Endoscopic ultrasonography (EUS)-guided interventions are an essential tool for complex (such as combined or subsequent) therapeutic measures and are, in current as well as future endoscopy, an indispensable part of modern gastroenterology. Longitudinal EUS scanners allow one to puncture transluminally both mediastinal and abdominal lesions which cannot be approached with other techniques. Using the EUS-guided puncture of such pathological lesions, it becomes possible to perform further, more advanced endoscopic interventions which thus become safer as well as more efficient and are associated with a lower complication rate compared with conventional endoscopic or even surgical interventions. A crucial aspect in interventional EUS is the adequate, less traumatic treatment of pancreatic pseudocysts. The transluminal route for interventions spanning from the approach to the placement of a drainage for abscesses and/or necroses is considerably easier under EUS-guidance, including better outcomes. Novel approaches and interventions are the internal EUS-guided insertion of a transluminal (from the upper GI tract) I) cholangiodrainage in patients with malignant obstruction of the bile duct but no option to achieve sufficient conventional cholangiodrainage with ERC or PTC, II) pancreaticodrainage in symptomatic patients with enlarged pancreatic duct -/+ pancreatic fistula postoperatively or in patients with chronic pancreatitis, which may be considered new therapeutic strategies with non-operative intentions and/or low invasiveness.