We present the case of 35-year-old male patient with a medical history of Schatzki ring and eosinophilic oesophagitis. He presented in the ED with severe right side chest pain after choking on his chicken dinner. His partner had performed Heimlich manoeuvre & back slaps. During his stay at the ED, he deteriorated and was intubated. Patient was then transferred to ITU.  An emergency CT revealed an extensive pneumomediastinum closely related to the air fluid oesophagus. There was a large volume right sided hydropneumothorax (fluid accounting for more than 75% of the pleural collection), with associated compressive collapse of the right lung. There were a significant contralateral shift of the trachea and the entire mediastinum. Findings were strongly suggestive of Boerhaave’s syndrome (BS). A chest tube drain was urgently inserted by the cardiothoracic team, and patient was started on broad – spectrum antibiotics. After multidisciplinary discussion an endoscopic approach was decided as first line approach and surgery reserved as second line. Treatment options were clearly communicated to the family members.  During endoscopy several fibrotic mucosal rings/strictures were identified that prevented the use of a distal attachment (cap). There was a food bolus encountered at lower oesophagus, which was pushed into the stomach. At the lower oesophagus a 2cm full thickness wall defect with clean margins was identified. The wall defect was treated with a suturing device (X-Tack, Boston Scientific). A fully covered oesophageal metal (Niti-s) stent was then deployed under direct vision. Two haemoclips applied to anchor the stent. Patient eventually recovered and was successfully discharged home after 40 days. On follow up endoscopy, at 5 weeks, the stent had migrated distally and was found at the stomach. It was retrieved uneventfully. The perforation site appeared well healed with no stenosis. BS is a rare condition associated with high morbidity and mortality. Timely diagnosis is essential to improve outcomes. This condition has been traditionally managed with surgical intervention. However, recent advancements in endoscopic techniques have emerged as viable alternatives. Endoscopic management includes placement of OTCs, through-the-scope clips, partial or fully covered SEMS. Stenting has been favoured for larger defects (> 1cm). Recent, less - well studied, methods of closure include endoscopic suturing, vacuum-assisted closure or use of sealants (fibrin glue or cyanoacrylate).  To our knowledge this is the first case treated with a defect > 1cm with a combination of a suturing device and stenting. The apposition of a larger defect that could theoretically impose on stent efficacy was managed by combining it with a suturing technique.