In the last decades, the management of gastro-intestinal (GI) and bilio-pancreatic diseases has been revolutionized due the advancements in diagnostic and interventional endoscopic procedures. Endoscopic ultrasound (EUS) has progressively evolved from being mainly a diagnostic tool to a therapeutic approach in the treatment of a large spectrum of conditions, as an alternative or complementary to interventional radiology or surgery. The high efficacy of interventional endoscopic ultrasound procedures (IEUSP), combined with the lower invasiveness, a relatively safe profile, a high cost-effectiveness, the potential avoidance of ionizing radiations, contributed to the EUS shift of paradigm [[1], [2], [3]]. IEUSP include pancreatic collections drainage, bile and pancreatic duct access and drainage, gallbladder drainage, anastomosis between two lumens (namely gastroenterostomy or enteroenterostomy), tumor ablation and different types of vascular interventions. An extended literature has been provided over the years on technical and clinical outcomes of IEUSP, showing similar or even improved efficacy when compared to percutaneous and surgical interventions. However, the rate and severity of adverse events (AEs) of IEUSP is still not negligible. Indeed, the pooled rates of AEs for drainage with lumen apposing metal stents (LAMS) of malignant biliary obstruction (MBO) are reported to be 17.1 % (95 % CI 12.5 %–22.8 %) [4], 11 % for the drainage of pancreatic fluid collections (PFC) [5] and 14.8 % (95 % CI 8.8 %–21.8 %) for EUS-guided gallbladder drainage (EUS-GBD) [6]. However, it should be noted that literature reports a wide variability in frequency of AEs, mainly because of a lack of standardization between the definitions of AEs among studies, but also in relation to a variety of different techniques and devices available for the same EUS-guided procedures. Thus, interventional EUS related complications appear to represent a relevant matter, and their management is not fully standardized yet, but rather delegated on individual expertise and available facilities. The aim of this study is to critically review the most common AEs related to IEUSP and their management.