S2274 Bravo Capsule Aspiration

Abstract

Introduction: Bravo wireless capsule is a catheter-free pH monitoring system used to diagnose GERD in patients who fail anti-secretory therapy. Several adverse events have been reported in the literature; these include nose or throat discomfort and dislocation from positioned sites. Case Description/Methods: A 72-year-old man with a history of GERD, prostate cancer, hypothyroidism, obstructive sleep apnea, presented for esophagogastroduodenoscopy (EGD) with Bravo™ placement due to persistent esophageal reflux symptoms despite appropriate therapy. The Bravo™ capsule (Medtronic, Minneapolis, MN) with a delivery system was introduced through the mouth and advanced into the esophagus. The device was placed with visual confirmation; however, the patient had severe a coughing fit. Suction was applied and the delivery system was then withdrawn. Repeat EGD was performed and no Bravo™ was seen in esophagus, stomach, or duodenum. Due to suspicion of dislodgement, a chest x-ray was performed and Bravo™ was seen in the left lung (figure 1, panel A). The patient was admitted to the hospital, and the pulmonology service was consulted for device removal. Bronchoscopy was performed successfully with the extraction of a capsule from the left main bronchus (Figure 1, panel B). After 24 hours observation, the patient did not have any symptoms or signs of aspiration pneumonitis and was discharged home. Discussion: We present a case of an adult patient with aspiration of the capsule into the lungs. This is an unusual complication with pH monitoring techniques(3). Given the limited number of cases of Bravo™ aspiration, there are no definite guidelines or gold-standard treatment up to date. A patent airway and good oxygenation must be maintained. The initial diagnostic evaluation includes chest radiographs, since the Bravo™ capsule is radiopaque(4).Once located, bronchoscopic tools can usually reveal the capsule, as was done with our patient.Figure 1.: Panel A, left: X-ray showing bravo capsule in left lung panel B, right: bronchoscopy showing reveals bravo capsule in left main bronchus.