Cold and Hot Snare Endoscopic Techniques for Removal of the Bravo pH Monitoring Capsule

Background: Currently, use of the Bravo capsule is a very common method for evaluating the gastroesophageal reflux because it has the advantage of being an intraesophageal catheter-free system. However, endoscopic removal of the capsule is necessary when technical problems or severe discomfort are present. Most frequently, endoscopists solve this problem by nudging the device with the tip of the endoscope to dislodge it; others have used a cold snare to produce traction on the capsule, and then tear the probe off. These techniques however are not free of complications. We report here the cold and hot snare techniques used in 4 of our patients, which resulted in the successful removal of the capsule without complications. Methods: The polypectomy cold snare procedure is a typical polypectomy method. The cold snare loops the mucosal pedicle and tightly closes it until sectioning is achieved. In the hot snare technique, a monopolar coagulating current is added to the previous procedure, making the resection more feasible when the cold snare is not sufficient. Finally, in both situations, the probe is removed from the esophagus with the same snare. Conclusions: The cold and hot snare techniques are safe and simple endoscopic procedures when the removal of the Bravo capsule is required. We recommend the cold snare method as a first option and the hot snare method in case the former fails. Copyright (c) 2009 S. Karger AG, Basel