Endoscopic Closure of a Spontaneous Esophageal Perforation Using an Over-the-Scope Clip (OTSC®): A Conservative Approach to Boerhaave Syndrome.

Boerhaave syndrome (BS), a rare and potentially fatal condition characterized by the spontaneous transmural rupture of the esophagus, often poses an initial diagnostic challenge due to its nonspecific clinical manifestations. Contrast-enhanced computed tomography (CT) is the preferred imaging modality for diagnosis. We present the case of a 63-year-old patient with multiple comorbidities who developed acute retrosternal chest pain following an episode of vomiting. Radiological imaging demonstrated a distal esophageal perforation, leading to the implementation of a conservative treatment approach involving ventilatory support, empirical antibiotic therapy, and thoracic drainage. Upper endoscopic examination identified the perforation, which was effectively closed with an Over-the-Scope Clip (OTSC; Ovesco Endoscopy AG, Tübingen, Germany). The patient experienced a positive clinical course, with resolution of the pneumothorax and subsequent transfer to a rehabilitation center. This case highlights the necessity of individualized therapeutic strategies in the management of BS and demonstrates the potential of minimally invasive endoscopic techniques, such as OTSC, as an effective option in stable and appropriately assessed patients.