Endoscopic ultrasound (EUS) allows high resolution imaging of the pancreas. EUS is a very useful technique for evaluating morphological features of a cystic tumors of the pancreas. These features include thick wall type, tumor protruding type, thick septal type, microcystic type, thin septal type and simple type. Malignant cystic lesions may present as a hypoechoic cystic/solid mass or as a complex cyst and are frequently associated with a dilated main pancreatic duct. There is some overlap between EUS appearances of non-neoplastic and neoplastic cystic pancreatic lesions. EUS guided FNA of cystic pancreatic lesions can play an important role in the differential diagnosis of these lesions and deciding about the need for surgery by evaluating cytology and tumor markers such as CEA in cyst fluid. There is some emerging data on EUS guided treatment of cystic pancreatic tumors by injection of alcohol.