Benign esophageal tumors are rare, accounting for about 0.5-0.8 of all esophageal tumors, and because of the mild or asymptomatic symptoms, patients often do not seek medical attention or are ignored by clinicians. In recent years, due to the advancement of X-ray and other examination techniques, the number of detected cases has gradually increased, among which 90% are esophageal smooth muscle tumors. Esophageal smooth muscle tumors originate from the intrinsic muscle layer of the esophagus, mainly from the longitudinal muscle, and most of them are in the wall of the esophagus, i.e., the outer mucosal wall is in the type. The majority of these tumors are in the wall of the esophagus, i.e., the outer mucosa. Some of these tumors are polyps in the lumen and have a tip attached to the wall of the esophagus, and have been reported to be vomited out of the mouth. Tumor can occur in any part of esophagus, but in China, the middle segment is the most common, the lower segment is the second most common, the upper segment is the least common, and there are very few in the cervical segment, because the cervical segment of esophagus is composed of random muscle, and there are not many in the ventral segment, so it is not easy to distinguish between esophagus or cardia muscle layer. Most of the tumors are solitary, and only about 2% to 3% are multiple, ranging from 2 to more than 10. Tumors vary in size, with 2-5 cm being the most common. Excised specimens range from as small as 0.5 cm × 0.4 cm × 0.4 cm to as large as 17 cm × 10 cm × 6 cm, with the smallest being 0.25 g and the heaviest being 5000 g. Tumors are round and oval in shape, and also have irregular shapes, such as lobulated, spiral, ginger-shaped, and horseshoe-shaped growing around the esophagus. In esophageal smooth muscle tumor disease, there are multiple tumors that can thicken the whole esophageal wall, so it is difficult to diagnose. The tumor is tough, with an intact envelope and smooth surface. The tumor grows mainly outside the lumen and is slow growing. The tumor cells are arranged in bundles or swirls, with a certain amount of fibrous tissue and occasionally nerve tissue. It is rare for esophageal smooth muscle tumors to become sarcomas, with some literature reporting 10.8%, but some scholars believe that sarcoma is another independent disease with no direct evidence of malignant transformation from smooth bone tumors. About half of the patients with smooth muscle tumors are completely asymptomatic and are detected by chest X-ray or gastrointestinal imaging for other diseases. Those that do have symptoms are mild, most commonly a mild dysphagia that rarely interferes with normal diet. Even if the tumor is quite large, the obstructive symptoms are not severe because of its slow development. This is important in the differential diagnosis, which is not quite the same as the short-term progressive dysphagia caused by esophageal cancer. The severity of feeding obstruction may be intermittent and not exactly parallel to the size and location of the tumor, but mainly depends on the growth of the tumor around the lumen, and is also related to the mucosal edema and erosion on the surface of the tumor and psychological factors. A small percentage of patients complain of pain, the location of which is variable and may be vague pain behind the sternum, chest, back and upper abdomen, but rarely severe. It can occur alone or in combination with other symptoms. About 1/3 of patients have digestive disorders, including heartburn, acid reflux, abdominal distension, postprandial discomfort and dyspepsia. Individual patients have upper gastrointestinal bleeding symptoms such as vomiting blood and black stool, which may be caused by mucosal erosion and ulceration on the surface of tumor.