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Introduction Colonoscopy surveillance in Lynch syndrome (LS) has historically shown substantial heterogeneity in quality and diagnostic outcomes, with performance targets yet to be established. Following the introduction of the LS-colonoscopic surveillance into the Bowel Cancer Screening Programme (BCSP) in July 2023, we aimed to assess colonoscopy quality and diagnostic yield in LS using the National Endoscopy Database (NED), and compare performance between BCSP and non-BCSP providers.Methods We conducted a cross-sectional analysis of LS surveillance colonoscopies extracted from NED between June 2024 to June 2025. Colonoscopy quality indicators, polyp (PDR) and advanced neoplasia (ANDR; defined as polyps ≥10mm or cancer) detection rates were calculated. Quality standards and diagnostic outcomes were compared between BCSP and non-BCSP providers. Multivariable logistic regression was performed to identify factors associated with polyp detection.Results Data was available from 505 UK endoscopy units, of which 288 sites contributed eligible data, yielding 3196 colonoscopies for analysis (58.1% female, median age was 52 [IQR 41-62] years). Most procedures were undertaken in England (90.2%), while 34.1% were within BCSP. Overall quality was high: complete procedures in 3118/3196 (97.6%), adequate bowel preparation in 2505/2814 (89.0%), and adequate tolerance in 2674/2777 (96.3%) cases. BCSP procedures demonstrated superior quality metrics compared to non-BCSP, with higher completion rates (98.5% vs 97.1%, p=0.015), and procedures with adequate bowel preparation (92.7% vs 86.7%, p<0.001) ( table 1).PDR and ANDR were 46.8% and 4.5% respectively; both were higher in BCSP compared to non-BCSP providers (PDR 53.7% vs 43.3%; p<0.001; ANDR 5.7% vs 3.9%, p=0.021). Higher PDR was associated with increasing age (OR range: 3.70-16.30 for ages 35-44 to ≥85 years), male gender (OR 1.42, 95%CI:1.22-1.64), BCSP status (OR 1.45, 95%CI:1.24-1.70) and procedures performed in England (OR 2.00, 95%CI:1.36-3.01).Conclusions Using NED data, we demonstrate that high-quality colonoscopy surveillance is associated with higher neoplasia detection in LS, with BCSP providers demonstrating superior quality indicators and diagnostic yield. This supports the national integration of colonoscopic surveillance to standardise practice and establish quality benchmarks in LS.Abstract O67 Table 1Colonoscopy quality and outcomes by BCSP vs non-BCSPTotal, N (%)BCSP, N (%)Non-BCSP, N (%)P-valueCompletion rate3118/3196 (97.6)1074/1090 (98.5)2044/2106 (97.1)0.015Good bowel preparation2505/2814 (89.0)1007/1086 (92.7)1498/1728 (86.7)<0.001Median (IQR) withdrawal time, minutes11.0 (8.6-14.0)12.0 (9.8-14.4)10.5 (8.0-13.7)<0.001Hyoscine butylbromide1225/3196 (38.3)559/1090 (51.3)666/2106 (31.6)<0.001Polyp detection rate46.8%53.7%43.3%<0.001Advanced neoplasia detection rate4.5%5.7%3.9%0.021