The esophagus may become perforated during upper gastrointestinal tract endoscopy.


Risk factors for esophageal perforation during endoscopy:

(1) use of a rigid endoscope

(2) difficult intubation

(3) inexperienced endoscopist

(4) uncooperative patient (perhaps indicating inadequate sedation)

(5) elderly frail patients with abnormal anatomy

(6) therapeutic endoscopy (dilatation, etc) or biopsy

(7) presence of a Zenker's diverticulum


Clinical findings:

(1) pain

(2) dyspnea

(3) cyanosis

(4) dysphagia

(5) fever and tachycardia

(6) subcutaneous emphysema

(7) infection

Site of Perforation

Site of Pain


neck and upper thorax


lower thorax or epigastrium with radiation to the scapular region


Imaging studies:

(1) air in the mediastinum

(2) mediastinal widening

(3) pleural effusion

(4) pneumothorax

(5) leakage of swallowed contrast medium


To read more or access our algorithms and calculators, please log in or register.