Esophageal malignancy is a major source of morbidity and mortality, despite the recently increased attention to screening and early detection. Prognosis for esophageal cancer remains grim, with advanced tumor stage and lymph node metastases conferring even graver outcomes. Several studies have demonstrated that the addition of preoperative neoadjuvant chemoradiotherapy may improve survival in patients with locally advanced tumor (T3) disease or local lymph node metastases. It is here that endoscopic ultrasonography finds its niche in the precise staging of these tumors and the subsequent use of stage-dependent treatment protocols.