The aim of this study was to retrospectively assess the photo-documentation at gastroscopy and colonoscopy in clinical practice and compare this to the recommended sites as per the ESGE guidelines.  

This was a single centre, retrospective analysis of 62 consecutive patients attending the endoscopy unit in a district general hospital during September and October 2025. The endoscopy reports were scrutinized for photographic evidence of the anatomical landmarks. The images capture on the Medilogic GI Reporting Tool were analysed and compared to the recommended ESGE guidelines. 

62 procedures were included, with standards followed in 77% of procedures. Procedures were performed by a range of professionals including gastroenterologists (n= 26), general surgeons (n= 21), and clinical nurse endoscopists (n= 15).  

In gastroscopies, BSG guidelines were followed in 72.4% of cases. In most cases, only one photo site was missing including the incisura (n=2), duodenal bulb (n=2), gastro-oesophageal junction (n=1), and middle body of stomach (n=1). In two cases, multiple photos were missing. Of the procedures where a photo was missing, a trainee endoscopist was present during half of the procedures (n=4). 

For colonoscopies, terminal ileum or appendix orifice were photographed in 100% of procedures. In 11.5% of procedures, rectum in retroflexion was not photographed and in one case retroflexion could not be completed as a polyp was being retrieved.  

Gastroenterogists were least likely to follow guidelines (65% followed), clinical endoscopists were most likely to (87% followed). Surgeons were 76%.

The British Society of Gastroenterology (BSG) and Association of Upper Gastrointestinal Surgeons (AUGIS) recently published a position statement in view of the variability of performance of a high-quality gastroscopy and an unacceptably high rate of failure to diagnose cancer at endoscopy. This set out the minimum expected standards in diagnostic upper gastrointestinal endoscopy. One recommendation is that photo-documentation should be made of relevant anatomical landmarks and any detected lesions. This practice encourages mucosal cleansing, mucosal inspection and ensures a complete examination. The European Society of Gastrointestinal Endoscopy (ESGE) guidelines describe a systematic approach to photo-documentation with a recommendation of eight anatomical landmarks to improve diagnostic endoscopy quality of endoscopy. For colonoscopy a minimum of two anatomical landmarks are recommended to confirm caecal intubation (appendix orifice, Ileo-caecal valve, tri radiate fold) and retroflexion in the rectum.  

In this study, photographic evidence of anatomical landmarks as per ESGE guidelines is only documented in 77%, with poorest compliance in gastroscopies particularly in the presence of trainee endoscopists. This study also observed substandard photo documentation of retroflexion during colonoscopy.  

Photographic documentation improves the diagnostic quality of endoscopy and acts as a medico-legal record of an adequate/complete procedure. We conclude, there remains room for improvement in the photographic documentation in both gastroscopy and colonoscopy of anatomical landmarks in clinical practice.