EUS-guided fine-needle biopsy (EUS-FNB) is essential for diagnosing pancreatic lesions, but evidence on its safety in a fully ambulatory setting with very early discharge is limited. We assessed the safety and feasibility of EUS-FNB in outpatients discharged after brief observation.

Single-centre retrospective study of consecutive ASA I–II outpatients undergoing EUS-FNB for solid pancreatic lesions between 2024 and 2025. Procedures were performed with anesthesiology assistance using propofol, spontaneous breathing and continuous monitoring. After the procedure, patients were observed for 2 hours and discharged if fit according to the Post-Anesthetic Discharge Scoring System (PADSS). Patients were contacted by telephone at 48 hours to assess post-procedural symptoms and unplanned healthcare use. The primary endpoint was successful early discharge after 2 hours with adequate PADSS. Secondary endpoints were emergency department (ED) visits within 48 hours and major procedure-related adverse events (pancreatitis, clinically relevant bleeding, perforation).

One hundred ninety-five patients were included. All procedures were completed, and all patients achieved an adequate PADSS score allowing discharge after 2 hours (primary endpoint met in 100% of cases). Within 48 hours, 3/195 patients (1.5%) accessed the ED: two for severe abdominal pain (one requiring opioid analgesia) and one for fever with leukocytosis. Imaging excluded EUS-FNB-related complications in all cases, and no major adverse events occurred (0%).

Ambulatory EUS-FNB with anesthesiologist-guided propofol sedation and a standardised 2-hour observation period appears safe and feasible in carefully selected ASA I–II outpatients. This pathway may reduce hospital bed occupancy and workload and accelerate diagnostic work-up for pancreatic diseases.