Ripot
Endoscopy · Contributor: Ripot

Upper GI endoscopy report template

An OGD / EGD reporting structure covering indication, sedation, anatomical findings, interventions and impression.

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Structure preview · No patient data

Upper GI Endoscopy

Patient: ____________________
Identifier: __________________
Date: ______________________

Report sections

  1. Indication
  2. Premedication / Sedation
  3. Findings
  4. Biopsy taken
  5. Biopsy site
  6. Number of biopsies
  7. Assessment / Impression
  8. Recommendation

Clinician: __________________
Signature: _________________

Included fields

Copy the blank report outline

A reusable starting point, without prefilled normal findings. Complete and check each section for the examination performed.

Patient name: [enter]
Patient identifier: [enter]
Report date: [enter]
Indication: [enter]
Premedication / Sedation: [enter]
Findings: [enter]
  Oesophagus: [enter]
    Upper oesophagus: [enter]
    Middle oesophagus: [enter]
    Lower oesophagus: [enter]
    Gastro-oesophageal junction: [enter]
  Stomach: [enter]
    Cardia: [enter]
    Fundus: [enter]
    Body: [enter]
    Antrum: [enter]
    Pylorus: [enter]
  Duodenum: [enter]
    Bulb: [enter]
    Second part: [enter]
Biopsy taken: [enter]
Biopsy site: [enter]
Number of biopsies: [enter]
Assessment / Impression: [enter]
Recommendation: [enter]
Impression: [enter]
Signed by: [enter]

Illustrative report layout (fictional)

Not a patient report, verified normal findings, or a PDF exported by Ripot. This is a text-only layout example; always document actual observations.

SAMPLE ONLY · NOT FOR CLINICAL USE

Demonstration OGD report

Indication: Dyspepsia (fictional)
Oesophagus: Example description — verify observed mucosa
Stomach: Example description — verify each region
Duodenum: Example description — verify examined extent
Specimens: Record actual sites and number
Impression: Example for layout demonstration, not a clinical result

Clinician: [example] · Signature: [not signed]

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