Endoscopic ultrasound fine needle aspiration (EUS FNA) provides high diagnostic accuracy in most settings. However, limitations associated with pancreatic EUS FNA reduce accuracy. These limitations most significantly impact patients with autoimmune and nonspecific pancreatitis, but also cystic pancreatic tumors, vascular tumors, and less so ductal carcinoma. The EUS trucut biopsy (TCB) needle design overcomes many of the shortcomings of EUS FNA by acquiring larger tissue samples to allow histologic examination. However, these techniques should be considered complimentary as technical or interpretive failure with one device often indicates a need for biopsy with the alternate method. The suggested role of EUS TCB in pancreatic disease is based on limited data and personal experience. As such, further study is needed to determine if this experience is widely applicable. Issues of afety, accuracy, and cost must also be clarified and considered before establishing the role of EUS TCB relative to EUS FNA.

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