Introduction: EUS is considered as safe as EGD. However, the longer, rigid tip of the EUS endoscopes raises concern about cervical esophageal perforation during intubation. Our aim was to determine the rate of this complication with EUS. Methods: Members of the American Endosonography Club were surveyed to determine the number of EUS examination performed and the number of cervical esophageal perforations encountered during intubation from their earliest experience till June 99. Specific details about patients with cervical esophageal perforation were elicited. Each questionnaire was coded to avoid duplicate reporting from the same institution. Results: Questionnaires were mailed to 203 members. Eightysix (42.4%) responded. Cervical esophageal perforation occurred in 16 out of 43,852 reported upper EUS procedures. Thus, the reported frequency of cervical esophageal perforation with EUS intubation was 0.03%. Fifteen (94%) patients were more than 65 years of age. History of difficult intubation with prior endoscopic procedures was present in 7 (44%) patients. Three patients had large cervical osteophytes which were thought to be contributory. A radial scanning echoendoscope was used in majority of cases (94%). In 9 (56%) patients, the procedure was done by an endosonographer with less than 1 year of experience. Two patients needed surgical management. One patient died as a result of the perforation and the other 13 (81%) patients were managed successfully with medical management with or without percutaneous drainage. Conclusions: The incidence of cervical perforation during upper EUS seems to be higher than EGD. Advanced patient age, difficult intubation during prior endoscopic examination, operator inexperience and presence of large cervical osteophytes may contribute to cervical perforation during upper EUS examination.