Leiomyomas are the most common benign esophageal neoplasm (2). They generally occur in men between the second to fifth decade of life. They are found in the distal esophagus, where smooth muscle predominates. The endoscopic appearance is a discrete bulging of the esophageal lumen without disruption of the mucosa. In addition, leiomyomas are mobile and the esophagoscope can be passed readily across the area of luminal narrowing. The diagnosis of leiomyoma is very difficult to make endoscopically and thus is generally made on radiographic examination of the esophagus or during endoscopic ultrasound (3).

Esophageal cysts are the second most common benign esophageal tumor and can be further classified into the more common inclusion cysts (intramural), or duplication cysts (extramural) (3, 4). Esophageal cysts are typically asymptomatic and are found incidentally during radiographic examination of the esophagus or during endoscopy. The inclusion cysts are usually found in the upper esophagus adjacent to the tracheal bifurcation. They are generally managed without surgery. In contradistinction, duplication cysts primarily occur in the lower third of the esophagus, and their lining may consist of gastric mucosa, thereby producing acid. Acid-producing duplication cysts can cause ulceration; thus excision of these cysts are generally recommended (5). Because they are extraluminal, their endoscopic appearance is characterized by a vague narrowing of the esophageal lumen without disruption of the mucosa.

Fibrovascular polyps are the most common benign intraluminal tumor (6). Generally they are pedunculated, grow slowly, and can become quite long, some > 20 cm (7, 8). Because fibrovascular polyps grow and can cause obstruction or bleeding as necrosis of the tip of the polyp occurs, excision is recommended (9).

Granular cell tumors are rare and typically asymptomatic. Over half are found in the distal one-third of the esophagus (3). Clinically they appear as smooth, oval, submucosal polypoid masses that are firm, pale, yellow, and sessile. They are generally <2 cm in diameter (10). Granular cell tumors are rarely malignant (1%–3%) and do not transform into malignancies (11, 12).

Lipomas are rare submucosal tumors that are detected during esophagoscopy as a bulging of the overlying esophageal mucosa. Lipomas typically arise in the upper one third of the esophagus and are soft and pale yellow (Fig. 8.1). While lipomas generally do not require follow-up, there are cases where lipomas can grow to large sizes and cause obstructive symptoms (2, 13).