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Endoscopic ultrasound (EUS) is one of the fastest growing areas within gastrointestinal endoscopy. Although the growth in the United States has been steady, EUS is exploding in areas of Asia and Eastern Europe. As utilization of EUS is increasing, so is the evolution of the discipline itself. As a result, it is critically important to periodically review the current state of the art. From its inception, EUS has been primarily utilized for staging cancer, assessment of pancreatic disease and evaluation of submucosal lesions.EUS has evolved and is now dominated by the application of EUS-guided fine needle aspiration cytology (EUS-FNA), and the newest emerging application is EUS-guided interventions. The recent literature is a reflection of these trends, with some articles devoted to the standard applications for EUS, but most of the emphasis is on EUS-FNA and EUS-guided interventions.This current review has important clinical implications, as it contains new information on standard applications for endoscopic ultrasound that should be adopted into clinical practice and also provides a glimpse into the future through EUS-guided interventions.