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Introduction The Baveno VII consensus reshaped the assessment and management of clinically significant portal hypertension (CSPH) in compensated advanced chronic liver disease.It’s application reduces referrals for gastroscopy (OGD), with environmental and health resource utilisation implications. Despite this, practice across centres varies. We audited adherence to Baveno VII guidance in our regional tertiary unit, serving a population of approximately half a million people.Methods All OGDs performed for variceal surveillance and screening at Bristol Royal Infirmary from 23/02/2022-30/09/2025 were audited, along with patient level data using electronic healthcare records.Exclusion criteria included variceal screening in: patients under 18 years of age, pregnancy, clinical trial participation, involvement in a banding programme, prior transjugular intrahepatic portosystemic shunt, liver transplant patients, hepatocellular carcinoma, Fontan circulation, non-cirrhotic portal hypertension.Estimates for carbon dioxide (CO2) emission and water usage in OGDs were based on published data. Cost estimates were based on existing UK National Health Service tariffs.Results 447 variceal screening OGDs were identified within the study period. 208 were excluded. 239 procedures were interrogated; 57/239 (23.8%) were clinically indicated, most commonly due to new decompensating events. 182 OGDs were performed for variceal screening without a specific indication. 87/182 (47.8%) patients had a screening OGD without up-to-date transient elastography and/or platelet count. 55 (30.2%) should have had non-selective beta blockers (NSBBs) initiated without an OGD, 4 (7.27%) of whom only received NSBBs prior to OGD. 40/182 (22.0%) had a screening OGD despite not meeting any Baveno VII criteria for CSPH. Notably, 1 patient did not meet the criteria but required variceal banding.The 182 non-indicated OGDs were associated with an estimated 1,604.8L of water use, NHS costs of approximately £153,230, and 5,168.8kg of CO2 emissions, equivalent to over 37,000 km of petrol vehicle travel.Conclusions A high number of potentially unnecessary variceal screening OGDs were identified within our centre. Improved adherence to Baveno VII guidance could deliver substantial environmental and cost savings. Understanding healthcare providers’ barriers to adherence is essential to reduce waste and optimise care.