Background/Aims: Leiomyoma is the most common benign tumor of the esophagus, but its incidence rate is low. The surgical indication of leiomyoma is controversial due to its benign behavior. The purpose of this study is to review its clinical characteristics and to suggest its managemeni. Methods: The clinical records of 33 patients who were diagnosed as esophageal leiomyoma pathologically were reviewed. The data were statistically analyzed by Mann-Whitney test. Results: It occurs more frequently in men than in women by a ratio of 2.3 to 1. Forty five percent of the patients are asymptomatic. Fifty two percent of the patients with symptom had coexisting cliseases such as gastromtestinal malignancy. Symptom of upper esophageal lesion appeared earlier than that of middle and low esophageal lesion. There were two postoperative complications. The one was esophagobronchial fistula observed in the patient who received enucleation after endose.opic biopsy, The other was. pneumomediastinitis observed in the patient who received endoscopic subrucosal resection to remove 6 crn sized leiomyoma. There was no mortality case. Conclusions: Esophageal leiomyoma is more common in men than in women. The patients with symptom usually accompany coexisting disease, and thus, precise evaluation is needed. The enucleation is a safe method, but the preoperative biopsy should be applied carefully for the prevention of serious complicaiions. (Kor 3 Gastroenterol 1998;32:565 - 570)