The role of endoscopic ultrasound (EUS) has transitioned from a diagnostic to a therapeutic one over the past 40 years. With the advent of curvilinear array echoendoscopes in the 1990’s with an accessory channel, multiple tools and devices have been developed and utilized for a variety of transluminal interventions. EUS provides a viable option and is becoming the procedure of choice for many interventions including bile and pancreatic duct drainage, guiding angiotherapy, pancreatic fluid collection management, gallbladder drainage, and creating a gastrojejunostomy.