Background In adults, non-food foreign body ingestions occur more in denture users, incarcerated individuals, and in patients with psychiatric disorders or alcohol intoxication. The majority of the ingested foreign body will pass spontaneously. Sharp or pointed foreign body, animal or fish bones, and magnets increase the risk of perforation. Patient An incarcerated patient with bipolar disorder swallowed a 14cm in length needle attached with a syringe three months prior to presentation. The needle penetrated the distal esophagus leading to mediastinitis. Methods In this video manuscript, we demonstrated endoscopic techniques on how to remove this 14cm long sharp object. Results The foreign body was removed uneventfully and mediastinitis resolved with antibiotic treatment. Conclusions Emergent endoscopy is indicated in (1) esophageal obstruction and the patient are unable to swallow secretions and (2) disk batteries and sharp-pointed foreign body in the esophagus.