EUS is a sensitive method for staging gastrointestinal malignancies and pancreatic lesions. EUS FNA offers a diagnostic accuracy of about 60% - 90% for pancreatic tumors and more than 90% for lymph nodes.There are several limitations of EUS FNA including the need for on - site cytopathology review. In addition, accuracy of cytologic review is hampered by the presence of blood, benign epithelial cells, desmoplasia and well - differentiated tumors. Furthermore, the small biopsy sample and destruction of tissue architecture limits the diagnostic sensitivity for GISTs and lymphomas. Many of these problems can be overcomed with use of EUS trucut biopsy (TCB) needles. These large calibers , cutting needles, acquire larger tissue samples allowing preservation of tissue architecture and histologic examination. Our recently described experience with EUS TCB initially in swine and later humans demonstrated the safety for acquiring histologic tissue representative of the target organs sampled enabling accurate diagnosis. These studies suggested greater diagnostic accuracy of EUS TCB for submucosal mass lesions and lymphoma and potentially the need for fewer needles passes for solid pancreatic neoplasms. In this paper we reviewed the current TCB literature, device design and technique, help trouble shoot potential problems, and offerred opinion as to the utility and role of this new device.