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Introduction Repeat endoscopy places a significant burden on services that are already under considerable pressure. While some repeat procedures are unavoidable, others could be prevented. By examining the reasons for repeat procedures across a large regional cohort, we can identify trends that help us target improvement efforts and ultimately reduce the overall demand on endoscopy services.Methods We carried out a retrospective review of data from 1 July 2023 to 30 June 2024 across five hospitals in Merseyside that participated in our regional audit. We examined all repeat endoscopies performed within three months of the index procedure (excluding those involving different modalities) and recorded the indications for these repeats. Reasons for repeat endoscopy were categorised into predefined ‘avoidable’ and ‘unavoidable’ groups.Results For lower GI endoscopy, we reviewed 802 cases. Of these, 68.1% of repeat endoscopies were considered avoidable. The most common reason was inadequate bowel preparation, accounting for 50.8% of all repeat lower GI endoscopies, followed by incomplete procedures due to technique, sedation or scope handling at 6.5%. Among the unavoidable indications, surveillance procedures such as those for IBD or post-polypectomy follow-up were the most frequent at 9.0%, while 12.5% were repeated for therapeutic purposes such as polypectomy.We also reviewed 1,699 cases of repeat upper GI endoscopies. Only 19.9% of these were deemed avoidable, with the largest group attributed to food residue or obscured views (14.2%). Most unavoidable repeat upper GI procedures (51.2%) were performed for appropriate surveillance indications, such as gastric ulcer follow-up. A further 10.2% of rescopes were required due to the need for deeper sedation and 9.3% were repeated to perform therapeutic interventions, including variceal band ligation or dilatation.Conclusions We found that a large proportion of repeat lower GI endoscopies were categorised as avoidable, this was less common in upper GI procedures. Suboptimal preparation was the most frequent avoidable cause for both upper and lower GI procedures, highlighting a clear target for quality improvement and patient experience. The most common indications for unavoidable repeat endoscopy were surveillance procedures; further assessment of whether surveillance endoscopies align with national guidelines could reveal additional areas for improvement. In upper GI endoscopy, a subset of repeat procedures was due to needing deeper sedation or therapeutic interventions. Optimising patient booking onto appropriate lists could reduce these occurrences. The main limitation of this audit is the potential subjectivity in assigning reasons for repeat procedures, as reported by individual trusts. Nonetheless, this audit identifies important trends that can guide further efforts to reduce the number of avoidable repeat endoscopies.