Post written by Andrew Storm, MD, from Mayo Clinic, Rochester, Minnesota, USA.

Every procedural specialty in medicine has procedure-related issues that might “keep them up at night.” In therapeutic EUS, for example, the short time after a particularly challenging novel anastomosis creation procedure between the gallbladder and duodenum, liver and stomach, or intestine and stomach can be nerve-wracking.

As the son of a cardiac electrophysiologist, I know that atrial fibrillation ablations, also known as pulmonary vein isolation ablations, although fairly routine, can raise alarm for our heart specialist colleagues, particularly during procedures using thermal energy (radiofrequency ablation) to affect the ablation. During these procedures, a temperature probe is often placed in the esophagus, and temperature spikes here raise the alarm for potential development of serious and sometimes life-threatening transmural injury.

Gastroenterologists who perform EUS are in a unique position to assist their cardiovascular colleagues when things get “hot.” Within a few days after an atrial fibrillation ablation, visualization of the thin tissues between the esophagus and right pulmonary vein isthmus with EUS allows for assessment and prognostication of any potential injury, including early fistula formation at this region. EUS also enables for assessment of this area without air insufflation as with an endoscopy-only approach, which may reduce the risk of air embolization into the pulmonary vein, if a fistula is present.

Our group’s manuscript examined our experience with EUS examination after high-risk cardiac ablation procedures. We concluded that EUS safely assesses mediastinal damage after ablation and may excel over EGD. For more information, please scope out our group’s publication in the February 2025 issue of Gastrointestinal Endoscopy.

EUS findings: 1, lymph node; 2, portal vein edema; 3, portal vein; 4, mediastinal edema; 5, mediastinal fluid collection; 6, early fistula formation; 7, esophageal wall damage with edema; 8, pericardial effusion; 9, left atrium edema; 10, atrioesophageal fistula; 11, left atrium.

Read the full article online.

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