Over a period of 5 years, 28 instances of acute food impaction of the esophagus were documented in 26 patients at our institution. In all patients the impacted bolus was successfully removed without complication using a flexible endoscope. Underlying diseases were identified during primary endoscopy in 31% of the cases. Further diagnostic workup was performed in all but 5 of the patients. After adequate evaluation pathologic findings were demonstrated in 90% of the cases (38% malignant and 52% benign diseases). Long-term therapy was deemed necessary in 17 of these 21 patients. Operative intervention was indicated in 4 cases, 2 of which were for malignant tumors. Acute food impaction should always be regarded as a symptom of esophageal disorders. In patients with esophageal cancer or other mediastinal tumors bolus impaction generally indicates an advanced tumor stage.