THE MORE widespread use of peroral endoscopy for the diagnosis and therapy of esophageal lesions has kept pace with advances in general and thoracic surgery, which have allowed for the successful treatment of these lesions. Assuming that all who perform these operations are equally skilled, the inevitable risks inherent in the procedure make it seem likely that perforations due to instrumentation alone in the presence or absence of a disease process will occur in some ratio to the number of endoscopic procedures performed. When perforations which occur spontaneously, from peptic ulceration, from ingestion of foreign bodies or from externally inflicted trauma, as in war wounds, blast and other injuries in which rupture is due to sudden marked increase in intraluminal pressure, are added to this number, then it becomes obvious that there is a need for a well defined method of treatment. Before the advent of sulfonamide and antibiotic therapy