The only method to prevent iatrogenic luminal perforation at the time of endoscopy is the avoidance of endoscopic procedures. Luminal perforation is among the most feared adverse events of GI endoscopy, and the rationale for this is multifactorial: (1) it may carry significant morbidity and mortality; (2) perforation may not be remediable without a surgical procedure; (3) management of perforation requires a multidisciplinary approach, often beyond the endoscopist’s control; (4) perforation usually requires hospitalization, thus adding to the cost of care; and (5) perforation has medicolegal implications, including liability not only for the endoscopist but other providers involved with the case.1 In addition, the mere mention of the word perforation triggers alarm and panic among faculty and trainees alike, often with the assumption that all perforations require surgical management. In some cases, there may even be disagreement among involved specialties as to the approach toward perforation.