Esophageal smooth muscle tumors are the most common benign tumors of the esophagus, often occurring in the middle and lower esophagus. It needs to be differentiated from esophageal cancer, mediastinal tumors and giant lymph nodes. It is often overlooked because of the mild or asymptomatic symptoms. In recent years, due to the advancement of X-ray and other examination techniques, the number of detected cases has gradually increased. The disease usually presents as a mild obstructive sensation of swallowing or dull pain behind the sternum. The symptoms tend to come on intermittently. It may be accompanied by epigastric discomfort, acid reflux, belching and loss of appetite. Barium X-ray esophagogram: It is the main diagnostic method for this disease, and combined with clinical manifestations, the diagnosis can often be confirmed in one imaging. Intraluminal filling defect is the main manifestation, and the defect is round or oval with smooth and sharp edges and clearly demarcated from normal esophagus. The accuracy of barium meal plus CT, plus ultrasonic gastroscopy can reach more than 90%, which can understand the location, size, number and shape of tumor. In particular, ultrasonic gastroscopy can reveal the mass protruding in the lumen of esophagus, the surface mucosa is intact, smooth and spreading, the folds disappear, light red and translucent, and the edges of myxoma are faintly visible, and ultrasonography under gastroscopy can indicate the level of growth of the mass, which should be submucosa to the muscle layer without involving mucosa, and there can be different degrees of lumen narrowing. Special attention should be paid to the smooth mucosa without abnormalities do not perform endoscopic biopsy! Because it will affect the surgery! Although esophageal smooth muscle tumor is benign, there are a few malignant tendencies, and the long-term growth of tumor may compress the surrounding organs and cause symptoms or even affect eating. Tumors less than 1cm in size, without any symptoms, or patients who are not suitable for surgery due to old age, weakness, low cardiopulmonary function and other physical conditions, should be treated surgically once diagnosed, and recurrence after surgery is rare.