This study evaluated EUS diagnostic yield in patients presenting with weight loss.

Among 74 EUS procedures performed between 2023–2024, patients with weight loss were identified (n = 28). Clinical presentation, EUS morphology, and final diagnoses were analyzed.

Of 28 patients with weight loss, 10 (35.7%) were diagnosed with a significant underlying lesion. Diagnoses included:

• 7 pancreatic adenocarcinomas

• 1 neuroendocrine tumor

• 1 pancreatic tuberculosis

• 1 TIPMP

The remaining 18 patients (64.3%) had no structural lesion on EUS.

Weight loss combined with jaundice showed the strongest association with malignancy.

Weight loss with fever predicted benign/infectious disease (TB case).

Cystic lesions (TIPMP and serous cystadenomas) did not present with isolated weight loss.

In patients referred for EUS due to weight loss, approximately one-third had a clinically relevant diagnosis, predominantly pancreatic malignancy. Weight loss alone was not sufficiently specific, but its association with jaundice greatly increased the likelihood of malignancy. EUS remains an essential tool in the evaluation of unexplained weight loss.