Improving the quality of upper gastrointestinal endoscopy (UGE) relies increasingly on structured performance measures (PMs) defined by the European Society of Gastrointestinal Endoscopy (ESGE). The 2025 update introduced revised key and minor PMs to strengthen standardization and enhance diagnostic performance. The aim of this study was to evaluate compliance with the updated 2025 ESGE UGE performance measures in a cohort of 100 consecutive UGE procedures, to calculate local quality metrics, and to compare these results with those obtained in the same centre in 2023, when examinations were assessed according to the 2016 ESGE framework.

Retrospective cohort study including 100 consecutive UGE performed in 2025 and 309 consecutive procedures performed in 2023 in a single centre. Standard exclusion criteria aligned with ESGE recommendations were applied to both cohorts. Each examination was evaluated against the corresponding ESGE performance measures: the 2025 PMs for the 2025 cohort and the 2016 PMs for the 2023 cohort. Extracted variables included key and minor performance measures, and a comparative analysis between 2023 and 2025 was performed using chi-square, with significance set at p<0.05.

In 2025, regarding key PMs, appropriate indication for the procedure was documented in 98% of examinations, fasting instructions in 100%, accurate photodocumentation in 99%, and standardized terminology in 91%. The management of epithelial precancerous conditions and early neoplasia of the stomach (MAPS) protocol was followed in 100% of applicable procedures (n=40), and recommended surveillance intervals in patients with gastric precancerous conditions were respected in 100% of applicable cases (n=21). Two key performance measures remained below ESGE minimum thresholds: the use of a validated mucosal visibility score (39%) and documentation of an inspection time ≥7 minutes (39%). Among minor PMs, a minimum 20-minute allocated time slot was assured in 100% of procedures and patients’ experience was not evaluated. Some PMs were not applicable due to the absence of eligible cases among the 100 consecutive UGE evaluated: Barrett’s oesophagus-related measures, chromoendoscopy in squamous neoplasia risk groups and post-therapeutic complications. Comparative analysis of PMs available in both 2023 and 2025 revealed no relevant differences in fasting documentation (100% vs. 100%, p=1.00), photodocumentation adequacy (99% vs. 99%, p=0.85), or use of standardized terminology (94% vs. 91%, p=0.54). There was a statistically significant improvement in the proportion of procedures in which the MAPS protocol was applied, when relevant (89% vs. 100%, p=0.03). Comparing the 2016 ESGE measures requiring documentation of time vs. the 2025 update additionally mandating an inspection time ≥7 minutes, the proportion of examinations meeting the PM improved significantly (22% vs. 39%, p<0.01), indicating a meaningful enhancement in compliance with time-related key PM. Overall, in 2025, 7 of the 10 available PM to evaluate were performed according to the ESGE minimum standard ≥90%.

This two-cohort analysis demonstrates measurable progress in adherence to ESGE performance measures following the 2025 update, with several key PMs meeting or approaching target standards. Improvements were particularly evident in time-related documentation and use of MAPS protocol for gastric precancerous assessment. Some PMs remain below ESGE minimum thresholds, giving room for continuous improvement, but the overall trend supports the positive impact of systematic quality monitoring and highlights ongoing opportunities to optimize UGE performance in accordance with evolving European standards.