Capsule endoscopy in examination of esophagus for lesions after radiofrequency catheter ablation: a potential tool to select patients with increased risk of complications.
BACKGROUND
Esophageal injury can result from left atrial radiofrequency ablation (RFA) therapy, with added concern because of its possible relationship to the development of atrial-esophageal (A-E) fistulas.


OBJECTIVE
Evaluate utility of esophageal capsule endoscopy to detect esophageal lesions as a complication of RFA therapy in the treatment of atrial fibrillation (AF).


METHODS
Consecutive patients with AF who underwent left atrial RFA therapy and received capsule endoscopy within 48 hours postablation. Video was reviewed by a single gastroenterologist. The medical records were also reviewed for symptoms immediately postablation and at the 3-month follow-up.


RESULTS
A total of 93 consecutive patients were included and 88 completed the study and were analyzed. The prevalence of esophageal lesions was 17% (15/88 patients). Nine percent (8/88) of these patients had lesions anatomically consistent with the location of the ablation catheter. Six patients with positive capsule findings had symptoms of chest pain (3/6, 50%), throat pain (2/6, 33%), nausea (1/6, 17%), and abdominal pain (1/6, 17%). An additional 24 patients were symptomatic postablation, but with normal capsule findings. All patients with identified lesions by capsule endoscopy received oral proton pump inhibitor therapy, and were instructed to contact the Cleveland Clinic in the event of worsening symptoms. No delayed complications were reported at the 3-month follow-up.


CONCLUSIONS
This study supports the use of capsule endoscopy as a tool for the detection of esophageal injury post-RFA therapy. PillCam ESO is well tolerated and provides satisfactory images of the areas of interest in the esophagus without potential risk related to insufflation with regular esophagogastroduodenoscopy.
Di Biase
Luigi
L
Texas Cardiac Arrhythmia Institute at St. Davids Medical Center, 1015 East 32th Street, Austin, TX 78705, USA.
Dodig
Milan
M
Saliba
Walid
W
Siu
Alan
A
Santisi
Janice
J
Poe
Stacy
S
Sanaka
Madhusudhan
M
Upchurch
Bennie
B
Vargo
John
J
Natale
Andrea
A
D015746:Abdominal Pain / Q000209:etiology; D000368:Aged; D001281:Atrial Fibrillation / Q000601:surgery*; D053704:Capsule Endoscopy; D017115:Catheter Ablation / Q000009:adverse effects*; D002637:Chest Pain / Q000209:etiology; D004937:Esophageal Fistula / Q000175:diagnosis* / Q000209:etiology / Q000473:pathology; D004945:Esophagoscopy; D004947:Esophagus / Q000293:injuries* / Q000473:pathology; D005260:Female; D006331:Heart Diseases / Q000175:diagnosis* / Q000209:etiology / Q000473:pathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009325:Nausea / Q000209:etiology; D009820:Ohio; D010147:Pain Measurement; D010612:Pharyngitis / Q000209:etiology; D010865:Pilot Projects; D011237:Predictive Value of Tests; D054328:Proton Pump Inhibitors / Q000627:therapeutic use; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
D054328:Proton Pump Inhibitors