Endoscopic ultrasound in the diagnosis of esophageal carcinoma is an indispensable procedure, not only to discuss the preoperative staging of the lesion, but also to evaluate the therapeutic effect of chemo-radiation therapy. The recent increase in the incidence of superficial esophageal cancer and promising developments in potentially curative endoscopic therapies have placed EUS to a central position in decision making. Recent data have called into question the staging accuracy of EUS to distinguish mucosal from submucosal lesions, particularly in patients with early disease. In those cases, diagnostic endoscopic resection may be useful for staging and curative in superficial lesions. Nonetheless, EUS has been regarded as the most accurate staging tool and should be performed to identify potential candidates for endoscopic resection.