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Background. Endoscopic Ultrasonography (EUS) is considered the best method for locoregional staging of oesophageal cancer (EC). Surgery with or without neo-adjuvant or adjuvant chemo-radiotherapy is the treatment of choice for most patients with EC. After preoperative chemo-radiotherapy (CRT), EUS accuracy is claimed to be poor, although considered helpful in guiding the management of these patients. Aim. To assess EUS staging accuracy after CRT and to identify EUS role in the patients’ prognosis. Methods. From January 2000 to April 2009, a total of 474 patients with oesophageal carcinoma who underwent oesophagectomy were examinated using preoperative EUS and CT. Of these patients, 267 underwent preoperative chemo-radiotherapy (CRT). Both EUS an CT scan were used to determine the depth of tumor penetration (T-stage) and the presence of lymph node metastases (N-stage) in according to AJCC TNM. EUS was perfomed using blind oesophagus-probe ( MH 908) at 7.5 MHz (50%), because of stenosis, the other were performed with the mechanical radial UM GFQ 130, 7.5 and 20 MHz (28%) or the electronic CF UE 160 12/20 MHz mini-probes (22%). EUS and CT staging after CRT were compared with surgical pathology stage. Results. Accuracy of EUS after CRT was 44.7% in detecting the depth of esophageal involvement, with better results in the T3 group (70%), and 60.6% in detecting lymph node metastasis. In these cases CT accuracy is comparably low with a 43.2% in T stage and 57% in N stage. Compared with EUS, CT tends to over-stage T stage and to under-stage N stage. On the other side the most common EUS errors post-CRT were over-staging if compared to resected surgical specimen.The multivariate analysis shows that survival rate in patients patients who underwent CRT is not related to EUS stage post CRT but only to surgical pathology stage.Conclusions. EUS Staging accuracy of esophageal cancer after chemo-radiotherapy using the conventional TN system, is lower than reported for pre-treatment staging (44.7% vs 80%). Over-staging is the most common error in EUS re-staging after CRT, apparently because fibrosis and inflammations, associated with chemo-radiotherapy, are indistinguishable from residual tumor on EUS imaging. In a select group (i.e.complete response or progression of the disease) EUS could be usefulness for the choice of the treatment (definitive vs surgery).