Since endoscopic ultrasound (EUS) was first developed in the 1980s, this technology has emerged as the principal modality for imaging the pancreas. When compared with other imaging techniques, EUS can more accurately image solid lesions of the pancreas and determine vascular involvement that might preclude surgery. Furthermore, EUS-guided fine needle aspiration allows safe and accurate sampling and histological diagnosis of these lesions. EUS also plays a large role in the evaluation of cystic lesions of the pancreas. EUS cyst morphology, as well as fluid analysis obtained by fine needle aspiration, can often be used to diagnose the etiology of these lesions, helping the clinician to more accurately assess the presence or potential for malignancy. EUS can also predict the probability of the presence of chronic pancreatitis, primarily on the basis of histological correlates. The focus of this review is to discuss the role of EUS in these and other commonly encountered pancreatic diseases.