Editorial: Closing holes that leak: Another dutch success story

The management of nonmalignant esophageal perforations is one of the most challenging situations in esophageal diseases. Traditionally, surgical repair has been the mainstay of therapy. Although endoscopic stenting has traditionally been used for management of malignant stenosis and fistulas, there has been limited information on its role in benign perforations. The study presented in this issue of the American Journal of Gastroenterology provides valuable information on the long-term success rate of esophageal stenting in this situation. In the series of 33 patients, van Heel et al. show that the majority of these perforations can be closed with endoscopic stenting. An important caveat of the study is that stents that are partially covered become increasingly difficult to remove after they have been in place for 6 weeks. Fully covered expandable metal and expandable plastic stents may be easier to remove, although they have a higher risk of migration. An ideal stent, which has low risk of migration and is simple and easy to place and remove, does not yet exist.