Endoscopic removal of the wireless pH monitoring capsule in patients with severe discomfort

BackgroundFew patients have significant symptoms during wireless esophageal pH monitoring, and the capsule typically sloughs spontaneously. Severe discomfort during monitoring can occur that requires endoscopic dislodgement of the capsule.ObjectiveTo determine the frequency with which endoscopic capsule dislodgement is required and the outcomes of the intervention.DesignChart review.SettingUniversity-based outpatient endoscopy facility.PatientsA total of 452 consecutive patients undergoing wireless pH monitoring over a 3.5-year period.InterventionsEndoscopic dislodgement of the capsule by using nudging with the endoscope tip and cold snare techniques.ResultsEight subjects (1.8%) required endoscopic capsule dislodgement because of severe chest pain or odynophagia (n = 7) or severe foreign-body sensation (n = 1). Chest pain was the initial indication for pH monitoring in 5 (62.5%) of the subjects. Initial nudging with the endoscope tip successfully dislodged 2 capsules; continued nudging produced mucosal stripping in 3 subjects, which required hemostasis in 1. A cold snare was used successfully, without complication, to separate the capsule from stripped mucosa and as a primary removal method in the remainder of subjects. Capsule removal uniformly resulted in marked improvement of discomfort.ConclusionsEndoscopic removal of the capsule was required in <2% of subjects who underwent wireless pH monitoring. Separation of the capsule from the mucosa with a cold snare may be the preferred method of accomplishing uncomplicated removal.