Since its development in the early 1980s, endosonography (EUS) is one of the most rapidly advancing fields in gastrointestinal endoscopy. It indeed provides new areas of endotherapy by its outstanding combination of endoscopic techniques and ultrasound imaging. Therapeutic EUS indications can be divided into two main areas: EUS imaging as an aid to standard interventional endoscopic procedures and direct interventions including drainage procedures and fine-needle injection therapies. The following review describes the current applications of therapeutic EUS, novel indications and future potential developments of this technology.