The European Society of Gastrointestinal Endoscopy (ESGE) recommends the use of a standardized safety checklist. The concept is gaining attention, but real-world data on its implementation and impact remain limited. This study aimed to assess the feasibility, adherence, and user perception of implementing the ESGE Safety Checklist in gastrointestinal endoscopic practice across Hungary.

A nationwide, prospective, multicenter observational study was conducted between 20 January and 14 February 2025 in 14 public and seven private endoscopy units. The ESGE Safety Checklist was translated into Hungarian and locally adapted before implementation. Data were collected on the checklist application, procedure type, preventable errors, and user feedback. Quantitative data were analyzed descriptively, and qualitative comments were thematically summarized.

Altogether, 5124 procedures were performed, of which 4160 (81.2%) were completed with the checklist. Adherence was higher in private (94.7%) than in public centers (80.0%). The checklist identified at least one preventable error in 335 procedures (8.0%) and multiple deficiencies in 117 (2.8%). The most frequent omissions were team introductions (5.7%), post-procedure instructions (2.7%), resumption of anticoagulation (1.9%), and rectal administration of nonsteroidal anti-inflammatory drugs during endoscopic retrograde cholangiopancreatography (2%). Preventable errors occurred most often during colonoscopy (4.5%) and gastroscopy (2.6%). Most centers reported improved communication, organization, and attention to patient safety.

In a considerable proportion of endoscopic procedures, the ESGE Safety Checklist helped identify preventable errors, confirming its practical value in improving procedural safety. Its implementation enhanced procedural structure and supports broader adoption, strengthening patient safety and quality.