Results of a conservative approach in the treatment of instrumental oesophageal perforation were evaluated in 54 patients. The perforations occurred either during introduction of/or manipulation with fibre-endoscopes (six), during dilatation procedures with metal olives (five), mercury bougies (six) or during pneumodilatation (two) in 19 patients without malignancy and during an intubation procedure of a plastic prosthesis in 35 patients with an inoperable malignant oesophageal narrowing. In the majority of patients (94.4%) the diagnosis of oesophageal perforation was made within two hours. Conservative treatment consisted of nothing by mouth, antibiotics and naso-oesophageal suction. Of the 19 patients without malignancy, 14 were treated conservatively and five by surgery (primary closure and drainage) with no deaths. All patients with an oesophageal perforation caused by palliative intubation received conservative treatment with three deaths (8.6%). Non-surgical treatment of instrumental oesophageal perforation is feasable and acceptable, provided the perforation is detected early, before major contamination has occurred and is indicated in case of perforation in patients with malignancy.