Quality improvement in endoscopic ultrasound (EUS) is essential to ensure diagnostic accuracy, procedural safety, and consistency in clinical practice. Given the expanding use of EUS, the European Society of Gastrointestinal Endoscopy (ESGE) released in 2025 an updated set of key performance measures (KPMs) to standardize and enhance quality assessment. The aim of this study was to evaluate compliance with the 2025 ESGE EUS KPMs in a cohort of 124 consecutive EUS procedures and to evaluate our centre’s performance across applicable KPMs.

Retrospective cohort study including 124 consecutive EUS procedures performed from September 2024 to October 2025 at a single centre, of which 50 involved EUS-guided fine-needle aspiration/biopsy (EUS-FNA/FNB) of solid lesions. Exclusion criteria were applied according to the 2025 ESGE recommendations. Each procedure was assessed individually for adherence to the relevant KPMs, encompassing both diagnostic EUS and EUS-FNA/FNB indicators. An overall compliance analysis was carried out for each applicable KPM to determine our centre’s adherence to the updated 2025 minimum standards (MS) proposed.

Among the six KPMs assessed, four met the established minimum standards. Informed patient consent was documented in 100% of all procedures (MS=100%). Adequate documentation of EUS anatomical landmarks was achieved in 96% of examinations (MS ≥90%). Regarding tissue acquisition from solid lesions, the overall success rate, defined as obtaining a tissue sample that allows an accurate diagnosis, was 86% (MS ≥85%). No adverse events related to EUS-FNA/FNB were recorded (MS <5% in cystic, <3% in solid lesions). The remaining indicators performed below the recommended thresholds. For cases involving pancreatic cystic lesions, standardized lesion description was recorded in 70% (7/10) (MS ≥85%). Finally, formal competence assessment of trainees performing EUS was not documented in any of the 11 eligible procedures (MS ≥20%).

This assessment of the 2025 ESGE EUS key performance measures demonstrated strong compliance across several essential domains, including informed consent, adequate documentation, successful and safe tissue acquisition from solid lesions. While some indicators did not fully meet the recommended thresholds, the findings primarily highlight opportunities for continued improvement of practice. Ongoing systematic monitoring of these indicators is crucial to optimize procedural quality, enhance training, and ensure consistent, high-standard EUS practice within our centre.