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.
The Methodist Hospital, Houston, Texas; Weill Cornell College of Medicine, Columbia University, New York, New York.
Elizabeth H
EH
Stephens
The University of Texas MD Anderson Cancer Center, Houston, Texas.
Arlene M
AM
Correa
The Methodist Hospital, Houston, Texas; Weill Cornell College of Medicine, Columbia University, New York, New York.
Min P
MP
Kim
The Methodist Hospital, Houston, Texas; Weill Cornell College of Medicine, Columbia University, New York, New York.
Puja
P
Gaur
The Methodist Hospital, Houston, Texas; Weill Cornell College of Medicine, Columbia University, New York, New York. Electronic address: shblackmon@tmhs.org.
Shanda H
SH
Blackmon
D057868:Anastomotic Leak / Q000145:classification* / Q000000981:diagnostic imaging / Q000601:surgery; D004935:Esophageal Diseases / Q000000981:diagnostic imaging / Q000601:surgery*; D004944:Esophagoplasty / Q000009:adverse effects / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D011475:Prosthesis Failure; D011859:Radiography; D012086:Reoperation; D012720:Severity of Illness Index; D015607:Stents