Purpose of Review <p>This review synthesizes current literature on the use of Endoscopic ultrasound (EUS) in congenital gastrointestinal (GI) conditions. Special emphasis is placed on pediatric applications, where EUS is increasingly recognized as both feasible and safe.</p> Recent Findings <p>EUS has transformed the evaluation and management of congenital anomalies affecting the GI tract and pancreaticobiliary system, and has been shown to be safe and effective in the pediatric population. By combining high-resolution imaging with the ability to perform real-time interventions, EUS addresses diagnostic uncertainties that historically required cross-sectional imaging or invasive surgery.</p> Summary <p>EUS offers precise diagnostics, minimally invasive evaluation, and therapeutic guidance in pediatric patients, potentially avoiding surgical intervention. Larger pediatric multicenter registries are needed to further validate its use in children. Widespread adoption remains limited by the scarcity of EUS-trained pediatric gastroenterologists and the lack of specialized equipment designed for small children.</p>