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Unbridled eosinophil-predominant inflammation leads to esophageal remodeling with reduced compliance, stricture formation, and increased esophageal fragility. Transmural esophageal perforations are well-known adverse events of EoE that are induced either by retching (Boerhaave syndrome) or by procedures.3 Nonpenetrating chest trauma can also lead to transmural esophageal perforation. Endoscopists should keep in mind that endoscopic examination in EoE patients may induce severe submucosal dissections or perforations, as illustrated by our case. Repositioning of EoE patients during endoscopy should be performed with care, with bidirectional communication, and under observation of the endoscope on the monitor.