Several methods for the extraction of esophageal foreign bodies have been described. The most common approaches use either the flexible fiberoptic esophagoscope or the rigid esophagoscope. We report an unusual complication following the attempted extraction of a sharp esophageal foreign body with a flexible esophagoscope, review the indications for these 2 methods of extraction, and discuss the potential morbidity and mortality of these 2 approaches.