Commentary: The Sengstaken-Blakemore tube, once considered the standard therapy for bleeding esophageal varices, has long since clinched its current position as the least-preferred method of treatment in large measure, and as illustrated in the current case, because of its high complication rate. Indeed, today’s fellows-in-training might not have even heard of the tube, and gastroenterologists in practice for only 2 decades or less may not have had the early-morning adventure of actually using it to stanch hemorrhage. I always found the most interesting part of its placement to be the means chosen to apply traction to the tube: a system of weights strung over a bed pulley and attached to the tube which, in turn, was anchored in place by a football helmet the patient wore as a somewhat comical but foreboding badge of courage. Self-expanding metal stents rarely have been used to tamponade variceal hemorrhage and also have been used to allow esophageal rents to heal. In the current case, we have an economy of purpose: not only did the stent expand, but its justification also expanded to accommodate both indications in one unfortunate individual.