In this two-centre cohort, prophylactic balloon dilation was associated with less early delayed conduit emptying and pneumonia after esophagectomy.

• Delayed emptying occurred in 15% with dilation versus 40.1% without; pneumonia in 20% versus 40.8%.
• Dilation was also associated with earlier nasogastric tube removal (median 4 vs 6 days) and shorter stay (9 vs 13 days).

The findings make intraoperative endoscopic dilation promising, but not yet practice-changing: only 40 of 187 patients received it, and retrospective adoption leaves room for temporal and other confounding.