Rectal neuroendocrine neoplasms (R-NENs) are rare but potentially malignant neoplasms originating from neuroendocrine cells within the intestinal tract.Their detection rate has gradually increased in recent years, making early diagnosis and therapeutic strategy selection crucial for prognosis.As a high-resolution imaging technique, miniprobe endoscopic ultrasound(MEUS) plays a pivotal role in the diagnosis and management of R-NENs.It enables precise assessment of tumor size, depth of invasion, origin layer, and regional lymph node status, providing critical guidance for formulating endoscopic or surgical treatment plans.In differential diagnosis, MEUS effectively distinguishes R-NENs from other submucosal lesions by analyzing lesion echogenicity and its relationship with intestinal wall layers.Although MEUS still has limitations in detecting minute lesions, assessing lymph nodes, and judging deep infiltration, the development of ultra-high-frequency probes, multimodal imaging, and AI-assisted technologies is opening broader application prospects for its precise diagnosis and treatment of R-NENs.This article reviews the current status and challenges of MEUS in the diagnosis, preoperative assessment, and future development of R-NENs.