The possibility of preoperative prediction of pathologic complete response in rectal cancer has been studied in order to identify patients who would respond to neoadjuvant therapy and to individualize therapeutic strategies. Endoscopic ultrasound of the rectum is an accurate method for the evaluation of local tumor and lymph node invasion. Objective: To evaluate the potential of endoscopic ultrasound as a predictor of complete pathological response to neoadjuvant treatment in patients with locally advanced rectal cancer. Material and methods: Retrospective study of patients with rectal cancer from January 2014 to December 2016. Results: We obtained a statistical association between T stage by endoscopic ultrasound and complete pathological response (p = 0.015). It is not so for N, sphincter involvement, circumferential involvement and maximum tumor thickness (p = 0.723, p = 0.510, p = 0.233 and p = 0.114, respectively). When multivariate logistic regression analysis was applied to assess the degree of influence of the predictor variables on pathologic response, none of these variables was associated with complete pathologic response. Conclusion: Prediction of pathologic complete response in rectal cancer has been considered as the crucial point upon which treatments for rectal cancer could be individualized. So far, no imaging method has been able to demonstrate efficacy in predicting complete pathologic response, and in turn there is no direct association between any endosonographic finding that can accurately predict it.