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胶囊内镜检查食管射频导管消融术后病变:一种选择并发症风险增加患者的潜在工具。

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

机构信息

Texas Cardiac Arrhythmia Institute at St. Davids Medical Center, 1015 East 32th Street, Austin, TX 78705, USA.

出版信息

J Cardiovasc Electrophysiol. 2010 Aug 1;21(8):839-44. doi: 10.1111/j.1540-8167.2010.01732.x. Epub 2010 Feb 16.

Abstract

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.

摘要

背景

左心房射频消融 (RFA) 治疗可导致食管损伤,由于其可能与房-食管 (A-E) 瘘的发展有关,因此更加令人担忧。

目的

评估食管胶囊内镜在检测 RFA 治疗心房颤动 (AF) 后食管病变中的作用。

方法

连续接受左心房 RFA 治疗并在消融后 48 小时内接受胶囊内镜检查的 AF 患者。由一位胃肠病学家单独审查视频。还查阅了病历,以了解消融后即刻和 3 个月随访时的症状。

结果

共纳入 93 例连续患者,88 例完成研究并进行了分析。食管病变的患病率为 17%(88 例患者中有 15 例)。这些患者中有 9%(8/88)的病变与消融导管的位置解剖一致。6 例胶囊检查阳性的患者有胸痛(3/6,50%)、咽喉痛(2/6,33%)、恶心(1/6,17%)和腹痛(1/6,17%)。另外 24 例患者消融后出现症状,但胶囊检查正常。所有通过胶囊内镜检查发现病变的患者均接受了口服质子泵抑制剂治疗,并被指示在症状恶化时联系克利夫兰诊所。在 3 个月的随访中没有报告迟发性并发症。

结论

本研究支持使用胶囊内镜作为检测 RFA 治疗后食管损伤的工具。PillCam ESO 耐受性良好,可提供食管感兴趣区域的满意图像,而无常规食管胃十二指肠镜检查相关的充气潜在风险。

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