Introduction: This study aimed to conduct a clinical audit of adverse events arising from gastrointestinal endoscopy, utilising the AGREE classification for adverse events and establishing its correlation with the ASGE classification. This study further integrated the economic repercussions of adverse events into the AGREE classification through the AIG-AGREE modification. Methods: A prospective observational study was conducted at the Asian Institute of Gastroenterology, Hyderabad, India, from July 1, 2021, to December 31, 2021. The study included all patients who underwent diagnostic or therapeutic endoscopic procedures. Adverse events were categorised using the American Society of Gastrointestinal Endoscopy (ASGE) and AGREE classifications. A quality indicator questionnaire containing 15 questions was graded based on the latest ASGE and ESGE guidelines. The grading scale ranged from 1-3 (poor), 4-6 (average), 7-9 (excellent), to 10 (outstanding). Additionally, the AIG-AGREE modification divided the economic impact into five scales (α, β, γ, δ, and ε) based on multiples of the baseline amount. (ClinicalTrials.gov Identifier: NCT05228353) Results: Over the six-month study period, a total of 42,471 endoscopic procedures were performed, identifying 220 adverse events. Analysis revealed a significant positive correlation (Pearson correlation coefficient = 0.79; P < 0.001) between the grades of adverse events in the AGREE and ASGE classifications. The median score for all quality indicators was 8, indicating excellent services based on feedback from 13,042 surveyed patients. Notably, patients with more severe adverse events (AGREE III-V) exhibited higher economic impact categories (β, γ, δ, ε) compared to those with less severe adverse events (AGREE I-II). Conclusion: The AIG-AGREE modification stands as a pioneering effort that highlights the importance of considering economic factors in the evaluation of adverse events in gastrointestinal endoscopy.