The incidence of esophageal foreign bodies is probably declining. The majority of patients are still in the pediatric age group. Clinical history and radiologic studies usually establish the diagnosis. Rigid esophagoscopy is still the standard method of therapy, but alternative methods can be employed with proper patient selection. The practicing physician must be familiar with the advantages and disadvantages of available methods of therapy. Observation for up to 24 hours is probably safe, and the proper method of therapy must be carefully selected according to the age of the patient, the type of the impacted foreign body, the location of impaction, the duration of impaction, and the available medical resources and skills. Major complications are to be expected with prolonged or missed impaction of foreign bodies in the esophagus. Prevention, high index of suspicion, and early treatment are important factors that can decrease the possible complications of impacted foreign bodies in the esophagus.