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Purpose: Endoscopy is a common and effective method to treat digestive system diseases. Not only can it detect the physiological state of the digestive tract, but also can conduct clinical operations. As a result, it’s of great significance to make clear the relationship between the clinical operation and the complications. Methods: Considering the difficulty in measuring the contact force and determining the stress distribution in real time during endoscopy, a specific-patient finite element model for the frictional behavior at the endoscope-esophagus interface was built in current study. By collecting the CT data of the patient, a 3D esophagus model was built and divided into three characteristic regions (narrow region, thoracic region and abdominal region) according to the physiological structure. Results: Results showed that the radius of the narrowest position was the dominant factor for the maximum von Mises stress when the endoscope passed through the narrow region. For abdominal region and thoracic region, with the increasing coefficient of friction (COF) and amplitude, the total force duo to frictional force (CFSM), frictional dissipation (FD), strain energy (SE) and maximum von Mises stress (Max) all increased correspondingly. Meanwhile, the region of stress concentration gradually approached the initial contact stage. Conclusions: The results can provide theoretical basis and technical support for clinical application and offer some suggestions for medical workers during endoscopy as well.