Imaging modalities are crucial for diagnosis and monitoring of various gastroenterological diseases. To overcome limitations in established imaging methods, to improve outcome and reduce invasive procedures alternate modalities are needed. Optoacoustic imaging (OAI), an emerging method in both preclinical and translational settings, offers possible solutions to currently existing limitations. By enhancing tissue contrast and visualization of chromophoric molecules, OAI can provide detailed information about tumour architecture, perfusion and inflammation—an urgently needed ability in gastroenterology. Whilst some gastroenterological applications like noninvasive monitoring of inflammatory bowel disease were already successfully translated into clinical settings, others still await their verification in human studies. With ongoing development of the technique, more translational applications can be expected to follow. This review is focused on summarizing previous and current preclinical and translational applications of OAI in gastroenterology, their benefits compared to established methods as well as limitations and possible future implementations of the technique in gastroenterological settings.