Endoscopic variceal ligation(EVL) was developed to provide a safer alternative than injection sclerotherapy for treatment of bleeding esophageal varices. EVL adds a new indication that will significantly increase the use of overtubes. overtube itself may have a role in predisposing to esophageal perforation but only one report has been published regarding an esophageal perforation related to the placement of an overtube. Recently, we experienced a case of esophageal perforation caused by overtube placement during endoscopic variceal ligation. So we report this case with review of relevant literatures.