Surface modified colloidal carriers such as nanoparticles are able to modulate the biodistribution of the loaded drug when given intravenously, but also to control the absorption of drugs administered by other routes. This review presents the different strategies to coat the surface of polymeric as well as inorganic nanoparticles with polysaccharides. Various physicochemical and biological methods have been described to demonstrate such surface modification. The medical applications, mainly in imaging cancer, of polysaccharide-coated nanoparticles are presented, including their abilities to increase the blood circulation time and to target specific tumoral tissues. It has been shown that these coatings allow also to improve drug absorption via nasal or ocular pathways, due the mucoadhesive and/or permeability enhancer properties of the polysaccharides. Finally, the ability of polysaccharide-coated nanoparticles to deliver DNA or oligonucleotides will be discussed.