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Introduction Eosinophilic oesophagitis (EoE) is a cause of dysphagia with increasing prevalence in children and adults. The British Society of Gastroenterology (BSG) and British Society of Paediatric Gastroenterology, Hepatology and Nutrition (BSPGHAN) created joint consensus guidelines on the diagnosis and management of EoE in 2022. These recommend that all adults undergoing gastroscopy with symptoms of dysphagia or food bolus obstruction with a normal looking oesophagus, or with endoscopic signs of EoE should have oesophageal biopsies taken. It is recommended that at least six biopsies should be taken from different oesophageal sites. The aim of this quality improvement project was to increase awareness and compliance of current guidelines and improve local endoscopy practice.Method A quality improvement project was conducted using the Plan-Do-Study-Act (PDSA) methodology at a single tertiary centre. Baseline data prior to guideline publication was collected retrospectively over a four-month period from all adult patients referred for a gastroscopy with ‘dysphagia’ as the indication. Patients were excluded if another cause of dysphagia was found during endoscopy. The primary outcome measure was whether biopsies were taken and if these were in line with guideline-recommended biopsy practice. Following baseline assessment prior to guideline implementation a further data collection was undertaken. Following a second cycle, a further intervention of clinician education was undertaken and a third cycle completed.Results In Cycle 1 (pre-guideline implementation), biopsies were taken in 24.42% of OGDs with normal oesophageal appearances. Of these, 32.43% met guideline standards with six biopsies taken, resulting in a 1% diagnosis rate of EoE. In Cycle 2 (post-guideline introduction), the proportion of procedures in which biopsies were taken remained similar (24.65%). However, compliance with recommended number of biopsies improved, with 38.89% of cases having six biopsies. Diagnosis rate was 1% in Cycle 2. In Cycle 3, (post-clinician education), the proportion of OGDs in which biopsies were taken increased to 41.41%. Despite this, the compliance with recommended number of biopsies decreased to 21.21%. This cycle yielded a 2.08% diagnosis rate.Conclusions This quality improvement project demonstrated that targeted clinician education on new guidelines can meaningfully influence endoscopy practice. While education was associated with an increased proportion of patients having biopsies taken, compliance with recommended number of biopsies remained suboptimal across cycles. Improved compliance may increase diagnostic accuracy and reduce the likelihood of missed diagnoses. Further cycles are planned, with poster reminders already introduced to prompt endoscopy staff and to reinforce ongoing education and practice improvement.