Optimizing Endoscopy Reporting: Structure, Standards, and Practical Applications in Clinical Practice

Vol. 31, Special Issue 1 (July 2026)

Sandie R. Thomson, MBChB, ChM, FRCS (Ed & Eng), FRCP(Ed), MWGO
Surgical Gastroenterologist
Emeritus Professor
Division of Medical Gastroenterology
Department of Medicine
University of Cape Town
Cape Town, South Africa

Sabina Beg, MBChB, MRCP, PhD, FRCP
Consultant Gastroenterologist and Endoscopist
Department of Gastroenterology
East and North Hertfordshire NHS Trust
Stevanage, UK
 

Shivangi T. Kothari, MD, FACG, FASGE
Associate Professor of Medicine
Director, Advanced Endoscopy and Endoscopy Innovation Programs
Division of Gastroenterology and Hepatology
University of Rochester Medical Center
Rochester, New York, USA
 

Abstract

Background: High-quality endoscopy reporting is essential for patient safety, quality assurance, research, and clinical education. Variability in documentation and lack of standardization can limit audit, training, and communication between clinicians. The introduction of structured electronic endoscopy reporting systems (EERS), quality frameworks such as the UK Joint Advisory Group (JAG) standards, and validated lesion classification systems has substantially improved the completeness and reproducibility of endoscopy reports.

Objective: This educational review summarizes the essential components of a high-quality endoscopy report, compares structured reporting frameworks used in the United Kingdom with those employed internationally, and highlights practical approaches to integrating classification systems, image documentation, and digital quality tools into routine clinical practice.

Methods: A narrative synthesis of published guidelines, peer-reviewed studies, and expert consensus statements from professional societies including the British Society of Gastroenterology (BSG), American Society for Gastrointestinal Endoscopy (ASGE), and European Society of Gastrointestinal Endoscopy (ESGE) was undertaken, together with literature describing electronic reporting platforms and national endoscopy registries.

Results: Comprehensive endoscopy reports include structured pre-procedure, intra-procedure, and post-procedure documentation. High-quality reporting incorporates validated classification systems, systematic photographic documentation of anatomical landmarks and pathology, and clear documentation of therapeutic interventions and follow-up recommendations. In the United Kingdom, reporting platforms integrated with the National Endoscopy Database (NED) enable automated extraction of key performance indicators and benchmarking across centers. Comparable national databases and digital reporting frameworks have been implemented in other regions, including the GIQuIC registry in the United States, the Japan Endoscopy Database, and the Norwegian Gastronet program. Emerging technologies such as artificial intelligence-assisted documentation may further enhance reporting efficiency and standardization.

Conclusion: Structured and standardized endoscopy reporting is fundamental to high-quality gastrointestinal practice. Integration of validated classification systems, digital reporting platforms, and national quality registries improves communication, training, audit, and research capability. Adoption of these principles across diverse healthcare settings, including resource-limited environments, will be essential to improving endoscopy quality and patient outcomes globally.

Keywords: Endoscopy reporting; electronic reporting systems; quality improvement; National Endoscopy Database; JAG; classification systems; artificial intelligence; LMICs; structured documentation

Introduction

Endoscopy has evolved from a purely diagnostic procedure to a cornerstone of modern gastrointestinal therapy, underpinning the detection, prevention, and management of malignancy and numerous benign conditions.¹ As procedural complexity has increased, so too has the need for robust and reproducible documentation.^2–4 The endoscopy report serves as both a clinical record and a medicolegal document, summarizing the indication, findings, interventions, and recommendations.^3–5 Its quality directly influences patient outcomes, interdisciplinary communication, and institutional quality assurance.^3–5

Despite the centrality of the endoscopy report, variability in content and format remains widespread. Studies from the UK, Europe, North America, and Africa reveal significant inconsistencies in how procedural completeness, lesion description, and follow-up plans are documented.^5–8 Such variation undermines clinical governance, hampers audit, and complicates inter-center comparison.

In response, professional societies such as the British Society of Gastroenterology (BSG), Joint Advisory Group on Gastrointestinal Endoscopy (JAG), and American Society for Gastrointestinal Endoscopy (ASGE) have issued detailed guidance defining minimum reporting datasets.^9–12 Meanwhile, the advent of electronic endoscopy reporting systems (EERS) has transformed the process, enabling structured data entry, automated quality monitoring, and integration with hospital information systems.^{13, 14}

A high-quality endoscopy report should not only document what was observed and performed but also reflect adherence to procedural standards and support data-driven learning. The use of established classification and grading systems, such as the Los Angeles classification for esophagitis, the Paris classification for superficial neoplasia, and the Forrest classification for bleeding lesions, further enhances objectivity and reproducibility.^15–17

This review outlines the essential components of an optimal endoscopy report, discusses classification systems and digital innovations, and compares reporting frameworks used in the UK with those internationally. It also explores educational and practical considerations for implementation across diverse healthcare settings, including low- and middle-income countries (LMICs).

Core Components of a High-Quality Endoscopy Report

A comprehensive endoscopy report provides a structured, objective, and reproducible record of the entire procedural episode. Although requirements may differ depending on whether the procedure is diagnostic, screening, or therapeutic, three universal phases exist: pre-procedure, intra-procedure, and post-procedure documentation. High-quality reporting systems such as the UK Joint Advisory Group’s standards, ASGE quality indicators, and ESGE performance measures emphasize these domains as the backbone of quality assurance.^9–12 These three phases are summarized in Table 1.

Table 1. Core Components of a High-Quality Endoscopy Report

Pre-Procedure

Accurate pre-procedure documentation ensures patient safety, traceability, and informed consent.

Patient identification and demographics are fundamental. Each report should include the patient’s full name, hospital or national identification number, date of birth, gender, and contact details. Integration with hospital electronic health records enhances continuity and auditability.

The indication for procedure must be clearly stated, specifying whether it is diagnostic, screening, surveillance, or therapeutic. Documenting the clinical indication ensures justification, facilitates outcome comparison, and aligns the report with service commissioning and audit frameworks.

Relevant medical history and comorbidities should be noted, particularly anticoagulant or antiplatelet use, bleeding disorders, previous gastrointestinal surgery, or cardiovascular instability.  These details guide pre-procedure preparation and inform procedural risk stratification.

Informed consent must be documented as being obtained, explicitly confirming that risks, benefits, and alternatives were discussed with the patient or guardian.

Sedation and monitoring details are critical for patient safety and medicolegal compliance. The report should specify the drugs used, dosage, vital sign monitoring, and any adverse events. If an anaesthetist or sedationist is responsible for separate sedation records, the main report should reference their documentation.

Intra-Procedure Details

This section forms the core of the endoscopy report, describing the examination in sufficient detail to allow independent understanding of what was performed and observed. Structured templates or EERS prompts help ensure completeness.

These include the type and extent of examination by defining the procedure performed and its completeness, and the names and roles of the endoscopists, assistants, and trainees.  It is necessary to document both normal and abnormal observations using consistent and objective terminology specifying size, shape, color, surface characteristics, location, and disease extent. To ensure reproducibility and inter-observer consistency, endoscopic findings should be categorized using validated classification and systems.^15-17 These frameworks allow uniform interpretation and facilitate multidisciplinary interaction research, training, and audit. Where available, reporting software should integrate these classifications into drop-down or prompted fields to reduce variability and promote standardized terminology.^10–12

Photographic and fluoroscopic documentation is essential. High-quality imaging supports quality assurance, training, and peer review. Image documentation should include key anatomical landmarks (e.g., esophagogastric junction, ampulla, caecum, ileocecal valve) to confirm completeness, and representative images of the pathological findings to convey accurate morphology and intervention images, before and after therapeutic procedures, confirming technical success. For interventional procedures such as ERCP or EUS-guided drainage, fluoroscopic images should be archived alongside endoscopic images. These should capture key steps such as contrast injection, cannulation, stent placement, or retrieval. All images should be linked to the endoscopy report via the EERS or hospital PACS, ensuring permanent traceability.

Therapeutic interventions should be documented comprehensively, detailing the type of intervention (e.g., biopsy, polypectomy, dilation, hemostasis, stenting), the devices and accessories used (e.g., snare type, balloon size, stent dimensions), the outcome, supported by imaging, any intra-procedural complications (bleeding, perforation, sedation-related reactions), and the management steps taken. Structured digital templates can prompt mandatory fields for intervention and complication documentation, improving audit quality.

Post-Procedure Documentation and Follow-up

The post-procedure section of the report should include a provisional diagnosis, clearly differentiating visual assessment from pending histology. Specimen details of site, number, and lab identification of all biopsies or resected tissue is mandatory. Discharge instructions regarding red flag symptoms and post-procedure diet, activity, and medication should be part of the record as are recommendations for follow-up, which should clearly identify the further management pathway. Each report should be signed and time-stamped electronically, confirming authorship and completion.

Summary

The ideal endoscopy report combines accurate pre-procedure data, standardized intra-procedure documentation, and clear post-procedure instructions. Incorporating validated classification systems and photographic or fluoroscopic evidence enhances reproducibility, supports quality assurance, and facilitates meaningful comparison between operators and centers.

Standardization, Reporting Systems, and International Comparisons

Standardization is the cornerstone of quality assurance in gastrointestinal endoscopy. Without consistent terminology, structure, and reporting metrics, data become difficult to interpret, benchmark, or compare across centers and regions.³ Disparities in report content, particularly in low- and middle-income countries (LMICs), remain a significant barrier to quality improvement and research.^{7, 25, 26}

Historically, endoscopy reports were handwritten, variable in format, and often incomplete.^5–7 With the transition to electronic systems, opportunities have emerged for standardization through structured fields, predefined classifications, and automated data extraction. These systems improve completeness, legibility, and enable the generation of quality metrics such as adenoma detection rate and caecal intubation rate.^{13, 14}

International organizations including the World Endoscopy Organization (WEO), the American Society for Gastrointestinal Endoscopy, and the European Society for Gastrointestinal Endoscopy have therefore promoted structured digital reporting and minimal standard terminology frameworks.^{18, 19}

WEO Minimal Standard Terminology (MST)

The World Endoscopy Organization Minimal Standard Terminology framework provides a unified system to describe endoscopic findings and supports semantic interoperability between reporting platforms.⁴

MST specifies that reports should include the following domains:

1. Anatomical structure and landmarks – defined by organ, site, and modifiers.
2. Endoscopic findings – described using a consistent set of terms, attributes (appearance), and attribute values (e.g., benign, malignant).
3. Reason for endoscopy – categorized by symptoms or diseases and qualified by duration, degree, or surveillance context.
4. Endoscopic diagnosis – visual diagnosis linked to standardized codes such as ICD-10 (e.g., C16 for gastric cancer, K26 for duodenal ulcer).
5. Procedures performed – interventions categorized by intent (diagnostic vs. therapeutic).
6. Adverse events – described by type, site, and severity.
7. Actions and outcomes – intra-procedural and post-procedural management, resolution, or complications.

By integrating MST into endoscopy reporting systems, clinicians can produce structured, analyzable data, improving the comparability of reports across centers.

Structured and Electronic Endoscopy Reporting Systems (EERS)

Electronic endoscopy reporting systems are now standard in most high-income countries. These systems support clinical documentation, image archiving, quality monitoring, and research data capture. Structured reporting templates improve accuracy and enable automated extraction of procedural metadata including completeness, timing metrics, and complication rates.^{13, 14}

Box 1. Essential components of an ideal EERS

Electronic Endoscopy Reporting Systems in High-Income Countries

Table 2 details the core functions and features of endoscopy reporting systems in high-income countries.

Table 2. Examples Electronic Endoscopy Reporting and Data Management Systems Used in High-Income Healthcare Systems


Abbreviations: PACS, Picture Archiving and Communication System; EHR, Electronic Health Record; KPI, Key Performance Indicator; HICCS, Healthcare Information and Clinical Coding Systems.
System capabilities and registry integration depend on institutional configuration. Product information and access details are available from the respective vendors.

The United Kingdom has developed one of the most integrated national frameworks for electronic endoscopy reporting, driven by the Joint Advisory Group on Gastrointestinal Endoscopy (JAG) and the National Endoscopy Database (NED).^{11, 14} The JAG accreditation program, established under the Royal College of Physicians, defines national quality standards for endoscopy training, service delivery, and documentation. A key requirement of JAG accreditation is the use of electronic endoscopy reporting systems capable of exporting structured procedural data to NED.

Launched in 2016, NED functions as a centralized national registry that automatically extracts standardized data from participating endoscopy units. Metrics including caecal intubation rate, polyp detection rate, polyp retrieval rate, complication rates, and procedure completion are captured directly from reporting platforms without additional manual data entry.^{13, 14} This automated data pipeline enables continuous benchmarking of key performance indicators across units and individual endoscopists.

The integration of structured reporting systems with a national quality registry has created a powerful framework for audit, accreditation, and service improvement.^{13, 14} By linking routine clinical documentation with automated data extraction, the UK model allows real-time monitoring of endoscopy quality, facilitates training oversight, and supports national quality improvement initiatives. As a result, the UK system is frequently cited as a model for the development of coordinated endoscopy reporting and quality assurance programs internationally.

International Endoscopy Databases

Table 3. International Comparison of Endoscopy Reporting Systems and Data Infrastructure


Abbreviations: ACG, American College of Gastroenterology; AI, artificial intelligence; ASGE, American Society for Gastrointestinal Endoscopy; GIQuIC, Gastrointestinal Quality Improvement Consortium; JAG, Joint Advisory Group on Gastrointestinal Endoscopy; JED, Japan Endoscopy Database; JGES, Japan Gastroenterological Endoscopy Society; LMIC, low- and middle-income countries; MST, Minimal Standard Terminology; NED, National Endoscopy Database; PACS, Picture Archiving and Communication System. LMIC models represent typical features reported in resource-limited healthcare systems rather than a single unified national framework.

Other high-income regions have also developed national endoscopy registries. These include the GI Quality Improvement Consortium (GIQuIC) in the United States, which collects colonoscopy quality metrics across thousands of endoscopists; the Japan Endoscopy Database (JED), a nationwide database supporting quality assurance and research; and Norwegian Gastronet, which integrates colonoscopy quality data with national registries.^20–22 These systems vary in sophistication, cost, and interoperability, but all facilitate benchmarking, audit, and large-scale clinical research using structured procedural data.

Artificial Intelligence in Endoscopy Reporting

Artificial intelligence (AI) is increasingly influencing both the optical detection of pathology and the documentation of endoscopic findings, creating opportunities to integrate lesion recognition with structured reporting. Computer-vision systems are already capable of assisting with the real-time detection and characterization of gastrointestinal lesions during endoscopy, while natural language processing (NLP) and generative AI tools address the complementary challenge of translating procedural observations into standardized clinical documentation.^23–26

When applied to endoscopy reporting, NLP-based systems can convert spoken procedural narration into structured, guideline-compliant reports in real time. During a procedure, an endoscopist may describe findings verbally, for example, “normal gastric mucosa” or “5 mm sessile polyp in the sigmoid colon,” while AI software trained on large medical datasets transcribes, interprets, and populates predefined reporting fields within the electronic endoscopy reporting system. This approach has the potential to reduce documentation time, enhance completeness and standardization of reports, and enable automated capture of quality indicators such as bowel preparation quality, withdrawal time, and lesion detection metrics.^24–26

Importantly, the greatest potential of AI lies in the integration of optical diagnosis with structured reporting workflows. Computer-vision algorithms capable of detecting or characterizing lesions may automatically generate corresponding report entries, link annotated images to specific anatomical descriptions, and populate classification systems within the report. In this way, AI can bridge the gap between visual interpretation and structured clinical language, ensuring that endoscopic observations are recorded in a reproducible and analyzable format.

Early implementations of AI-assisted documentation are being explored within commercial reporting platforms, demonstrating promising improvements in efficiency, reporting completeness, and data extraction for quality monitoring and research.^{25, 26} However, further validation through multi-center studies is required, particularly to evaluate user acceptance, interoperability with existing reporting systems, and governance of the large datasets required to train and maintain these algorithms.

Reporting in Low- and Middle-Income Countries

In many low- and middle-income countries (LMICs), structured endoscopy reporting systems and national quality registries remain uncommon. Endoscopy reports are frequently handwritten, inconsistently structured, and often limited to the documentation of positive findings rather than a comprehensive procedural record.^7, 27–29 These limitations restrict opportunities for audit, benchmarking, training feedback, and research.

Efforts to implement electronic endoscopy reporting systems (EERS) in regions such as Sub-Saharan Africa and the Pacific Islands have encountered multiple barriers. These include the high cost of commercial software platforms, limited hospital information technology infrastructure, lack of local technical support, and competing healthcare priorities in resource-constrained health systems. In addition, limited clinician engagement and the absence of national quality frameworks or registries can slow adoption of standardized reporting practices.^27–29

Despite these challenges, several locally developed digital reporting solutions have demonstrated feasibility in resource-limited environments. Examples include the University of Cape Town FileMaker® endoscopy reporting system and REDCap-based databases, which provide adaptable and relatively low-cost alternatives to commercial platforms.^{27, 28} These systems typically incorporate structured fields for demographic and procedural data, drop-down menus aligned with Minimal Standard Terminology (MST), integrated image storage, and the ability to generate trainee logbooks and audit datasets. Such platforms illustrate how pragmatic digital solutions can support quality improvement and data capture even in settings with constrained resources.

Successful implementation of structured reporting systems in LMICs depends on several key factors. Institutional leadership and clinician engagement are essential to ensure sustained adoption. Endoscopists and nursing staff require training in structured data entry and standardized terminology, and reporting templates must be adapted to local procedural profiles, language requirements, and information technology capacity. Regular audit of key performance indicators can reinforce adherence to reporting standards and drive continuous quality improvement, while compliance with national data protection regulations remains essential.²⁹ Through these measures, structured reporting can become a realistic and scalable component of endoscopy quality improvement in resource-limited healthcare systems.

Training Implications

Beyond immediate clinical communication, standardized reporting systems provide an objective framework for training and competency assessment. Systems with integrated Direct Observation of Procedural Skills (DOPS) such as Unisoft and EndoSoft, or similar criteria-based assessments modules, enhance formative feedback.³¹ Consistent data capture allows supervisors to review key performance indicators, offer targeted feedback, and monitor progression against defined benchmarks. At a service level, structured datasets enable meaningful benchmarking of performance against peers, institutional targets, and national quality standards. For departments, structured reports improve audit readiness and accreditation compliance.

Conclusion

The transition from handwritten documentation to structured digital reporting represents a major shift in endoscopic practice. Structured reporting improves communication between endoscopists and referring clinicians while supporting continuity of care and evidence-based clinical decision-making.

At a systems level, electronic reporting platforms transform routine clinical activity into high-quality data for audit, research, and performance monitoring. National endoscopy databases are an example that further enable benchmarking and quality assurance across healthcare systems.

Broader global adoption of structured reporting systems adapted to local resource contexts will be essential to improving endoscopy quality, safety, and research capacity. Ultimately, structured reporting is not merely an administrative exercise but a foundation for measurable performance improvement and improved patient outcome and research.

References

1. Facciorusso A, Antonino M, Di Maso M, et al. Advanced endoscopic techniques for gastrointestinal malignancies: current status and future directions. World J Gastroenterol. 2021;27(27):4530-4546. doi:10.3748/wjg.v27.i27.4530
2. Cohen J, Pike IM, Adler DG, et al. Quality indicators for esophagogastroduodenoscopy. Gastrointest Endosc. 2006;63(4 Suppl):S10-S15. doi:10.1016/j.gie.2006.02.019
3. Cotton PB, Eisen GM, Aabakken L, et al. Standardized endoscopic reporting. Gastrointest Endosc. 2008;67(6):805-807. doi:10.1016/j.gie.2008.02.038
4. Aabakken L, Rembacken B, LeMoine O, et al. Minimal standard terminology for gastrointestinal endoscopy – MST 3.0. Endoscopy. 2009;41(8):727-728. doi:10.1055/s-0029-1214949
5. Moorman PW, van Ginneken AM, van der Lei J, et al. The contents of free-text endoscopy reports: an inventory and evaluation by peers. Endoscopy. 1994;26(6):531-538. doi:10.1055/s-2007-1009000
6. de Lange T, Moum BA, Tholfsen JK, et al. Standardization and quality of endoscopy text reports in ulcerative colitis. Endoscopy. 2003;35(10):835-840. doi:10.1055/s-2003-42623
7. Maharaj SP, Noorbhai MA, Madiba TE. Does the reporting of gastro-intestinal endoscopy meet the minimal terminology standard at King Edward VIII Hospital? S Afr J Surg. 2017;55(4):36-42. doi:10.17159/2078-5151/2017/v55n4a2220
8. Umar MT, Noorbhai MA. A comparative analysis of the upper gastrointestinal endoscopic reporting systems within the Durban Metropolitan complex. S Afr J Surg. 2022;60(4):242-247. doi:10.36303/SAJS.00304
9. Joint Advisory Group on Gastrointestinal Endoscopy. JAG Quality Standards Framework for Gastrointestinal Endoscopy Units. London: Royal College of Physicians; 2023.
10. Early DS, Ben-Menachem T, Decker GA, et al. Appropriate use of GI endoscopy. Gastrointest Endosc. 2012;75(6):1127-1131. doi:10.1016/j.gie.2012.02.008
11. Bisschops R, Areia M, Coron E, et al. Performance measures for upper gastrointestinal endoscopy: a European Society of Gastrointestinal Endoscopy quality improvement initiative. Endoscopy. 2016;48(9):843-864. doi:10.1055/s-0042-110763
12. Kaminski MF, Thomas-Gibson S, Bugajski M, et al. Performance measures for lower gastrointestinal endoscopy: a European Society of Gastrointestinal Endoscopy quality improvement initiative. Endoscopy. 2017;49(4):378-397. doi:10.1055/s-0043-103411
13. Ragunath K, Thomas-Gibson S, Haycock A, et al. Quality assurance in gastrointestinal endoscopy: the role of structured reporting systems. Frontline Gastroenterol. 2011;2(2):77-82. doi:10.1136/fg.2010.003319
14. Rees CJ, Thomas-Gibson S, Rutter MD, et al. National Endoscopy Database (NED): a new tool to improve the quality of endoscopy in the UK. Frontline Gastroenterol. 2019;10(4):356-362. doi:10.1136/flgastro-2018-101115
15. Lundell LR, Dent J, Bennett JR, et al. Endoscopic assessment of oesophagitis: validation of the Los Angeles classification. Gut. 1999;45(2):172-180. doi:10.1136/gut.45.2.172
16. Participants in the Paris Workshop. The Paris endoscopic classification of superficial neoplastic lesions. Gastrointest Endosc. 2003;58(Suppl):S3-S43. doi:10.1016/S0016-5107(03)02159-X
17. Forrest JA, Finlayson NDC, Shearman DJC. Endoscopy in gastrointestinal bleeding. Lancet. 1974;2(7877):394-397. doi:10.1016/S0140-6736(74)91770-X
18. World Health Organization. Global Strategy on Digital Health 2020–2025. Geneva: WHO; 2021.
19. World Endoscopy Organization Digital Health Taskforce. Global Strategy for Endoscopy Informatics and Digital Reporting. Munich: WEO; 2024.
20. Lieberman DA, Rex DK, Winawer SJ, et al. The GI Quality Improvement Consortium (GIQuIC): a registry for quality improvement in endoscopy. Gastrointest Endosc. 2014;80(3):437-445. doi:10.1016/j.gie.2014.02.1041
21. Matsuda T, Ono A, Fujii T, et al. Japan Endoscopy Database (JED): a nationwide endoscopy database for quality assurance and research. Dig Endosc. 2020;32(7):1007-1014. doi:10.1111/den.13626
22. Holme Ø, Bretthauer M, Fretheim A, et al. Gastronet: the Norwegian quality assurance program for colonoscopy. Scand J Gastroenterol. 2010;45(7-8):933-939. doi:10.3109/00365521003734129
23. Bisschops R, Antonelli G, East JE, et al. Artificial intelligence in gastrointestinal endoscopy: ESGE position statement. Endoscopy. 2022;54(12):1211-1231. doi:10.1055/a-1905-8885
24. Repici A, Badalamenti M, Maselli R, et al. Efficacy of real-time computer-aided detection of colorectal neoplasia in a randomized trial. Gastroenterology. 2020;159(2):512-520.e7. doi:10.1053/j.gastro.2020.04.062
25. Barua I, Vinsard DG, Jodal HC, et al. Artificial intelligence for polyp detection during colonoscopy: systematic review and meta-analysis. Lancet Gastroenterol Hepatol. 2021;6(6):468-478. doi:10.1016/S2468-1253(21)00033-5
26. Ngu J, Grover SC, Schoeman MN, et al. Artificial intelligence and the future of endoscopy reporting and documentation. Endosc Int Open. 2023;11(2):E247-E255. doi:10.1055/a-1974-5063
27. Thomson SR, Hair C, Oyeleke GK. Outside the training paradigm: challenges and solutions for endoscopy provision in resource-limited settings. Tech Innov Gastrointest Endosc. 2024;26(4):270-282. doi:10.1016/j.tgie.2024.06.004
28. Scriba M, Chinnery G, Thomson SR. Photo- and video-documentation of gastrointestinal endoscopy in under-resourced settings. S Afr J Surg. 2025;63:19-22. doi:10.36303/SAJS.01082
29. Perman ML, Hair C, Malani J, et al. A quantitative analysis of human and material resources for endoscopy services in Pacific Island countries. JGH Open. 2024;8(12):e70068. doi:10.1002/jgh3.70068
30. Clarke DL, Thomson SR. Establishing and integrating datasets beyond instilling a culture of capture. S Afr J Surg. 2022;60(2):74-76. doi:10.17159/2078-5151/SAJS3922
31. Siau K, Hodson J, Valori R, et al. Development of the Direct Observation of Procedural Skills (DOPS) assessment tool for colonoscopy training. Endoscopy. 2014;46(10):893-900. doi:10.1055/s-0034-1377333