Esophageal ultrasound is a minimally invasive endoscopic technique by which mediastinal nodes, paraesophageal located lung tumors, posterior mediastinal masses, and the left adrenal gland can be aspirated under real-time ultrasound guidance. Esophageal ultrasound can be performed with either conventional GI equipment or an EBUS scope (EUS (B)). EUS (B) is complementary to endobronchial ultrasound (EBUS) in its diagnostic reach as it targets different areas of the mediastinum. For the diagnosis and staging of lung cancer, EUS (B) has major impact on patient management by providing added value to EBUS due to improved mediastinal staging, and assessment of left adrenal metastasis with resulting impact on preventing invasive surgical staging procedures. For diagnostic purposes, EUS (B) is an attractive alternative to EBUS for the analysis of subcarinal and left side lesions in a setting of mild sedation, as patients prefer an esophageal over and endobronchial approach. EUS (B) is recommended by international lung cancer staging guidelines, can easily be performed by EBUS operators after a short training, and is additionally an accurate and safe test to assess noncaseating granulomas in patients with suspected stage I/II sarcoidosis.