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Iatrogenic perforations of the gastrointestinal tract related to diagnostic or therapeutic endoscopy are a rare but severe adverse event, associated with significant morbidity and mortality. Esophagopleural fistula (EPF) is a rare postoperative complication that commonly occurs after pneumonectomy, or after other traumatic events, and less commonly associated with infectious or neoplasic pathology. Esophageal fistula could be congenital, postsurgical, traumatic, infectious or neoplasic. Their severity depends on the coexistence of septic intraabdominal process and the debit of the fistula. EPF is usually accompanied by serious infection and lifethreatening morbidity, that underlines the importance of an early diagnosis. The main diagnosis test is the CT, if possible, with oral contrast in order to see the fistulous path. Although endoscopy can help not only in diagnosis but also in the treatment, in most cases the treatment of choice is the surgery.