Endoscopist-administered sedation is safe and widely used in Europe ^1,2, but sedation in interventional-EUS (i-EUS) is usually performed by anesthetists³. Given the increasing demand and limited resources, this study aimed to evaluate the safety of endoscopist-led sedation in i-EUS.

Retrospective, single center study, including all i-EUS performed between February 2020 and August 2025 in Hospital Universitario de Salamanca (Spain). Hemodynamically stable patients received propofol in boluses and continuous infusion administered by the endoscopist and nurses (with dedicated training in sedation); along with high-flow nasal oxygen at 15 L/min. Optional midazolam, fentanyl, or hyoscine were also given. Drug doses, vitals and sedation-related adverse events are systematically recorded, prospectively, by the nurse responsible for sedation, using a form specifically designed for this purpose. Furthermore, any sedation-related adverse events are also documented in the endoscopy report.

317 i-EUS were included (139 cholecystostomies, 66 gastroenterostomies, 57 pancreatic collections, 30 hepaticogastrostomies, 14 abscess drainages and 11 choledocoduodenostomies). 57 patients (18%) also underwent an ERCP or 2 i-EUS in the same session. Median age was 81.5 y.o. (IQR 67.4-88.4). ASA classification for anesthetic risk: I (1%), II (44%), III (50%), IV (5%). Comorbidities included OSA n=7 (2.4%), COPD n=19 (6%), LVEF <40% n=4 (1.3%), severe aortic stenosis n=1 (0.3%). 6 hemodynamically unstable patients (1.9%) had sedation and support by ICU.

Mean propofol dose was 271 mg (CI 95% 254-289). Hyoscine was given to 75 patients (24.2%) with a median dose of 40 mg (IQR 20-40); Midazolam to 2 patients (0.6%), median dose 2 mg (IQR 1-3); and Fentanyl to 18 patients (5.8%), median dose 75 mcg (IQR 68.75-75).

There was one sedation-related adverse event (AE): a moderate desaturation in a 99 year-old patient without significant comorbidities, who received 80 mg of propofol. This was reversed with Bag-Valve-Mask ventilation by the endoscopist; allowing completion of the procedure (cholecystostomy). No aspirations, bradycardia requiring atropine, significant hypotension (systolic BP <80 mmHg despite IV fluids), or need for urgent ICU support occurred. No sedation-related deaths were reported.  One 92-year-old male with a metastatic cholangiocarcinoma died in the recovery room 40 minutes after finishing an uneventful hepaticogastrostomy. The cause of the death was unclear, since no autopsy was performed given age and comorbidities.

There were 8 LAMS misdeployments (2.5%) and 16 AEs (5%) including: bleeding (3.2%), migration (1.3%), bile leak (0.3%) and perforation (0.3%). None of these events were associated with sedation complications. 

In our series, endoscopist-led sedation with propofol for i-EUS was safe. Only one sedation-related AE (desaturation) occurred, which was moderate, managed by the endoscopist, and the procedure could be succesfully completed. The presence of AEs or misdeployments inherent to these techniques was not associated with an increased rate of aspiration, hypotension, or other complications.