Overall , there is little direct evidence for components of ERAS , with much derived from nonesophageal thoracoabdominal surgery .
ERAS in principle seems logical and safe for esophagectomy .
OBJECTIVE This article aims to provide the first systematic review of enhanced recovery after surgery ( ERAS ) programs for  esophagectomy  and generate guidelines .
BACKGROUND ERAS programs use multimodal approaches to reduce complications and accelerate recovery .
Although ERAS is well established in colorectal surgery , experience after esophagectomy has been minimal .
However , esophagectomy remains an extremely high-risk operation , commonly performed in patients with significant comorbidities .
Consequently , ERAS may have a significant role to play in improving outcomes .
No guidelines or review s have been published in esophagectomy .
Computed Tomography Versus Water-Soluble Contrast Swallow in the Detection of Intrathoracic Anastomotic Leak Complicating Esophagogastrectomy (Ivor Lewis): A Prospective Study in 97 Patients
Purpose : Water-soluble contrast swallow ( CS ) is usually performed before refeeding for anastomosis assessment after esophagectomy with intrathoracic anastomosis but the sensitivity of CS is low . Another diagnostic approach is based on analysis of computed tomography ( CT ) scan with oral contrast and of CT mediastinal air images . We undertook to compare them prospect ively . Methods : Ninety-seven patients with an esophageal carcinoma operated by intrathoracic anastomosis were included prospect ively in a study based on a CT scan at postoperative day 3 ( without oral and intravenous contrast ) and CT scan and CS at day 7 . CT scan analysis consisted of assessing contrast and air leakage . In case of doubt , an endoscopy was done . Results : A diagnosis of anastomotic leak was made in 13 patients ( 13.4 % ) , in 2 cases before day 7 and in 3 beyond day 7 . At day 3 , 94 CT scans were performed , but the diagnostic value was poor . In 95 patients with both CS and CT scan at day 7 , CS disclosed a leak in 5 of 11 , and CT scan was abnormal in 8 of 11 . Leakage of contrast and /or presence of mediastinal gas had the best negative predictive value ( 95.8 % ) . Endoscopy was done in 16 patients with only mediastinal gas at day 7 CT scan . It disclosed a normal anastomosis in 11 , fibrin deposits in 4 , and a leak in 1 . Conclusions : In comparison with CS only , CT at day 7 improves the sensitivity and negative predictive value for diagnosing an anastomotic leak . In case of doubt endoscopy is advisable . This approach provides an accurate assessment of the anastomosis before refeeding
Overall , there is little direct evidence for components of ERAS , with much derived from nonesophageal thoracoabdominal surgery .
ERAS in principle seems logical and safe for esophagectomy .
OBJECTIVE This article aims to provide the first systematic review of enhanced recovery after surgery ( ERAS ) programs for  esophagectomy  and generate guidelines .
BACKGROUND ERAS programs use multimodal approaches to reduce complications and accelerate recovery .
Although ERAS is well established in colorectal surgery , experience after esophagectomy has been minimal .
However , esophagectomy remains an extremely high-risk operation , commonly performed in patients with significant comorbidities .
Consequently , ERAS may have a significant role to play in improving outcomes .
No guidelines or review s have been published in esophagectomy .