The prognosis of patients with esophageal carcinoma is strongly correlated with the stage of disease at time of diagnosis. Overall, stage is determined via assessment of depth of penetration (T stage) and the presence or absence of local nodal or distant metastases (N and M stage, respectively). Endoscopic ultrasonography (EUS) is currently the only clinically available imaging modality that allows visualization of the individual tissue layers of the esophageal wall. In addition, most common sites of nodal metastases are seen easily. Thus, EUS is uniquely suited to the preoperative staging of esophageal malignancies. This article describes the techniques involved in performing accurate and safe preoperative staging of esophageal malignancies with EUS.