Two cases of iatrogenic cervical esophageal perforation caused by diagnostic flexible fiberoptic endoscopy are described. The relative risks of perforation at fiberoptic and rigid esophagoscopy are discussed and the importance of contrast radiology and early diagnosis are emphasized. Cases with a small tear and minimal contamination may be treated conservatively. Early surgical repair with drainage is otherwise the treatment of choice for cervical esophageal perforation. Even if there has been abscess formation tracking down into the mediastinum, drainage can be successfully achieved via the neck, avoiding the need for thoracotomy.