Endoscopic ultrasound guided fine needle aspiration (EUS-FNA) was developed to enhance the diagnostic capabilities of EUS by providing cytologic and histologic samples to support imaging interpretations. More than 25 years have passed since EUS-FNA was first introduced. One outcome of the significant growth and maturation of EUS-FNA throughout the world has come the development of EUS guided therapies such as EUS-guided celiac plexus neurolysis, tumor ablation, drainage of pancreatic fluid collections and intra-abdominal abscess and the development of anastomosis. These interventions can be traced directly to the ability to very precisely place a needle into structures adjacent to the GI track – a technique learned from experience with EUS-FNA. Though these techniques have potential to be less invasive and safer than surgery, the standardization of these techniques and long-term result of their efficacy and complications have not yet determined. This international symposium will discuss the current status of these techniques and will explore the current experimental and clinical trials which will determine future directions for therapeutic EUS.