RipotColonoscopy report template
Record bowel preparation, segmental findings, interventions and impressions in a reusable colonoscopy report.
Contributor: Ripot · Starter template
Preview and use →Choose your reporting style
Narrative: flexible free-text sections · Guided: conditional follow-up fields
Gastroenterology · Contributor: Ripot
Upper GI endoscopy report template — guided
A guided OGD / EGD template with optional conditional details. Keep the narrative version for a simpler report.
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UPPER GI ENDOSCOPY — GUIDED Patient: ________________ Identifier: ________________ Date: ________________ PROCEDURE CONTEXT Indication: ________________ Endoscopist and team: ________________ Examination date and time: ________________ Endoscope used: ________________ Consent and safety checks: ________________ Fasting status: ________________ Antithrombotic medication and management: ________________ Premedication, sedation and doses: ________________ QUALITY AND EXTENT Extent reached: ________________ Mucosal visibility / cleanliness and score used: ________________ Limitations / reasons for incomplete examination: ________________ Examination duration (min): ________________ Landmarks and abnormalities photographed: ________________ OESOPHAGUS Findings: ________________ Oesophagitis present?: ________________ Los Angeles grade / description: ________________ Suspected or known Barrett’s?: ________________ Landmarks, Prague C/M, islands and biopsy protocol: ________________ Hiatal hernia present?: ________________ Junction, diaphragmatic pinch and hernia size: ________________ Other lesions: site, size and description: ________________ STOMACH Findings by region: ________________ Gastric ulcer present?: ________________ Ulcer site, size, appearance and bleeding stigmata / Forrest class where applicable: ________________ Atrophy / metaplasia assessment performed?: ________________ Assessment method, distribution and biopsy mapping: ________________ DUODENUM Bulb and distal findings: ________________ Duodenal ulcer present?: ________________ Site, size, appearance and bleeding stigmata / Forrest class where applicable: ________________ SAMPLING AND THERAPY Samples taken?: ________________ Each specimen: site, indication and container identifier; protocol used: ________________ Therapy performed?: ________________ Method, site, devices and immediate result: ________________ CONCLUSION AND FOLLOW-UP Adverse events and tolerance: ________________ Conclusion / impression: ________________ Plan, pathology follow-up and communication: ________________ Clinician: ________________ Signature: ________________
Upper GI Endoscopy — Guided
Patient: ________________
Identifier: ________________
Date: ________________
Procedure context
Indication: ________________
Endoscopist and team: ________________
Examination date and time: ________________
Endoscope used: ________________
Consent and safety checks: ________________
Fasting status: ________________
Antithrombotic medication and management: ________________
Premedication, sedation and doses: ________________
Quality and extent
Extent reached: ________________
Mucosal visibility / cleanliness and score used: ________________
Limitations / reasons for incomplete examination: ________________
Examination duration (min): ________________
Landmarks and abnormalities photographed: ________________
Oesophagus
Findings: ________________
Oesophagitis present?: ________________
Los Angeles grade / description: ________________
Suspected or known Barrett’s?: ________________
Landmarks, Prague C/M, islands and biopsy protocol: ________________
Hiatal hernia present?: ________________
Junction, diaphragmatic pinch and hernia size: ________________
Other lesions: site, size and description: ________________
Stomach
Findings by region: ________________
Gastric ulcer present?: ________________
Ulcer site, size, appearance and bleeding stigmata / Forrest class where applicable: ________________
Atrophy / metaplasia assessment performed?: ________________
Assessment method, distribution and biopsy mapping: ________________
Duodenum
Bulb and distal findings: ________________
Duodenal ulcer present?: ________________
Site, size, appearance and bleeding stigmata / Forrest class where applicable: ________________
Sampling and therapy
Samples taken?: ________________
Each specimen: site, indication and container identifier; protocol used: ________________
Therapy performed?: ________________
Method, site, devices and immediate result: ________________
Conclusion and follow-up
Adverse events and tolerance: ________________
Conclusion / impression: ________________
Plan, pathology follow-up and communication: ________________
Clinician: ________________
Fictional example text
A demonstration of the layout using invented observations. It is not a patient report, normal-report default or clinical reference.
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UPPER GI ENDOSCOPY — GUIDED FICTIONAL EXAMPLE - NOT FOR CLINICAL USE Illustrative content only; not a clinical reference. Patient: FICTIONAL PATIENT Identifier: DEMO-001 Date: 01 January 2026 PROCEDURE CONTEXT Indication: Persistent dyspepsia (fictional). Endoscopist and team: Dr Demo A (fictional). Examination date and time: 01 January 2026 09:00 (fictional). Endoscope used: Demonstration scope identifier. Consent and safety checks: Documented in the fictional procedure record. Fasting status: Status checked before the fictional examination. Antithrombotic medication and management: Medication history reviewed; document individual management. Premedication, sedation and doses: None administered in this fictional example. QUALITY AND EXTENT Extent reached: Second part of duodenum. Mucosal visibility / cleanliness and score used: Adequate views; record the named score if used. Limitations / reasons for incomplete examination: No limitation recorded in this fictional example. Examination duration (min): 8 Landmarks and abnormalities photographed: Oesophageal landmarks, stomach and duodenum documented. OESOPHAGUS Findings: No focal abnormality described in this fictional example. Oesophagitis present?: No Suspected or known Barrett’s?: No Hiatal hernia present?: No Other lesions: site, size and description: None described. STOMACH Findings by region: No focal lesion described in this fictional example. Gastric ulcer present?: No Atrophy / metaplasia assessment performed?: No DUODENUM Bulb and distal findings: No focal lesion described in this fictional example. Duodenal ulcer present?: No SAMPLING AND THERAPY Samples taken?: No Therapy performed?: No CONCLUSION AND FOLLOW-UP Adverse events and tolerance: No immediate adverse event recorded in this fictional example. Conclusion / impression: Findings documented for clinician interpretation. Plan, pathology follow-up and communication: Individual advice and follow-up to be completed by the endoscopist. Clinician: DEMONSTRATION ONLY - NOT SIGNED FICTIONAL EXAMPLE - NOT FOR CLINICAL USE
Upper GI Endoscopy — Guided
FICTIONAL EXAMPLE - NOT FOR CLINICAL USE
Illustrative content only; not a clinical reference.
Patient: FICTIONAL PATIENT
Identifier: DEMO-001
Date: 01 January 2026
Procedure context
Indication: Persistent dyspepsia (fictional).
Endoscopist and team: Dr Demo A (fictional).
Examination date and time: 01 January 2026 09:00 (fictional).
Endoscope used: Demonstration scope identifier.
Consent and safety checks: Documented in the fictional procedure record.
Fasting status: Status checked before the fictional examination.
Antithrombotic medication and management: Medication history reviewed; document individual management.
Premedication, sedation and doses: None administered in this fictional example.
Quality and extent
Extent reached: Second part of duodenum.
Mucosal visibility / cleanliness and score used: Adequate views; record the named score if used.
Limitations / reasons for incomplete examination: No limitation recorded in this fictional example.
Examination duration (min): 8
Landmarks and abnormalities photographed: Oesophageal landmarks, stomach and duodenum documented.
Oesophagus
Findings: No focal abnormality described in this fictional example.
Oesophagitis present?: No
Suspected or known Barrett’s?: No
Hiatal hernia present?: No
Other lesions: site, size and description: None described.
Stomach
Findings by region: No focal lesion described in this fictional example.
Gastric ulcer present?: No
Atrophy / metaplasia assessment performed?: No
Duodenum
Bulb and distal findings: No focal lesion described in this fictional example.
Duodenal ulcer present?: No
Sampling and therapy
Samples taken?: No
Therapy performed?: No
Conclusion and follow-up
Adverse events and tolerance: No immediate adverse event recorded in this fictional example.
Conclusion / impression: Findings documented for clinician interpretation.
Plan, pathology follow-up and communication: Individual advice and follow-up to be completed by the endoscopist.
Clinician: DEMONSTRATION ONLY - NOT SIGNED
View all included fields
- Procedure context
- Indication
- Endoscopist and team
- Examination date and time
- Endoscope used
- Consent and safety checks
- Fasting status
- Antithrombotic medication and management
- Premedication, sedation and doses
- Quality and extent
- Extent reached
- Mucosal visibility / cleanliness and score used
- Limitations / reasons for incomplete examination
- Examination duration
- Landmarks and abnormalities photographed
- Oesophagus
- Findings
- Oesophagitis present?
- Los Angeles grade / description
- Suspected or known Barrett’s?
- Landmarks, Prague C/M, islands and biopsy protocol
- Hiatal hernia present?
- Junction, diaphragmatic pinch and hernia size
- Other lesions: site, size and description
- Stomach
- Findings by region
- Gastric ulcer present?
- Ulcer site, size, appearance and bleeding stigmata / Forrest class where applicable
- Atrophy / metaplasia assessment performed?
- Assessment method, distribution and biopsy mapping
- Duodenum
- Bulb and distal findings
- Duodenal ulcer present?
- Site, size, appearance and bleeding stigmata / Forrest class where applicable
- Sampling and therapy
- Samples taken?
- Each specimen: site, indication and container identifier; protocol used
- Therapy performed?
- Method, site, devices and immediate result
- Conclusion and follow-up
- Adverse events and tolerance
- Conclusion / impression
- Plan, pathology follow-up and communication
Using this reporting structure
Choose the detail you need
Selecting a finding reveals its related prompts. Unselected findings are not assumed normal. Record examination extent and limitations, and review the rendered report before signing.
Link samples to findings
Identify each sample by site and container. Document any intervention and immediate outcome, and state who will review pathology results. The 2025 ESGE STAR project informed this documentation structure; this is not an independently validated clinical protocol.
Documentation help, not clinical guidance. Use current specialty guidance and local protocols. Review every report before signing or sharing.
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