The increase in esophageal pressure measured during mechanical ventilation does not reflect the stretch of the anastomosis. The distending force that stresses the wall of an organ depends on the differential pressure between inside and outside the organ. If the pressure is applied from outside, the organ will tend to collapse and no parietal strain develops. For example, as demonstrated by many articles on respiration, airway pressure far greater than pleural pressure (ie, high transpulmonary pressure) is required to induce lung injury. On the contrary, when very high airway pressure is applied, pressure measured inside the esophagus reflects only a transmitted pressure and the esophagus is not dilated but is instead compressed from outside. For this reason, high intrathoracic pressures are not likely to stress the anastomosis. As Carron highlighted in his letter to the Journal, swallowing air and the resulting gastric insufflation probably represent the main threat for anastomosis during NIV, as a positive transesophageal pressure may develop. The device used to provide ventilation in the current article was a laryngeal mask, which is less likely to induce gastric insufflation compared with face mask, the standard device for NIV. To confirm the safety of NIV after esophagectomy, we believe that future clinical trials should focus increasing pressure inside the esophagus during NIV when delivered by face mask.