Capsule endoscopy in examination of esophagus for lesions after radiofrequency catheter ablation: A potential tool to select patients with increased risk of complications

Luigi Di Biase, Milan Dodig, Walid Saliba, Alan Siu, Janice Santisi, Stacy Poe, Madhusudhan Sanaka, Bennie Upchurch, John Vargo, Andrea Natale

Research output: Contribution to journalArticle

34 Scopus citations


Capsule Endoscopy in Examination of Esophagus. 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. Conclusion: 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.

Original languageEnglish (US)
Pages (from-to)839-844
Number of pages6
JournalJournal of cardiovascular electrophysiology
Issue number8
StatePublished - Aug 1 2010



  • atrial fibrillation
  • atrioesophageal fistula
  • capsule endoscopy
  • catheter ablation
  • complications
  • esophageal injury

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

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