The integration of metasurfaces on the tip of optical fibers enables advanced wavefront manipulations in Lab-on-Fiber application scenarios, and brings about new degrees of freedom that can be exploited for optimizing the surface sensitivity to local variations of the refractive index. Here, a novel biosensing platform is reported based on the integration of a phase-gradient plasmonic metasurface on the tip of an optical fiber, able to detect biomolecular interactions with very high sensitivity. Specifically, the capability of the proposed platform to detect very low concentrations of streptavidin in running buffer solutions, with a limit of detection of the order of a few ng mL−1, is demonstrated. In addition, its inherent integrability within medical catheters/needles renders it potentially very attractive for application scenarios of real-time diagnosis via liquid biopsy at precise locations inside the human body.