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CC BY 4.0 · Endoscopy 2025; 57(S 01): E861
DOI: 10.1055/a-2658-0422
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Endoscopic ultrasound-guided esophageal hematoma drainage after radiofrequency ablation for atrial fibrillation

Mustafa Suveran
1   Department of Gastroenterology and Hepatology, Acibadem Altunizade Hospital, Istanbul, Turkey (Ringgold ID: RIN713016)
,
Can Boynukara 
2   Department of Internal Medicine, Acibadem Mehmet Ali Aydınlar University, Istanbul, Turkey
,
Duhan F. Bayrak
3   Department of Cardiology, Acibadem Altunizade Hospital, Istanbul, Turkey (Ringgold ID: RIN713016)
,
Sena Sert Sekerci
3   Department of Cardiology, Acibadem Altunizade Hospital, Istanbul, Turkey (Ringgold ID: RIN713016)
,
Gurhan Sisman 
4   Department of Gastroenterology and Hepatology, Acibadem Mehmet Ali Aydınlar University, Istanbul, Turkey
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Transesophageal radiofrequency ablation (RFA) for atrial fibrillation may cause esophageal injuries, including hematomas, which are rare but potentially serious [1]. Endoscopic ultrasonography (EUS) is a valuable tool for both diagnosis and minimally invasive management of such complications, enabling precise targeting and drainage [2].

A 67-year-old woman developed dysphagia, odynophagia, epigastric pain, and inability to tolerate oral intake after transesophageal RFA. Gastroscopy (Evis Exera III GIF H190; Olympus, Japan) revealed a lesion obstructing the esophageal lumen at 18 cm ([Video 1]). EUS (GF-UCT linear ultrasound endoscope; Olympus, Japan) confirmed a submucosal hematoma, and thoracic computed tomography (CT) showed a 4-cm hematoma in the mid-esophagus. EUS-guided drainage was performed. The procedure involved puncturing the hematoma with a 19-gauge needle (Expect; Boston Scientific, United States) and placing a 0.035-inch guidewire (VisiGlide; Olympus, Japan) under fluoroscopic guidance. The tract was dilated using a 6-Fr cystotome (Cystotome; Endo-Flex, Germany), and a 7-Fr, 5-cm plastic pigtail stent (Bile Duct Stents; Endo-Flex, Germany) was inserted into the hematoma cavity. Enteral nutrition was started via a nasogastric tube. One week later, CT showed the hematoma size reduced to 2.5cm. The stent was removed 1 month later, with a follow-up endoscopy revealing mucosal ulcerations. The esophageal mucosa was normal at 6 months, and the lumen remained patent.

Endoscopic ultrasound-guided esophageal hematoma drainage after radiofrequency ablation for atrial fibrillation.Video 1

This case demonstrates the efficacy of EUS-guided drainage for esophageal hematomas occurring after RFA. Early intervention prevents progression to perforation or fistula, which can be fatal [3]. EUS offers several advantages: it enables real-time visualization, precise targeting, and safe decompression, minimizing risks associated with surgical or blind procedures. Its minimally invasive nature allows faster recovery and mucosal healing, as seen in this patient. Given the increasing use of transesophageal ablation techniques, EUS-guided management should be considered a valuable option in similar cases [1] [2]. To our knowledge, this case is the first such reported in the English-language literature.

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Publication History

Article published online:
01 August 2025

© 2025. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/).

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