One hundred and sixty seven consecutive patients with esophageal carcinoma (squamous cell carcinoma: n = 108, adenocarcinoma: n = 59) who underwent surgery were preoperatively examined by endoscopic ultrasonography (EUS), and the results were compared with intraoperative exploration and histopathological evaluation of resection specimens. The T and N stage were correctly determined by EUS in 86% and 73%, respectively. The assessment of the T stage for cases with traversable (n = 124) versus non-traversable (n = 43) tumor stenoses was 85% and 70%, respectively. Prediction of resectability by EUS (89%) was correct for adenocarcinoma (82% actual R0 resection rate), but not for squamous cell cancer (64%). This was due to the high incidence of submucosal microscopic tumor spread of squamous cell cancer not detectable on EUS. We consider EUS an indispensable diagnostic tool in the local staging of esophageal cancer since it provides important information in the assessment of resectability, aids in therapeutic decisions and in determining the prognosis. Our comparably low rate of primary surgery (66%) and the high resection rate of 95% are due to the exact preoperative staging by EUS.