Background: Esophageal obstruction is common in horses and can result in life-threatening complications. Previous studies have described clinical findings in horses with esophageal obstruction, but there are no reports that attempt to make correlations of clinical findings with outcome.Hypothesis: Specific clinical features of horses with esophageal obstruction are associated with increased likelihood of complications.Animals: One hundred and nine horses with esophageal obstruction. Methods: Retrospective cross-sectional study. All clinical records of horses admitted between April 1992 and February 2009 for esophageal obstruction were reviewed. The association among 24 clinical, hematological, biochemical, therapeutic variables and the likelihood of complications was investigated by a univariable logistic regression model, followed by multivariable analysis.Results: Multiple logistic regression analysis revealed that intact males (P 5 .02), age 415 years (P o .01), and a need for general anesthesia (P o .01) were associated with the development of complications after an episode of esophageal obstruction. Increased respiratory rate (422 breaths/min) and moderate or severe tracheal contamination, although not associated with complications as a whole, significantly increased the risk of developing aspiration pneumonia (P .01).Conclusions and Clinical Importance: Signalment, clinical variables, and endoscopic findings were confirmed as important tools in assessing the severity of the esophageal lesion and pulmonary involvement. Knowledge of risk factors for the development of complications will aid in making informed decisions to optimize treatment and assist in the assessment of prognosis.