AIM: To summarize the endoscopic ultrasonography (EUS) characteristics of esophageal tuberculosis and evaluate the role of EUS and EUS guided fine needle aspiration (EUS-FNA) in the diagnosis and differential diagnosis of esophageal tuberculosis. METHODS: The clinical data, EUS and EUSFNA data for 11 patients with esophageal tuberculosis were collected and analyzed retrospectively. RESULTS: Eight lesions were found in the middle part of the esophagus and 3 in the upper part. The lesions demonstrated as protrusion in 7 cases and ulceration in 4 cases. The layers of the esophageal wall were unclear or disappeared in some cases, and in some patients low echo occupying lesions inside or outside the esophageal wall were showed by EUS. The internal echo of the lesions was heterogeneous, and strong echo spots could be observed. In most cases, enlarged mediastinal lymph nodes were observed. EUS-FNA was used to take biopsy specimens in 7 cases: caseouse necrosis was found in 2 cases; 3 biopsy specimens suggested tuberculosis; no cancer cells were observed in 2 biopsy specimens. CONCLUSION: EUS can not only show the morphology and internal echo of the lesions, as well as the relationship between the lesions and esophageal wall, but also allow to observe the lymph nodes outside the esophageal wall. Biopsy specimens can be taken by EUS-FNA. EUS and EUS-FNA have high value in the diagnosis of esophageal tuberculosis. © 2014 Baishideng Publishing Group Co., Limited. All rights reserved.