Classification of esophageal stent leaks: Leak presentation, complications, and management

Background Esophageal stent leaks can have catastrophic consequences if not promptly recognized and managed appropriately. However, there are different mechanisms for esophageal stent leaks that may demonstrate unique features in presentation and response to management strategy. The objective of this study was to develop a classification system for esophageal leaks and assess distinctions between leak types. Methods Patients with esophageal stent leaks from 2007 to 2010 managed at The Methodist Hospital were classified into the following 5 leak types: type 1, proximal; 2, distal retrograde; 3, stent lining; 4, between stents; and 5, migrated stent. Patients' baseline characteristics, procedural data, and outcomes were analyzed. Results Of the 89 patients who underwent esophageal stenting, 23 stent leaks were identified after the first procedure. Mean age was 57 ± 14 years, 61% were male, 43% had esophageal cancer, and 52% were status postesophagectomy. Seven of the leaks were type 1, 6 were type 2, 2 were type 3, 4 were type 4, and were type 5. The vast majority (70%) of leaks were detected within the first 48 hours. The management of leaks varied significantly depending on the leak type (p < 0.001) and included additional stenting, placement of a larger stent, bridle, percutaneous gastrostomy, stent exchange, observation, and surgery. The majority of leaks (65%) ultimately resolved. Survival according to leak type was not different (p = 0.072). Conclusions Esophageal leaks tend to be managed differently depending on leak type. The majority of leaks ultimately resolve with stenting. Our proposed leak classification may enhance esophageal stent management strategy.