Objective  To investigate whether assessment of the tumor origin and histological features through endoscopic ultrasonography could improve the operative efficacy of endoscopic resection of esophageal leiomyoma.    Methods   The clinical data of patients with esophageal submucosal tumor who were treated in our department and diagnosed as leiomyoma pathologically from January 2016 to June 2020 was retrospectively analyzed. A total of 58 patients with esophageal leiomyoma underwent endoscopic resection following evaluation of endoscopic ultrasonography. The en bloc resection rate, operation time, hospitalization day, and complications were evaluated.  Results  Preoperative endoscopic ultrasonography showed that leiomyoma originated from muscularis mucosa in 39 cases and muscularis propria in 19 cases. The mean tumor size was 1.50 (0.2-6.5) cm, and 20 cases underwent endoscopic mucosal resection (EMR), 32 cases underwent endoscopic submucosal excavation (ESE), and 6 cases underwent submucosal tunneling endoscopic resection (STER). The overall en bloc rate was 96.6%. The mean operation time was 38.29 (15-100) min. The postoperative complication rate was 15.5% (9/58), and all were recovered after conservative treatment. Among the 39 cases originated from the muscularis mucosa, 20 cases underwent EMR and 19 cases underwent ESE. There were no significant differences in tumor size and complications between the two groups, but the operative time and the length of postoperative hospitalization in the EMR group were significantly shorter (P<0.05). Among the 19 patients originated from the muscularis propria, 13 cases underwent ESE and 6 cases underwent STER. Thee   were no significant differences in tumor size, operative time, the length of postoperative hospitalization and complications between the two groups.    Conclusion  Preoperastive endoscopic ultrasonography could precisely detect the origin and histology characteristics of esophageal leiomyoma and improves the operation effect.