The clashes on the edges of Eastern Ghouta killed at least 13 members of pro-regime forces and six fighters from the Jaish al-Islam rebel group, the Britain-based Syrian Observatory for Human Rights said.
"Violent clashes are taking place in the Al-Marj area, which is a frontline" of the rebel-held enclave near Damascus, Observatory head Rami Abdel Rahman said.
"They are the most violent clashes to take place since the beginning of the month," he added.
More than 500 civilians have been killed in a bombing campaign launched a week ago by regime forces on Eastern Ghouta.
According to the Observatory and a Syrian pro-regime newspaper, the clashes are aimed at paving the way for a ground offensive by government forces against Eastern Ghouta.
The clashes came a day after the UN Security Council unanimously adopted a resolution calling for a 30-day ceasefire in Syria "without delay" to allow for aid deliveries and medical evacuations.
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