The description by Gupta et al. deals with the most lethal of all gastrointestinal perforations, being specially focused on new treatment approaches now potentially available [1]. Serious consequences of esophageal perforations are mainly related to the spread of food or gastrointestinal fluids in the para-oesophageal space with mediastinitis and possible extension to the pleural cavity. Within 12 h of perforation, a polymicrobial infection is common [2]. The reported mortality from treated esophageal perforation is 10–25 %, when therapy is initiated within 24 h of perforation, but it may rise up to 40–60 % when the treatment is delayed beyond 48 h [3]. Instrumentation is the most common cause of esophageal perforation (52–64 % of perforations) [4–6], the reported incidence ranging from 0.018 to 0.03 % for diagnostic endoscopy [7], to 1–10 % for therapeutic endoscopy [8, 9]. Ingestion of foreign bodies [10] is the second cause (14–23 % of perforations), followed by traumatic perforations(13.9 %) [6, 11], and spontaneous rupture (5.5–15 % of cases) [4–6]. The clinical presentation of esophageal rupture is often non-specific, and may easily be confused with other disorders such as spontaneous pneumothorax, myocardial infarction, aortic aneurysm, peptic ulcer, and pancreatitis [10, 11]. Patients typically present with pain. Signs include an acutely ill-appearing patient with fever, subcutaneous or mediastinal emphysema, increased heart rate, rapid breathing, low blood pressure, fever with chills, and vomiting, (which may include blood). Dyspnoea is noted in 40 % of patients, fever in 33.3 %, and subcutaneous emphysema in 69.4 % [6]. The new onset shortness of breath, epigastric pain after a bout of vomiting (brownish material), and a physical examination consistent with the presence of bilateral pneumothorax, should alert clinicians [1]. Recent advance in treatment strategies is the second point of interest in this case record. Surgical treatment has long been the ‘gold standard’ for these emergencies with different procedures (from local repair and muscle flaps up to esophagectomy) according to localization of perforation, local infection, and general conditions of the patient. Over the past few years, new minimally invasive endoscopic treatment options have emerged, the literature description being limited to esophageal stents. Esophageal stent placement is used for the palliative treatment of malignant dysphagia [12]. The main drawbacks of stent placement are stent migration and tissue invasion or overgrowth, both of which indeed necessitate a repeat intervention. In palliative care, the stent remains in place for the lifetime of the patient, and stent design is focused on prevention of migration and recurrent obstruction. In more recent years, a good outcome with low morbidity and mortality has also been reported for treating benign esophageal ruptures and leaks with temporary stent placement. In these benign diseases, safe removal is an essential feature. For effective management of benign esophageal lesions, the stent should be: easily retrievable or repositioned; technically easy to place; designed to have a small-caliber delivery device with minimal shortening on usage; have low migration rates; and finally, insertion and removal should be associated with minimal complications. To limit reactive nonmalignant tissue invasion or overgrowth, fully (FSEMS) or partially (PSEMS) covered self-expanding metal stents or a & Pietro Amedeo Modesti pa.modesti@unifi.it