Background: Metastases to pancreas cannot be differentiated from primary pancreatic tumors based on imaging alone. Tissue diagnosis is imperative to plan appropriate treatment. Endosonography guided fine needle aspiration (EUS-FNA) is an alternative for cytodiagnosis of pancreatic lesions. Methods: Amongst 114 consecutive EUS-FNA from pancreatic lesions, metastases were diagnosed in 12 patients (9.5%). Longitudinal echoendoscopes and 22 gauge needles were used for EUS-FNA. Results: Mean age of patients was 61 years (36-74). Out of 6 patients with cancer in history (breast 3, renal cell 2, salivary gland 1) 4 had recurrence while two had a second carcinoma metastasizing into pancreas. In those without prior cancer, cytology revealed metastases from renal cell, colonic, ovarian and esophageal primary tumors in 4 patients, respectively. One had malignant lymphoma, while the other primary site could not be identified. The clinical outcome was poor (median survival 6 months). 8 patients received non-surgical palliation and 3 underwent surgery for their pancreatic metastases. EUS showed metastases in the head/corpus of the pancreas, measuring 1.8-4 cm with inhomogeneous hypoechoic echotexture indistinguishable from primary pancreatic cancer. Conclusion: Pancreatic metastases are one of the important causes of focal pancreatic lesions. EUS features are not characteristic for diagnosis. A simultaneous EUS-FNA enables cytodiagnosis and may avoid surgery.