-métrie oesophagienne par le système Bravo® a été réalisée chez
145 patients: 85 sans anesthésie ni endoscopie (par voie nasale ou orale) et 60 au cours d’une gastroscopie réalisée sous
anesthésie générale. La voie orale est préférable à la voie nasale (35 % d’échec par voie nasale). Le taux d’échec global
(échec de l’examen ou enregistrement d’une durée inférieure à 48 heures) ou lié à la pose du dispositif était identique dans
les deux groupes. L’enregistrement de 48 heures était disponible chez 123 patients (85 %): la rentabilité diagnostique des
24 heures supplémentaires d’enregistrement était de 18 %, sans différence significative entre les deux groupes. L’implantation
du dispositif peut donc se faire avec ou sans gastroscopie: les résultats sont similaires, et le choix dépendra de l’expertise
locale et de l’indication de la pH-métrie.
The Bravo® oesophageal pH monitoring system uses a telemetric capsule and allows a recording to be made for a longer period
under conditions which are physiologically closer to normal. The objective of this study was to use a retrospective series
to assess whether the results were different according to the method employed to place the capsule. Oesophageal pH monitoring
with the Bravo® system was carried out in 145 patients. In 85 of these, the nasal or oral route was used without anaesthesia
or endoscopy, while the remaining 60 patients had the capsule placed during gastroscopy performed under general anaesthetic.
The oral route is better than the nasal, with a failure rate of 35% for the latter. The overall failure rate (failure of the
procedure or a recording of less than 48 hours duration) or that associated with placement of the device was the same in both
groups. A 48-hour trace was obtained in 123 patients (85%). The diagnostic benefit of the second 24 hours of this recording
was 18%, with no significant difference between the two groups. The placement of the device can, therefore, be effected with
or without gastroscopy. Results are similar and the choice of technique depends on local expertise and the indication for
Mots cléspH-métrie-Œsophage-Capsule télémétrique-Gastroscopie
KeywordspH monitoring-Oesophagus-Telemetric capsule-Gastroscopy