What is the typical cause of iatrogenic esophageal perforations?

Iatrogenic esophageal perforations are most commonly associated with medical procedures, and upper endoscopy is a significant contributor to this type of injury. During upper endoscopy, a flexible tube with a camera at the end is inserted through the mouth, down the esophagus, and into the stomach to allow visualization and intervention. This procedure carries the risk of perforating the esophagus, especially if there is pre-existing pathology, difficult anatomy, or if excessive force is used during the examination.

The perforation can lead to serious complications, including mediastinitis and sepsis, hence demonstrating that while certain activities or bodily responses like vomiting, coughing, or heavy lifting may place stress on the esophagus, they are not typically considered iatrogenic causes. The primary context for such injuries relates to medical interventions where the risk is inherent to the techniques and instruments used. Thus, the process of upper endoscopy is recognized as the most direct cause of iatrogenic esophageal perforations in clinical practice.