PTH-64 An audit of Bravo Capsule use in a tertiary referral centre

IntroductionWireless pH monitoring is an increasingly used modality in the assessment of gastro-oesophageal reflux disease (GORD). BSG guidelines recommend the use of wireless pH monitoring in patients who have symptoms suggestive of GORD but who have either previously been intolerant, or would likely be intolerant, to catheter-based pH monitoring. Evidence has shown that wireless monitoring using the Bravo capsule system is better tolerated than conventional catheter-based techniques, meaning less disruption of daily activities for patients. This better tolerability allows for longer periods of monitoring and potentially higher diagnostic yield.MethodsWe performed a retrospective audit looking at the use of the Bravo capsule at our centre. The objective was to look at the adherence to the BSG guidelines and to collect relevant clinical information on patients referred to help inform future decisions on how to most effectively use the service. Data was collected using electronic patient records. We looked at results over a 20-month period comprising 84 patients in total.ResultsWe found the Bravo capsule to be an extremely well-tolerated procedure with only 1 of our 84 patients not tolerating the capsule insertion. Diagnostic yield was high, with 84% of patients having DeMeester scores above 14.72 and 78% having a total reflux time over 4.2%. 49% of patients were referred for consideration of surgery whilst the remainder were managed medically. The majority of patients (78.6%) had previously been intolerant of, or had borderline results from, catheter-based pH testing prior to being referred for the Bravo capsule which is consistent with BSG guidance. Most patients had an OGD prior to referral (91.7%). Of these patients 68% showed either a hiatus hernia, oesophagitis or peptic ulcer whilst 30% were normal. In our subgroup analysis we found that patients referred with a cough had a significantly lower DeMeester than those referred for other indications. We also found that patients with a previously normal catheter-based monitoring test had a lower mean DeMeester.ConclusionsOverall, our results showed that referrals for capsule-based pH monitoring were generally being performed according to BSG guidance. Our subgroup analysis should help inform further study into which patient groups benefit most from Bravo capsule referral.