Katheterfreie pH-Metrie mittels Bravo-System – Erfahrungen an 198 Patienten und Etablierung der Zwei-Helfer-Methode als neues Applikationsverfahren

Zusammenfassung

Die Langzeit-pH-Metrie stellt ein wesentlicher Teil der Diagnostik der gastroösophagealen Refluxerkrankung (GERD) dar und gilt als Goldstandard zur Bestimmung der Säureexposition im distalen Ösophagus. Probleme in der Patientenakzeptanz und Compliance der transnasalen Sonde führten zur Weiterentwicklung eines katheterfreien, telemetrischen Messsystems, der sogenannten BRAVO-Kapsel, mit einer verlängerten Analysedauer bis zu 96 Stunden. Im Gegensatz zu der Literatur beschriebenen Technik wurde die BRAVO-Kapsel unter endoskopischer Sicht platziert. Durch die Applikation der Messkapsel unter endoskopischer Kontrolle ist eine exakte Platzierung 5 cm oberhalb der Z-Linie möglich. Hierdurch wird die diagnostische Sicherheit erhöht und die Dislokationsrate verringert. Das Bravo-System ermöglicht dem Patienten normale Alltagsaktivitäten, realistische Nahrungsaufnahme und geringe Beeinträchtigung der Atemwege bei hohem Tragekomfort.

Abstract

Long-term pH monitoring is an important element in diagnosing gastroesophageal reflux disease (GERD) and is considered the gold standard for determining acid exposure in the distal oesophagus. Problems with patient acceptance and compliance with the transnasal probe have encouraged further development of a catheter-free, telemetric measuring system, the BRAVO capsule, with an extended analysis time of 96 hours. Unlike techniques described in the literature, the BRAVO capsule is placed in the distal oesophagus under endoscopic control. The level in the oesophagus (5 cm above the GE-Junction) is precisely defined beforehand by endoscopy, improving the diagnostic accuracy. The dislocation could be reduced. The Bravo system allows the patient to continue with normal daily activities, eat relatively normally and ensures virtually no interference with the respiratory passages. It offers a very high level of wearing comfort.

Schlüsselwörter

Bravo-pH-Metrie - Applikation - Dislokation

Key words

Bravo pH metry - application - dislocation

• Literatur

• 1 Locke GR, Talley NJ, Fett SL et al. Prevalence and clinical spectrum of gastroesophageal reflux: a population based study in Olmstead country, Minnesota. Gastroenterology 1997; 112: 1448-1156
• 2 Vakil N, van Zanten SV, Kahrilas P et al. The Montreal definition and classification of gastroesophageal reflux disease: a global evidence based consensus. Am J Gastroenterol 2006; 101: 1900-1920
• 3 Hollenz M, Stolte M, Labenz J. Prevalence of gastroesophageal reflux disease in general practice. Dtsch Med Wochenschr 2002; 127: 1007-1012
• 4 Kahrilas PJ, Quigley EM. Clinical esophageal pH recording: A technical review for practice guideline development. Gastroenterology 1996; 110: 1982-1996
• 5 Pandolfino JE. Bravo Capsule pH monitoring. Am J Gastroenterol 2005; 100: 8-10
• 6 Hirano I, Richter JE. ACG practice guidelines: esophageal reflux testing. Am J Gastroenterol 2007; 102: 668-685
• 7 Pandolfino JE, Richter JE, Ours T et al. Ambulatory esophageal pH monotorimng using a wireless system. Am J Gastroenterol 2003; 98: 740-749
• 8 Hakanson BS, Berggren P, Granqvist S et al. Comparison of wireless 48h (Bravo) versus traditional ambulatory 24h-ph monitoring. Scan J Gastroenterol 2009; 44: 276-283
• 9 Johnson LF, DeMeester TR. Development of the 24-hour intraesophageal pH monitoring composite scoring system. J Clin Gastroenterol 1986; 8: 52-58
• 10 Mönkemüller K, Neumann H, Fry L et al. Catheter-free pH-metrie using the Bravo Capsule versus standard pH-metry in patients with NERD. Z Gastroenterol 2009; 47: 351-356
• 11 Masclee AA, deBest AC, deGraf R. Ambulatory24-hour pH-metry in the diagnosis of GERD. Determination of criteria and relation of endoscopy. Scand J Gastroenterol 1990; 25: 225-230
• 12 Koop H, Schepp W, Müller-Lissner S et al. Consensus conference of the DGVS on gastric reflux. Z Gastroenterol 2005; 43: 163-164
• 13 Vitale GC, Cheadle WG, Sadek S et al. Computerized 24-h ambulantory esophageal pH monitoring and esophagogastroduoenoscopy in reflux patients. A com parative study. Ann Surg 1984; 200: 724-728
• 14 Weusten BL, Akkermans LM, van Berge-Henegouwen GP et al. Dynamic characteristics of gastro-esophageal reflux disease and normal control subjects. Scan J Gastroenterol 1995; 30: 731-737
• 15 Jung B, Steinbach J, Beaumont C et al. Lack of association between esophageal acid sensitivity detected by prolonged pH monitoring and Bernstein testing. Am J Gastroenterol 2004; 99: 410-415
• 16 Pandolfino JE. Bravo capsule pH monitoring. Am J Gastroenterol 2003; 98: 740-749
• 17 Ahlawart SK, Novak DJ, Williams DC et al. Day-to-day variability in acid reflux patterns using the Bravo pH monitoring system. J Clin Gastroenterol 2006; 40: 20-24
• 18 Mönkemüller K, Neumann H, Fry LC et al. Catheter- free pH-metry using the Bravo Capsule vs. Standard pH-metrie in patients with NERD. Z Gastroenterol 2009; 47: 351-356
• 19 Des Varannes SB, Mion F, Ducrotte P et al. Simultaneous recordings of wireess system Bravo. GUT 2005; 54: 1687-1692
• 20 Iqbal A, Lee YK, Vitamvas M et al. 48h-pH monitoring increases the risk of false positive studies when the capsule is prematurely passed. J Gastrointest Surg 2007; 11: 638-641
• 21 Tharavej C, Hagen JA, Portale G et al. Bravo capsule induction of esophageal hypercontractivity and chest pain. Surg Endosc 2006; 20: 783-786
• 22 Hirano I, Richter JE. ACG practice guidelines: esophageal reflux testing. Am J Gastroenterol 2007; 102: 668-685