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

Background: Few 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. Objective: To determine the frequency with which endoscopic capsule dislodgement is required and the outcomes of the intervention. Design: Chart review. Setting: University-based outpatient endoscopy facility. Patients: A total of 452 consecutive patients undergoing wireless pH monitoring over a 3.5-year period. Interventions: Endoscopic dislodgement of the capsule by using nudging with the endoscope tip and cold snare techniques. Results: Eight 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. Conclusions: Endoscopic 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.