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Your Procedure Guide | BRAVO pH Monitoring BRAVO pH Monitoring We would like to take this opportunity to thank you for choosing the Atherton Endoscopy Center. Our goal is to provide you with the highest quality of care in a friendly environment. We always welcome your feedback regarding your experience at our facility. About the Test Your doctor has recommended that you have a BRAVO pH Test to test for gastro-esophageal acid reflux disease (GERD). BRAVO is a catheter free pH monitoring device that assists your doctor in evaluating the frequency and severity of your acid reflux disease. The BRAVO capsule is placed in the lower esophagus; this may be done at the time of an upper endoscopy, or at a later time if you have had a previous endoscopy. The capsule will transmit information to a pager- sized receiver worn on your waistband or belt for 48 hours. You will be given a diary to write down your symptoms during this period. BRAVO is generally completely painless although some patients say they have a vague sensation that "something" is in their esophagus. After the test is completed you will return the receiver and diary to Atherton Endoscopy Center; the staff will upload the data to a computer, which will provide a comprehensive report so your doctor can diagnose your condition. The BRAVO capsule will naturally fall off the wall of the esophagus and pass through the digestive tract to be eliminated from the body. BRAVO is an extremely safe and highly effective diagnostic tool. If you will be having an upper endoscopy as well, please also read upper endoscopy. Ten Days before the Test: Unless your physician has specifically instructed you otherwise, please discontinue all acid blocking medications (Aciphex, Nexium, Pepcid, Prevacid, Prilosec, Protonix, Tagamet, Zantac, etc.). It is okay to use short acting antacids (Maalox, Mylanta, Rolaids, Tums, etc.) until the day before the test if you are having discomfort. Two Days Prior To Your Procedure One of our nurses will be contacting you two days prior to your test to obtain your medical history and review your preparation instructions. We will be happy to answer any questions you may have at that time. Please make sure you tell the nurse if you have any of the following:
Allergies to any medications or latex products
Pacemaker, implantable defibrillator or neurostimulator
The nurse will ask you about the medications you take. Please let her/him know if you are taking, or have recently taken, any of the following medications:
Diabetes medications such as Insulin or oral diabetes medications
If you are taking medications for your heart, lungs or blood pressure the nurse will let you know if you should take them in the morning with sips of water.
Atherton Endoscopy Center • 3351 El Camino Real, Suite 220, Atherton, CA 94027 • Phone: 650.363.2800 • Fax: 650.364.9599 The Day Before Your Procedure Important: Please be aware that the time you take your preparation may vary depending on the time of your procedure. Please follow the instruction times given to you by your physician. Transportation If you are having an endoscopy in conjunction with the BRAVO capsule being placed you will be receiving sedation. If you are having the BRAVO placed independent of an endoscopy you will not require sedation and may drive yourself home. If you will be receiving sedation (which may alter your reflexes, judgment and reaction time), you must make arrangements for a responsible adult to drive you home after your procedure. Taxis and buses are not permitted unless you are accompanied by a responsible adult. If you do not make the above arrangements, your appointment will need to be rescheduled for a time when a driver is available. This is for your safety and protection, as well as the safety and protection of others. Please contact us several days in advance if you are having difficulty finding a ride; we may be able to provide you with some resources for transportation assistance. The Day of Your Test Preparation: For an AM procedure time: Do not eat or drink anything after midnight. For a PM(afternoon) procedure time: You may have a clear liquid breakfast before 8 am. Clear liquids consist of: black coffee or tea, beef/chicken broth, apple juice, white grape or white cranberry juice, jell-o (no red or purple flavors). Your doctor may also allow you to have a light solid breakfast. Do not take any antacids on the day of the test. What to Wear Please wear loose, comfortable clothing that is easily removed. Avoid tight fitting garments such as pantyhose. Please leave your valuables at home. You will be changing into a patient gown; you may usually leave on a small T-shirt and will not have to remove anything from the waist down. Bring the following items with you:
Your insurance cards and driver's license or suitable ID card
A list of all medications you are taking (or bring the bottles with you)
Respiratory inhalers or insulin, if you use them
Please arrive at our center 30 minutes prior to your scheduled procedure time unless otherwise instructed. Expect to be at the Center for 1 to 2 hours if you are also having an endoscopy; 1 hour if you are having BRAVO alone. Your ride may wait in our waiting room or they may return to pick you up at the specified time. We will also be happy to call your ride when you are ready if
Atherton Endoscopy Center • 3351 El Camino Real, Suite 220, Atherton, CA 94027 • Phone: 650.363.2800 • Fax: 650.364.9599
they don't want to wait. When you arrive our receptionist will review your insurance and contact information with you. Please let her know of any changes. The nurse will bring you back to the admission area to get you ready for your procedure.
She/he will review your medical history if this has not already been done.
The nurse will be starting an intravenous in your arm if you are being sedated.
You will be signing a consent to have your physician perform the BRAVO pH Capsule Placement. If you are being sedated you will also be agreeing that:
1. You are not to drive or operate machinery until the next day. 2. You should not work until the next day. 3. You should not sign any important documents or make important decisions until
4. You should not exercise strenuously until the next day.
During Capsule Placement in Conjunction with an Endoscopy You will be brought into one of the private procedure rooms where you will be cared for by your doctor and a Registered Nurse. The nurse will obtain your blood pressure, pulse, oxygen saturation and cardiac rhythm, which will be monitored continuously throughout the procedure. You will be lying on your left side for the procedure. Once you have had a chance to talk to your doctor, the nurse will begin administering the sedation. Your throat may be sprayed with a numbing medication so that you do not gag, and you will be asked to remove any dental appliances. Your nurse may administer oxygen through a small tubing that rests under your nose. Once your doctor feels you are adequately relaxed, he/she will gently pass the endoscope over the back of your tongue and into your esophagus, stomach and duodenum. Your doctor may take a biopsy, which you will not feel. At the end of the endoscopy your doctor will pass a small catheter that will deliver the BRAVO capsule to the desired location. Most patients doze throughout the procedure and, because of the sedation, do not remember much. During Capsule Placement without an Endoscopy You will be brought into one of the private procedure rooms where you will be cared for by your doctor and a Registered Nurse. The nurse will obtain your blood pressure, pulse, oxygen saturation and cardiac rhythm. Your throat may be sprayed with a numbing medication so that you do not gag, and you will be asked to remove any dental appliances. You will be lying on your left side for the procedure. Your doctor will pass a small catheter through your mouth that will deliver the BRAVO capsule to the desired location. After Your Procedure After your procedure is complete you will be taken to the recovery area. The nurses there will continue to monitor your blood pressure, pulse and oxygen saturation. When your throat is no longer numb you will be able to drink liquids and will be able to eat as soon as you leave the Center. Once you are steady on your feet you will be able to go home; this is usually after about 30 minutes if you were sedated. The doctor will talk to you (and your family/friend if desired) about the results of your procedure before you leave, but if you were sedated you may not remember this. We will give you all of your discharge instructions in writing. Patient Instructions for pH Study
You may resume your normal diet as soon as you leave the Center. Eat normally; try to have three good sized meals per day. Don't eat many small meals or snack frequently.
Atherton Endoscopy Center • 3351 El Camino Real, Suite 220, Atherton, CA 94027 • Phone: 650.363.2800 • Fax: 650.364.9599
It's good to eat at least one very fatty meal. Log your meal times on the diary; don't write what you ate, just when.
Try to drink liquids only at mealtime. Don't sip water or other liquids throughout the day, as this will essentially wash acid off the probe. If you do have a drink (coffee, soda, etc,) separately from a meal, log it on the diary as a meal.
Approximately 5% of patients may feel the capsule. It may feel like a mild pressure in the chest, or it may feel slightly uncomfortable when you swallow food. Do not worry if this happens to you. If you experience severe pain or inability to swallow you should call the Atherton Endoscopy Center (7am - 4pm, Monday through Friday) or your physician if it is after hours.
The receiver needs to be no more than 3 feet away from you to record data; to alert you, it will beep if it is out of range. The BRAVO receiver is a very expensive piece of medical equipment; please be very careful not to get it wet or drop it. Please take it off your belt prior to using the bathroom. You may take a shower; just leave the receiver two or three feet outside of the shower.
Occasionally you may come in contact with electrical currents that can interfere with the receiver, such as a hairdryer, an old computer, or a radio tower. The receiver will beep if it has interference; just move away from whatever is interfering and re-establish the connection by placing the receiver over your chest until the beeping stops.
Do not take any antacids during the study unless instructed by your physician. (Maalox, Mylanta, Tums, Rolaids, Zantac, Tagamet, Pepcid, Axid, Prilosec, Nexium, Prevacid, Aciphex, Protonix, etc).
Sleep - Log on your diary when you are lying nearly completely flat; if you are sleeping with your head elevated on the couch or in a reclining chair this does not count.
The capsule will fall off in 5 to 7 days and pass through your digestive system naturally. If you need an MRI within 30 days of the capsule being placed, please inform the physician so they can make sure the capsule has completely passed from you body. Please place the enclosed MRI ID card in your wallet.
Please read about additional discharge instructions if you also had an endoscopy under "About My Endoscopy." The nursing staff will call you the following business day to see how you are doing. Please let her/him know if you have any concerns. You are welcome to call us anytime during our open business hours as well. 48 Hours after Placement Please return the receiver and your diary to the Atherton Endoscopy Center at the time specified by the nurse. Atherton Endoscopy Center • 3351 El Camino Real, Suite 220, Atherton, CA 94027 • Phone: 650.363.2800 • Fax: 650.364.9599
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Your Procedure Guide | BRAVO pH Monitoring 
they don't want to wait. When you arrive our receptionist will review your insurance and contact information with you. Please let her know of any changes. The nurse will bring you back to the admission area to get you ready for your procedure.
She/he will review your medical history if this has not already been done.
The nurse will be starting an intravenous in your arm if you are being sedated.
You will be signing a consent to have your physician perform the BRAVO pH Capsule Placement. If you are being sedated you will also be agreeing that:
1. You are not to drive or operate machinery until the next day. 2. You should not work until the next day. 3. You should not sign any important documents or make important decisions until
4. You should not exercise strenuously until the next day.
It's good to eat at least one very fatty meal. Log your meal times on the diary; don't write what you ate, just when.
Try to drink liquids only at mealtime. Don't sip water or other liquids throughout the day, as this will essentially wash acid off the probe. If you do have a drink (coffee, soda, etc,) separately from a meal, log it on the diary as a meal.
Approximately 5% of patients may feel the capsule. It may feel like a mild pressure in the chest, or it may feel slightly uncomfortable when you swallow food. Do not worry if this happens to you. If you experience severe pain or inability to swallow you should call the Atherton Endoscopy Center (7am - 4pm, Monday through Friday) or your physician if it is after hours.
The receiver needs to be no more than 3 feet away from you to record data; to alert you, it will beep if it is out of range. The BRAVO receiver is a very expensive piece of medical equipment; please be very careful not to get it wet or drop it. Please take it off your belt prior to using the bathroom. You may take a shower; just leave the receiver two or three feet outside of the shower.
Occasionally you may come in contact with electrical currents that can interfere with the receiver, such as a hairdryer, an old computer, or a radio tower. The receiver will beep if it has interference; just move away from whatever is interfering and re-establish the connection by placing the receiver over your chest until the beeping stops.
Do not take any antacids during the study unless instructed by your physician. (Maalox, Mylanta, Tums, Rolaids, Zantac, Tagamet, Pepcid, Axid, Prilosec, Nexium, Prevacid, Aciphex, Protonix, etc).
Sleep - Log on your diary when you are lying nearly completely flat; if you are sleeping with your head elevated on the couch or in a reclining chair this does not count.
The capsule will fall off in 5 to 7 days and pass through your digestive system naturally. If you need an MRI within 30 days of the capsule being placed, please inform the physician so they can make sure the capsule has completely passed from you body. Please place the enclosed MRI ID card in your wallet.