Application of a Combined Deep-Moderate Sedation Strategy in Endoscopic Ultrasound-Guided Fine-Needle Aspiration: A Retrospective Cohort Study

Background and Objectives: As a cornerstone in diagnosing hepatobiliary-pancreatic conditions, endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) often involves deep lesion access, which poses significant challenges for sedation. This study was designed to assess the utility of a combined deep-moderate sedation protocol for EUS-FNA. Methods In this retrospective cohort study, 185 patients who underwent EUS-FNA between January 2021 and June 2025 were enrolled. Participants were divided into two groups: the exposed group (n = 97), which received combined deep and moderate sedation, and the unexposed group (n = 88), which received deep sedation alone. The primary endpoint was the success rate of puncture. Secondary endpoints included: ① hemodynamic parameters (MAP, HR, SpO₂) at key procedural time points (T0–T5) and changes in PetCO₂ at T0/T4; ② clinical outcomes, including procedure duration, recovery time, propofol consumption, adverse events, procedural complications, and patient satisfaction. Results Primary Endpoint: The exposed group demonstrated a significantly higher puncture success rate (100% vs. 93.18%; P = 0.028).Secondary Endpoints:(1) Hemodynamic parameters: At key procedural time points (T2–T4), the exposed group showed significantly higher MAP and SpO₂ levels, as well as higher HR at T2–T3, compared to the unexposed group (all P < 0.05). PetCO₂ at T4 was significantly lower in the exposed group (P < 0.05).(2) Clinical outcomes: Recovery time, propofol consumption, incidence of adverse events (8.25% vs. 23.86%), and procedural complications (1.03% vs. 9.09%) were all significantly better in the exposed group (all P < 0.05). Patient satisfaction was comparable between the two groups (96.91% vs. 96.59%; P > 0.05).Patients with BMI ≥ 30 had a significantly increased risk of puncture failure (OR = 1.92, 95% CI: 1.18–3.14). Lesions with a diameter of 1.0–1.9 cm were associated with a higher failure rate. Puncture success was not correlated with gender, age, procedure duration, or number of needle passes, but was significantly associated with BMI and lesion size. Conclusion This retrospective study suggests that the use of a combined deep-moderate sedation protocol during EUS-FNA may be associated with improved puncture success rates and enhanced perioperative safety, whereas high BMI and smaller lesion size represent potential risk factors requiring attention. These exploratory findings merit further validation in prospective studies.