Adoption of unsedated transoral wireless pH capsule at a Veterans Affairs hospital: a feasibility study

The Lyon Consensus 2.0 recommends prolonged wireless pH monitoring for unproven gastroesophageal reflux disease. Endoscopic placement may be limited by cost and resource availability, especially in publicly funded health systems. Transoral placement represents a valid alternative. This study aimed to assess the technical success, safety, and reliability of unsedated transoral wireless pH capsule wireless capsule placement in a Veterans Affairs hospital cohort. We conducted a retrospective cohort study of patients aged ≥18 years who underwent ambulatory reflux testing from January 2023 to December 2024. Patients were divided into those receiving transoral-transoral wireless capsule (TO-WC) placement and those undergoing esophagogastroduodenoscopy (EGD) with wireless capsule (EGD-WC) placement. The primary outcome was technical success. Secondary outcomes included study failures, adverse events, pH study duration, and time-to-capsule placement. Of 120 patients, 41 underwent TO-WC placement and 79 EGD-WC placement. No differences were identified in baseline sociodemographic and clinical variables between both groups. There was a nonsignificant trend toward a lower technical success rate in the transoral group (35/41 [85.4%, TO-WC] vs 75/79 [94.9%, EGD-WC], P = .072). In addition, premature detachments (<48 hours) were more common in the transoral placement group (12/41 [29.3%] vs 8/79[10.1%], P = .014). Two patients (4.8%) in the TO-WC group experienced odynophagia, which was managed conservatively. Unsedated TO-WC placement may be a less successful method for ambulatory pH monitoring in a Veterans Affairs hospital population, especially for prolonged wireless pH testing.