Pancreatic cancer is one of the most malignant tumors with the worst prognosis in digestive system. Because most patients are already in the advanced stage when they are first diagnosed, they lose the opportunity of radical surgical resection. With the deepening of the research on the pathogenesis and treatment strategy of pancreatic cancer, the treatment mode has gradually shifted from surgery to multidisciplinary comprehensive treatments. Among them, preoperative neoadjuvant therapy has become the preferred protocol for borderline resectable and locally advanced pancreatic cancer. In this context, endoscopy plays a crucial role in the diagnosis and treatment of pancreatic cancer. Therefore, endoscopic ultrasound (EUS) has become an important means for the diagnosis and treatment of pancreatic cancer. In particular, EUS-guided puncture biopsy and local treatment can provide patients with accurate pathological diagnosis and minimally invasive intervention, Moreover, EUS-guided biliary intervention treatment is an advanced treatment method to resolve biliary obstruction caused by pancreatic cancer. This paper systematically reviews the latest progress of EUS diagnosis and treatment based on the neoadjuvant therapy for pancreatic cancer. It is expected to provide the clinical references.