Perforation due to endoscopy has mortality rate of 18-49% with medical management and 16-21% with surgical management. Intrathoracic perforations are at higher risk for mortality than cervical perforations.

Simple pneumomediastinum due to endoscopy may be difficult to distinguish from perforation. It may occur due to gagging, retching during the procedure.

Chest x ray may demonstrate sub-cutaneous emphysema, pneumothorax and pneumomediastinum. Contrast studies of esophagus should be done first using gastro-graffin. If this is negative, barium should be used. A negative study does not exclude perforation.

Patients with pneumothorax need chest tube placement. Management of esophageal perforation is usually surgical emergency since mortality increases with delayed surgery. On rare occasions, a self-contained leak in clinically stable patients without any evidence of infection may be managed medically. In latter case, the patient should be very carefully monitored and an low threshold for surgical intervention should be employed.