Endoscopic ultrasound (EUS) has become the most accurate imaging modality for locoregional cancer staging of the gastrointestinal (GI) tract. Fine-needle aspiration (FNA) capabilities have added a whole new level of accuracy in nodal staging with reported numbers in the 90% range for luminal and pancreaticobiliary disease. In addition, new non-GI applications are being evaluated like the role of EUS-FNA for non-small cell lung carcinoma and exploration of the posterior mediastinum. Furthermore, the same capabilities that allow for safe tissue sampling are being explored for interventional applications like EUS-guided celiac plexus neurolysis and fine-needle injection. The following review describes the current clinical status of EUS in GI oncology as well as future and novel indications and therapeutic strategies for this technology.