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This review summarizes evidence on epidemiology, diagnostic workup, and endoscopic ultrasound (EUS)\u2013guided management of PanNETs, encompassing diagnostic evaluation, tissue acquisition, and therapeutic interventions. EUS provides the highest diagnostic yield for lesions &lt;\u200920\u2009mm and enables detailed morphologic and vascular assessment through contrast\u2010enhanced and harmonic EUS, quantitative elastography, and, in selected cases, needle\u2010based confocal laser endomicroscopy. Fine\u2010needle biopsy is superior to fine\u2010needle aspiration for specimen adequacy, immunohistochemistry, and Ki\u201067 assessment, but preoperative grading may still be underestimated, with direct impact on decisions between surveillance, surgery, and systemic therapy. Therapeutically, EUS\u2010guided radiofrequency ablation achieves high short\u2010term to midterm clinical and radiologic control in insulinomas \u2264\u20092\u2009cm and in selected small nonfunctioning PanNETs, at the cost of adverse event rates around 15%\u201320%. Ethanol and microwave ablation are feasible but supported by less mature data, and all EUS\u2010guided ablation strategies should currently be regarded as investigational, pending long\u2010term comparative studies versus surgery and active surveillance. In borderline or locally advanced disease, neoadjuvant [\n                    <jats:sup>177<\/jats:sup>\n                    Lu]\u2010Lu\u2010DOTATATE appears to facilitate resection, but its optimal role remains to be defined. Emerging artificial intelligence and radiomics models using EUS images may refine risk stratification and support a precision endoscopy paradigm in PanNETs.\n                  <\/jats:p>","DOI":"10.1111\/jgh.70302","type":"journal-article","created":{"date-parts":[[2026,3,8]],"date-time":"2026-03-08T14:22:49Z","timestamp":1772979769000},"page":"1173-1190","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Endoscopic Ultrasound for the Management of Pancreatic Neuroendocrine Tumors: Diagnosis, Treatment, and Future Perspectives"],"prefix":"10.1111","volume":"41","author":[{"ORCID":"https:\/\/orcid.org\/0009-0002-0895-1225","authenticated-orcid":false,"given":"Angelo","family":"Bruni","sequence":"first","affiliation":[{"name":"Gastroenterology Unit IRCCS Azienda Ospedaliero\u2010Universitaria di Bologna  Bologna Italy"},{"name":"Department of Medical and Surgical Sciences University of Bologna  Bologna 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