SRS195 - Systematic photo-documentation significantly improves lesion detection in oesophagogastroduodenoscopy: results from the gastroprove randomised controlled trial

Abstract Background Missed lesions account for up to 15% of post-OGD cancers. International societies advocate systematic photo-documentation, yet evidence remains low-quality and Irish KPIs require only two images (D2 and retroflexed fundus). Methods We conducted a randomised trial using the Simbionix GI Mentor™ simulator. Sixteen early surgical trainees (<50 OGDs in 15/16) were randomised to either: (i) control—Irish KPI protocol, or (ii) intervention—BSG 8-landmark photo-documentation. Each trainee completed 10 OGDs (5 normal, 5 pathology-positive). Outcomes were lesion detection, multi-lesion performance, procedure time, and adherence to photo-documentation. A baseline questionnaire assessed KPI knowledge and lesion-specific biopsy/reporting protocols. Results Across 80 pathology-positive cases, case-level detection was 80% in intervention versus 52% in control. In multi-lesion scenarios, ‘all-lesions-found’ (ALF) rates were 95% versus 25%, with control misses almost entirely due to non-imaged sites (incisura, antrum). Intervention trainees captured all landmarks in nearly every case; controls averaged 59% coverage. Recognition errors despite full coverage were rare (1 miss in 54 lesions). Procedure times were slightly longer in intervention (4:06 versus 3:26). Questionnaire data confirmed limited baseline knowledge: 31% correctly identified Irish KPIs, 12.5% knew the Prague system, 25% the Seattle protocol, and 6% the Sydney protocol. No control trainee reported prior awareness of the BSG 8-landmark standard, supporting absence of contamination. Conclusions Systematic 8-landmark photo-documentation substantially improves lesion detection, especially in multi-lesion cases, by eliminating coverage-driven misses. Recognition gaps remain a minority issue. These findings provide the first randomised evidence supporting photo-documentation as a quality metric in OGD training and practice.