Pancreatic exocrine insufficiency is a frequent but clearly underdiagnosed life-threatening condition, which is the consequence of different pancreatic as well as extrapancreatic diseases. Chronic pancreatitis, as one of the most relevant causes of pancreatic exocrine insufficiency, is underdiagnosed too, and the diagnosis of the disease in early phases is a clinical challenge. Recognition of pancreatic exocrine insufficiency and its causes, and the appropriate therapeutic approach to this condition have a relevant clinical impact on prevention of complications and mortality.

Endoscopic ultrasound (EUS) has evolved in recent years into a technique with a major clinical impact in the management of pancreatic diseases. EUS also provides guidance for fine-needle aspiration and biopsy, allowing for the preoperative diagnosis of pancreatic lesions. In addition, several new diagnostic techniques associated with EUS have being developed over the last years, including EUS-guided elastography and contrast-enhanced EUS that are very useful for the differential diagnosis of solid lesions. These techniques are becoming essential in clinical routine. EUS-guided therapy is also increasing in terms of new indications, such as drainage procedures, tumour ablation, and injection techniques, such as celiac plexus neurolysis. The Department of Gastroenterology and Hepatology of the University Hospital of Santiago de Compostela, Spain, is a reference centre for the diagnosis and therapy of pancreatic diseases, as well as for education and development in endoscopic ultrasound.