Background The nutritional status of esophageal cancer patients during neoadjuvant therapy remains a challenging problem. The objective of this study was to determine whether routine enteral feeding tube placement improved nutritional status and perioperative outcomes for patients undergoing neoadjuvant therapy for esophageal cancer. Methods The Society of Thoracic Surgeons database was used to identify patients who underwent neoadjuvant therapy and esophagectomy at our institution between 2010 and 2014. Nutritional status before and after neoadjuvant therapy was determined through standardized nutrition consultations. Predictors of change in nutrition and adverse events were evaluated with multivariable and univariate logistic regressions. Results Two hundred thirty-four esophagectomy patients were identified, and 127 (54%) received neoadjuvant therapy. Of those receiving neoadjuvant therapy, 80% (102/127) presented with dysphagia, and 48% (61/127) received enteral feeding access (EA). Multivariable regression revealed that high initial albumin level, high initial body mass index, and presence of EA were associated with nutritional stability during neoadjuvant therapy. However, 27.9% (17/61) of patients who received EA did not use their access at all or did not use it consistently during the course of preoperative treatment. The preoperative grades of malnutrition and esophagectomy outcomes were similar between groups (EA vs no EA). Conclusions EA is associated with improved nutritional status for patients undergoing neoadjuvant therapy for esophageal cancer. However, adverse events and suboptimal use are common. Esophagectomy outcomes were similar for patients with and without EA. These results support judicious patient selection for EA, expedited neoadjuvant therapy, and close collaboration with nutritionists.