Background <p>Hemangioma most commonly occurs in the head and neck, rarely affects the digestive tract, and often presents without any clinical signs. The treatment of esophageal hemangioma has been widely reported internationally. However, reports on the sole application of endoscopic band ligation for the treatment of esophageal hemangioma are relatively rare.</p> Case presentation <p>The patient was a 47-year-old woman with a large esophageal hemangioma initially misdiagnosed as isolated esophageal varices. The lesion was a single varicose vein (1.2&#xa0;cm in diameter) located on the left wall of the esophagus, approximately 23&#xa0;cm to 28&#xa0;cm from the incisors. Endoscopic ultrasound revealed thickened variceal walls with a honeycomb-like heterogeneous hypoechoic pattern, and Doppler imaging detected blood flow signals. CT indicated a venous mass (1.3&#xa0;cm × 1.2&#xa0;cm × 5&#xa0;cm) in the mid-esophagus with a honeycomb-like internal structure, which was highly suggestive of esophageal hemangioma. No arterial origin was observed, the superior and inferior venae cava appeared normal, and there were no signs of cirrhosis. The esophageal hemangioma was endoscopically ligated twice. Four months later, repeat examination revealed smooth mucosa at the surgical site and complete disappearance of the esophageal hemangioma with the formation of a white scar.</p> Conclusions <p>This case suggests that endoscopic band ligation may be a safe and effective minimally invasive treatment for large esophageal hemangioma.</p>