Impact of Sedation Regimen on Diagnostic Adequacy in Endoscopic ultrasonography-Guided Tissue Acquisition of Solid Pancreatic Lesions.

Background and study aim Endoscopic ultrasonography-guided tissue acquisition (EUS-TA) requires patient cooperation for optimal tissue yield. Sedation improves comfort and procedural conditions, but the impact of different sedation strategies on tissue adequacy is unclear. This study compared balanced propofol sedation (BPS) versus general anesthesia (GA) for EUS-TA of solid pancreatic lesions (SPLs) using propensity score matching (PSM). Patients and methods Single-center, cohort study with retrospective analysis of a prospectively collected database. All patients undergoing EUS-TA for SPL from April 2013 to February 2025 were included. Standalone EUS was performed under BPS; combined EUS-ERCP procedures under GA. Anesthetist-assisted (AS) deep sedation (without intubation) was classified as. Adequacy was defined as sufficient material for cytologic/histologic interpretation (inadequate if only blood or epithelial cells). Direct comparisons, multivariable logistic regression, and PSM were performed. Results In all, 491 EUS-TA procedures in 433 patients (50.3% female) were performed; the overall adequacy was 85.7%. BPS was used in 370 (74.5%, adequacy 84.6%), GA in 93 (18.9%, 89.2%), and AS in 28 (5.7%, 89.3%) ( p = 0.448). No significant difference between BPS and GA ( p = 0.256) or endoscopist-directed (BPS) vs. anesthetist-directed sedation (GA + AS) ( p = 0.209). Multivariable regression (adjusted for needle type, diagnosis, lesion location) showed no association of sedation method with adequacy (GA vs. BPS: p = 0.565). After PSM (needle type, adenocarcinoma, pancreatic head lesions), no significant differences emerged across modalities. Conclusions In this large real-world cohort, BPS achieved comparable adequacy to GA for EUS-TA of SPL. Deeper sedation does not appear to improve adequacy in tertiary centers. Prospective studies on safety and cost-effectiveness are needed.