Esophageal tuberculosis (ET) is a relatively rare clinical condition, characterized by often atypical clinical features. The lack of specificity in diagnostic methods, such as esophagogastroduodenoscopy and various imaging techniques, frequently leads to misdiagnosis and inappropriate treatments. Compared to esophagogastroduodenoscopy, endoscopic ultrasonography (EUS) offers a more comprehensive examination of esophageal tuberculosis lesions, including the extent of wall layer involvement and the internal structure characteristics of the lesions. Furthermore, when necessary, endoscopic ultrasonography-guided fine-needle aspiration can be employed to acquire deeper pathological tissue, significantly aiding diagnosis. When combined with the patient's clinical presentation, endoscopic findings, and pathological features, EUS plays a crucial role in the definitive diagnosis of ET and in the differential diagnosis process. This article meticulously reviews both national and international literature to summarize the relevant features of ET, with a focus on its appearance under EUS, and to highlight the clinical value of EUS in enhancing the diagnosis of ET and in distinguishing it from other conditions. The aim is to offer guidance for the accurate diagnosis of ET.