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Background The Bravo wireless pH monitoring system is widely used and better tolerated to evaluate gastroesophageal reflux disease (GERD). This is particularly useful in older children and children with behavioural problems who are likely to pull out a conventional pH probe. No significant complications are reported, although short durations of chest pain can happen. Currently, no data exists on the risk of capsule retention in the pediatric population. We report a case of capsule retention in an 8-year-old child and successful retrieval after 140 days.Case Presentation An 8-year-old boy with hypoxic–ischemic encephalopathy, four-limb cerebral palsy with dystonia, global developmental delay, refractory epilepsy, and gastrostomy feeding following redo fundoplication (for hiatus hernia) had a Bravo capsule inserted to assess ongoing reflux symptoms. 20 weeks later, an incidental chest X-ray revealed the capsule was retained in the lower chest. He did not have any new symptoms other than reflux-related. He was admitted electively for oesophagogastroduodenoscopy (OGD) and capsule retrieval. Endoscopy showed a normal oesophagus, an open gastroesophageal junction, and mild erythema in the gastric body. The capsule was not seen on initial examination, but on careful examination with fluoroscopy; it was identified within the hiatus. The capsule was successfully retrieved endoscopically under fluoroscopic guidance using a mobile image intensifier, without complication.Discussion The Bravo capsule typically detaches spontaneously within 5–7 days and is passed uneventfully. Often, older children report that they can feel when the capsule is dislodged, but this is not monitored. There is no need to retrieve the capsule once the study is completed. Some reported side effects are chest pain/dysphagia for a short period, but the risks of perforation or capsule retention are not reported.Current practice suggests no indications to check if the capsule has dislodged or if the patient has passed the capsule. There are a few anecdotal case studies in the adult population of aspiration and retention, but these were noted following changes in hemodynamic status and compliant by the patient. However, there are no previous case reports in the paediatric population documented in the literature.Given anatomical variations /motility issues, these may influence adherence, detachment, or migration of the capsule, complicating retrieval and interpretation of pH monitoring results. In patients with known behavioural or anatomical abnormalities, consideration should therefore be given to interval imaging, i.e. x-rays; to confirm capsule passage and prevent delayed recognition of retained or displaced devices.References Sabreen Aulakh, Sharon Ashley, Kelly Haas, Trinh Truong. Esophageal pH Capsule Retention. ACG Case Reports Journal.Yasir Alshareefy, Ali Alshareefy. Oesophageal pH capsule retention: case report and proposed endoscopic management. Int J Surg Case Rep. 2023 Oct 3;111:108917. doi:10.1016/j.ijscr.2023.108917Jose Cabrera, Miriam Davis, Debbie Horn, et al. Esophageal pH monitoring with the bravo capsule. Experience in a single tertiary medical center. JPGN Oct 2011. https://doi.org/10.1097/MPG.0b013e3182203caaAbstract LBA1 Figure 1a) Top central – Bravo capsule – measuring 30mm in length; b) Middle left – open gastro-oesophageal junction showing hiatus hernia; c) Middle right – Bravo capsule attached to oesophageal mucosal liningAbstract LBA1 Figure 1d) Bottom left – Fluoroscopy imaging revealing retained Bravo capsule; e) Bottom right – Retrieval of retained capsule under fluoroscopic guidance