British Society Of Gastroenterology Guidelines Research Articles

DOP02 Developing explicit thresholds for outcomes to inform (GRADE) Evidence to Decision frameworks for Inflammatory Bowel Disease guidelines

Abstract Background Evidence to decision (EtD) frameworks are a key recent development in Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) methodology. They aim to ensure that decisions about healthcare interventions are based on a thorough, transparent and unbiased assessment of the available evidence. Core to this is to agree the importance of outcomes to be used, the specific measures for each outcome that have the most consensus and finally to develop explicit thresholds for interpretation of effect sizes of outcomes to inform (GRADE) evidence to decision frameworks. This ensures decisions are made in an unbiased fashion and allows stakeholders to focus on discussions based on their significant experience and expertise, rather than interpretation of evidence. Therefore, our study aims to develop these thresholds for the EtD framework to establish their use in several key IBD guidelines. Methods This online survey using Survey Monkey was conducted by inviting experts and stakeholders from the United Kingdom and British Society of Gastroenterology. Each expert was asked to select important clinically relevant outcomes and were asked about what magnitude of the effect they consider large, moderate, small, or trivial for each of the clinical, endoscopic, radiological, biochemical, histological outcomes and adverse events. Questions were framed as neutral statements without introducing a specific direction. Response options included sliding bars going from 1 to 100% for the desirable magnitude of effect for each outcome (Figure 1). The mean average of responses of experts were calculated. Results A total of 89 clinical experts/stakeholders participated in this online survey. Clinical remission, clinical response, endoscopic remission, withdrawal due to adverse events, and serious adverse events were considered critical outcomes. Trivial to small, small to moderate and moderate to large thresholds were as follows - clinical remission (10%, 20% and 31%), clinical response (13 %, 24% and 36%), endoscopic remission (9%, 17% and 28%), withdrawal due to AE (7 %, 14% and 23%), serious AE (6%, 11% and 17%) (Table 1). Conclusion This is the first study to develop thresholds for outcomes in IBD which can be used in EtD for the development of IBD guidelines. These thresholds have been used in the development of upcoming British Society of Gastroenterology guidelines for the management of IBD.

Dedicated endoscopy for Barrett’s esophagus randomized blinded pilot study: comparing a dedicated Barrett’s surveillance service with standard care

Background and aimsBarrett’s esophagus endoscopic surveillance is prone to poor guideline adherence. This study was undertaken to obtain pilot data comparing standard care with a dedicated Barrett’s endoscopy service. MethodsAdults with non-dysplastic Barrett’s esophagus at two sites in the Northwest of England were randomized to a dedicated service versus a non-dedicated service for their routine surveillance. On the dedicated arm 64% were male, 72% non-dedicated with median ages of 66years and 63years and mean Prague C length of 2cms and 3cms respectively. The dedicated service was performed by endoscopists trained in Barrett’s assessment on specific sessions. Data were obtained on dysplasia detection and adherence to British Society of gastroenterology guidelines. ResultsOf 112 recruited cases (80% recruitment rate), 92 had endoscopy of which 39 were correctly performed on the dedicated arm and 25 on the non-dedicated arm. In the dedicated arm 5/39(13%) cases of dysplasia were found, and2/25 (8%) cases in the non-dedicated arm. Guideline adherence was better in the dedicated arm, particularly Prague classification documentation (37/39, 95%, versus 20/25, 80%) and Seattle protocol adherence (34/39, 87% versus 15/25, 60%). Post-hoc analysis with χ2 showed improved Seattle protocol adherence (34/37 dedicated vs 15/24 non dedicated, p=0.005), visible lesion documentation (37/38 dedicated vs 12/23 non-dedicated, p=<0.001), and use of targeted biopsies (25/39 dedicated vs 3/25 non-dedicated (p=<0.001). ConclusionsThis study is the first pilot randomized trial of dedicated services versus non-dedicated services for Barrett’s surveillance. It shows the study design is feasible and informs a future powered multicenter study.

Recent advances in the treatment of functional dyspepsia and irritable bowel syndrome

Introduction and purpose: While irritable bowel syndrome (IBS) and functional dyspepsia (FD) are common problems in everyday clinical practice, their treatment often remains inefficient. The aim of our work is to present the newest discoveries and research conducted in the topic, while putting special accents on methods available in Poland. We decided to refer to British Society of Gastroenterology guidelines of treatment of IBS and FD as commonly accepted treatment standards in Europe. Description of the state of knowledge: Number of patients suffering from IBS and FD remains high. According to current research, there are some new therapeutical options in IBS: fecal microbiota transplant, spinal catepsin S, olorinab and tenapanor. Methods already being in use in other applications such as vitamin D supplementation, losartan and fecal microbiota transplant are also being investigated. Fecal microbiota transplant seems the most promising one. There are no new treatment options in FD, however there are new research on already used rifaximin and prokinetics, which show their efficacy. Intensive research is being conducted on the use of herbal medicines in treatment of FD. Even though some papers prove the effectiveness of acupuncture we have decided to omit this topic due to its controversial nature.   Conclusions: Treatment of IBS and FD remains difficult, there are few advances in that area. Unconventional methods such as herbal medicine and fecal microbiota transplant seem to be gaining in importance.

Dedicated service for Barrett’s oesophagus surveillance endoscopy yields higher dysplasia detection and guideline adherence in a non-tertiary setting in the UK: a 5-year comparative cohort study

ObjectiveBarrett’s oesophagus (BO) endoscopic surveillance is performed to varying quality, dedicated services may offer improved outcomes. This study compares a dedicated BO service to standard care, specifically dysplasia detection rate...

Editorial introductions.

Current Opinion in Gastroenterology was launched in 1985. It is one of a successful series of review journals whose unique format is designed to provide a systematic and critical assessment of the literature as presented in the many primary journals. The field of gastroenterology is divided into 12 sections that are reviewed once a year. Each section is assigned a Section Editor, a leading authority in the area, who identifies the most important topics at that time. Here we are pleased to introduce the Section Editors for this issue. SECTION EDITORS Don RockeyDon RockeyDr Don Rockey completed internship, residency, chief residency, and fellowship at the University of California, San Francisco, USA. He is currently Director of the Medical University of South Carolina Digestive Disease Center. He has active, basic and clinical research interests in liver disease. His basic research focuses on understanding the molecular basis of fibrosis and portal hypertension. His laboratory initially demonstrated that a key player, the hepatic stellate cell, exhibits a contractile phenotype and transforms to a myofibroblast. Further, following liver injury, stellate cells not only produce increases quantities of extracellular matrix, but also exhibit exaggerated contractility, constrict liver sinusoids, and contribute to increased intrahepatic vascular resistance typical of portal hypertension. Dr Rockey also has an active clinical research program, focused on clinical management problems in gastrointestinal bleeding, drug induced liver injury, and chronic liver diseases including complications of portal hypertension. Dr Rockey and colleagues have published some 300 peer reviewed original scientific papers and over 100 editorials, reviews, and book chapters. He has served as a mentor for over 125 trainees, including students, residents, fellows, and junior faculty members - the vast majority of whom have pursued or who are pursuing careers in academic medicine. He has had a number of editorial responsibilities, including as Associate Editor for Hepatology, Liver International, and the Journal of Investigative Medicine, and has served on multiple NIH and other study sections, and editorial boards. Reena SidhuReena SidhuProf. Reena Sidhu is a Consultant Gastroenterologist and an Honorary Professor with the University of Sheffield, UK. Her main area of interest is the small bowel and she completed a clinical MD with the University of Sheffield on modern modalities of investigation of the small bowel. She is currently the lead for the tertiary double balloon enteroscopy service at Sheffield Teaching Hospitals and co-runs one of the biggest Capsule Endoscopy services in Europe. Both of these services are established regional services which have won national awards. She runs an international capsule endoscopy course for doctors. She carries out clinical research related to the small bowel and continues to publish actively in this field with > 100 Medline publications to date. She has research fellows under her banner. She is regularly invited to speak at national and international meetings. She has led an ESGE curriculum for Capsule and Device Assisted Enteroscopy. She has also been involved in formalizing accreditation for capsule endoscopy and enteroscopy in the UK. She was awarded the Hopkins Endoscopy Prize by the BSG in 2012, the first female gastroenterologist to have ever won this. She is the first author of the British Society of Gastroenterology guidelines on capsule endoscopy and enteroscopy, published in 2008 and is also a co-author on the 2023 ESGE guidelines on small bowel endoscopy. She also led a UK wide Position Statement on the use of Propofol sedation for complex endoscopy in the UK and a co-author on the BSG Iron Deficiency Anaemia Guidelines 2021. She is the current BSG Education Chair and has curated an entirely new platform for e-learning for gastroenterology in the UK during her tenure as the BSG Web Editor.

SP3.1.10 The use of predictive severity scoring for lower gastrointestinal bleeding in a tertiary colorectal unit

Abstract Introduction Lower GI bleeding (LGIB) has an estimated 1-year prevalence of 10% in the UK, accounting for 3% of emergency surgical referrals. The British Society of Gastroenterology (BSG) recommend risk scoring for LGIB to categorise severity and plan management. Experience in a tertiary colorectal centre suggests this potentially overestimates the severity of bleeding and the requirement for inpatient admission. Method Data was retrospectively collected for all patients referred from primary care or emergency departments with LGIB from 01/05/20–01/04/21. Demographics and an Oakland score (OS), recommended in BSG guidelines, were collected. OS &amp;gt;8 suggests admission. Outcomes following referral, including admission, discharge, blood transfusion and radiological/surgical intervention, were assessed. Results 294 patients were assessed. 176 patients (59.9%) were admitted for further management. The median OS for admitted patients was 12 (IQR 9–17). 30 patients (10.2%) required blood transfusion, 3 required radiological/surgical intervention (1%). 118 (40.1%) patients were discharged. The median OS was 10 (IQR 8–12). 80 patients discharged had a score &amp;gt;8, recommending admission; 4 patients required readmission (5.0%), however, none required intervention. 38 patients were discharged with a score ≤8; again, 4 patients (10.5%) required readmission for LGIB, with none requiring intervention. Fisher's exact test showed no statistical significance between OS and readmission (p=0.22). Conclusion Risk assessment scoring recommended admission for a large cohort of patients safely discharged after initial assessment in our centre. A small number required readmission, however, none suffered significant adverse outcomes. Further investigation should assess whether such scoring systems are too cautious for use in specialist colorectal centres.

TU1.4 Adequacy of endoscopic photo-documentation in an OGD: Closing the loop!

Abstract Aims The technical competence of Oesophago-Gastro-Duodenoscopy (OGD) is rapidly acquired but to support the practice of complete examination, the British Society of Gastroenterology (BSG) and Association of Gastrointestinal Surgeons of Great Britain and Ireland (AUGIS) recommend documentation of 8 anatomical stations. Photo-documentation ensures a complete examination, gives an opportunity to inspect area of interest and serves as legal record of an adequate procedure. Our Aim was to assess the hospitals practice of photo-documentation against the BSG and AUGIS guidelines and to improve practice by conducting teaching sessions and designing a poster for the endoscopy rooms. Methods 1st Cycle: 100 OGD reports were randomly selected from 1/1/2018 to 31/3/2020 and were reviewed on the hospitals electronic reporting system (Endorad). Data on patients demographics, speciality of Endoscopist and the documented stations was collected. Data was presented at the departments meeting and a simultaneous teaching session was conducted. A poster was designed and displayed outside the endoscopy rooms. 2nd Cycle: 100 OGD reports were selected from 1st January to 30th June 2021 and re audited. Results 66% of the OGD reports had photo-documentation of all 8 stations and 81% of reports had 7 documented stations which was a significant improvement in practice as the first audit had no report with photographic documentation of all the stations. The highest number of stations documented in the first audit were 5 and that too in only 40% of the cases. Conclusions The audit cycle showed significant improvement in photo-documentation of all the stations, highlighting the benefit of the process.

Implementation of optical diagnosis with a “resect and discard” strategy in clinical practice: DISCARD3 study

Optical diagnosis (OD) of polyps can be performed with advanced endoscopic imaging. For high-confidence diagnoses, a "resect and discard" strategy could offer significant histopathology time and cost savings. The implementation threshold is a≥90% OD-histology surveillance interval concordance. Here we assessed the OD learning curve and feasibility of a resect and discard strategy for≤5-mm and<10-mm polyps in a bowel cancer screening setting. In this prospective feasibility study, 8 bowel cancer screening endoscopists completed a validated OD training module and performed procedures. All<10-mm consecutive polyps had white-light and narrow-band images taken and were given high- or low-confidence diagnoses until 120 high-confidence≤5-mm polyp diagnoses had been performed. All polyps had standard histology. High-confidence OD errors underwent root-cause analysis. Histology and OD-derived surveillance intervals were calculated. Of 565 invited patients, 525 patients were included. A total of 1560<10-mm polyps underwent OD and were resected and retrieved (1329≤5mm and 231 6-9mm). There were no<10-mm polyp cancers. High-confidence OD was accurate in 81.5% of≤5-mm and 92.8% of 6-9-mm polyps. Sensitivity for OD of a≤5-mm adenoma was 93.0% with a positive predictive value of 90.8%. OD-histology surveillance interval concordance for≤5-mm OD was 91.3% (209/229) for U.S. Multi-Society Task Force, 98.3% (225/229) for European Society of Gastrointestinal Endoscopy, and 98.7% (226/229) for British Society of Gastroenterology guidelines, respectively. A resect and discard strategy for high-confidence≤5-mm polyp OD in a group of bowel cancer screening colonoscopists is feasible and safe, with performance exceeding the 90% surveillance interval concordance required for implementation in clinical practice. (Clinical trial registration number: NCT04710693.).

309 Adherence to BSG Guidelines Regarding Definitive Management of Gallstone Pancreatitis at Epsom and St Helier Hospitals

Abstract Aim To audit the definitive management of gallstone pancreatitis in terms of cholecystectomy and ERCP at St Helier Hospital and comparing with the standard British Society of Gastroenterology guidelines (BSG), between Nov 2019 to Nov 2020. Method It's a local audit and data was collected retrospectively. A total of 72 patients with gallstone pancreatitis in a year were identified. Results The total number of patients managed according to guidelines, i.e., within two weeks of diagnosis (Lap chole + ERCP) were 20 patients (27.78%). Timing of ERCP, when needed was adequate (7 out of 9). No intervention has been done yet in 43% of the patients. Declined/ unsuitable for any intervention/surgery (35%), Patient transferred to another trust (16%) and death of the patients are the most common causes of the no-intervention. Conclusions Gallstone pancreatitis patients will come under P2 as a priority which means these patients will get priority over biliary colic/symptomatic gallstones for the early date of surgery. Recommendations have been submitted for another theatre slot for emergency laparoscopic cholecystectomy.

P-BN57 The impact of COVID-19 pandemic on management of patients with acute uncomplicated gallstone pancreatitis

BackgroundCurrent British Society of Gastroenterology guidelines suggest that patients presenting with acute uncomplicated gallstone pancreatitis should ideally undergo laparoscopic cholecystectomy during the index admission or within two weeks of discharge from hospital. COVID-19 pandemic had a significant impact on the delivery of elective and semi-elective surgical services in the National Health Service (NHS) due to limited availability of theatre resources. The aim of this study was to evaluate compliance with the BSG guidelines during the COVID-19 pandemic and the impact of the newly introduced `Hot’ lists at our centre.MethodsPatients admitted with first presentation of acute uncomplicated gallstone pancreatitis between 01/03/19 and 25/02/21 were identified from electronic records. Pregnancy and lack of fitness for surgery were the exclusion criteria. Patients admitted between 01/03/19 and 31/12/19 were defined as the pre-COVID cohort. Those admitted between 23/03/20 and 25/02/21 formed the COVID cohort and had access to urgent gallbladder lists. Baseline characteristics, choice of imaging and timing of laparoscopic cholecystectomy were compared between the two cohorts using STATA software. Continuous variables were compared with Mann Whitney test and categorical variables were compared with Pearson’s Chi-Squared test.Results53 patients were identified in the total cohort with 27 being hospitalised prior to COVID-19 outbreak and 26 presenting after the national lockdown. Baseline characteristics did not differ significantly between the two groups.  Biliary imaging pathway was similar between the two cohorts and importantly there appeared to be no delays in radiological tests during the lockdown. The overall proportion of patients undergoing cholecystectomies remained similar between the two groups and percentage of patients having it during the index admission did not differ. However, patients undergoing cholecystectomy post discharge had a significantly shorter waiting time during the lockdown (p = 0.021) as they were prioritised on the ‘Hot lists’ created to meet the demands of reduced planned theatre service. ConclusionsDuring the 2020 COVID pandemic our service for patients with uncomplicated gallstone pancreatitis continued to be delivered. Despite clinical pressures, there were no notable delays in biliary imaging. The introduction of the urgent operating lists has significantly reduced the time to laparoscopic cholecystectomy following admission for patients with acute uncomplicated gallstone pancreatitis during this period.

Cost Analysis of Diagnostic Endoscopic Procedures for Chronic Diarrhoea.

Chronic diarrhoea is a common condition that affects up to 5% of the population which heavily affects the quality of life for the patient. The British Society of Gastroenterology guidelines recommend that for those who suffer with chronic diarrhoea, a colonoscopy with a biopsy is recommended to exclude microscopic colitis. This retrospective audit included 147 patients who received endoscopic procedures in 2019 at Walsall Manor Hospital for chronic diarrhoea. The results show that a total of £56,797 was incurred through endoscopic and histological investigation with four patients (2.6%) diagnosed with microscopic colitis. Given the lack of diagnostic yield, there is room for advancement in the current guidelines for managing persistent diarrhoea.

SP7.1.16 Endoscopy and biopsy for chronic diarrhoea: an audit and cost analysis

Abstract Aims The aim of the study is to analyse the costs of performing diagnostic endoscopy with histopathological sampling for patients suffering with chronic or persistent diarrhoea. Methods 300 patients were identified who required an endoscopy in 2019 according to the British Society of Gastroenterology guidelines. Patient’s presenting complaint, endoscopic and histological diagnosis and follow up plans were noted. 147 patients were included into our study whose presenting complaint was solely chronic or persistent diarrhoea. Those who presented with acute diarrhoea, PR bleeding or other concomitant indication for lower gastrointestinal endoscopy were excluded. Data from the national schedule of NHS costs was used to calculate expenditure. Results The total expenditure calculated for the 147 patients was £55,973. There was a total of 126 colonoscopies and 21 flexible sigmoidoscopies performed by the department. The number of patients who received medical treatment following endoscopy was 13/147 (9%) 8 of whom had nonspecific colitis on histology. There were 29 patients (20%) who required symptomatic treatment and there were 98 patients (66%) who received no intervention or were discharged immediately and 7 patients (5%) that required surgical intervention. The total cost of procedures not leading to surgical or medical management with steroids or immunomodulators was £47733 which is 85.3% of the total expenditure. Conclusion A significantly large proportion of investigations lead to no intervention or symptomatic treatment of the patient. Given this lack of diagnostic yield and financial burden, there could be room for advancement in the current guidelines for managing persistent diarrhoea.

359 Incidental Fatty Liver Disease; Are We Adhering to Guidelines?

Abstract Aim Hepatic steatosis is an increasingly prevalent condition, with estimates of up to 30% amongst western populations. Fatty liver is a common incidental finding on abdominal imaging. Current British Society of Gastroenterology guidelines suggest the use of scoring systems, such as FIB-4 or NFS, to stratify these patients into risk categories for the development of non-alcoholic steatohepatitis, and subsequent liver failure or hepatocellular carcinoma. We carried out an audit of our own practice, to see if these guidelines were being followed. Method We interrogated the national imaging management system to identify all scans performed in Wexford general hospital from 16th April to 16th October 2020 which identified “hepatic steatosis” or “fatty liver”. Data extracted included: patient demographics, imaging modality &amp; finding. We correlated this data with the patient’s LFTs to calculate their FIB-4/NFS score and investigated whether suitable patients had been referred to gastroenterology. Results Of the 145 patients identified as having hepatic steatosis on imaging, 65 (44.8%) had ALT derangement, 42 (29%) had ALP derangement, 81 (56%) had GGT derangement and 23 (16%) had an elevated total bilirubin. Only 26 (17.9%) of these patients had evidence of subsequent liver serology studies, and only 11 (7.6%) had been referred to gastroenterology. None of the patient cohort had either a FIB-4 or NFS score calculated. Conclusions There is clear evidence that guidelines are not being followed in the management of patients who are incidentally found to have hepatic steatosis.

1333 A Retrospective Audit Against National Standards and Guidelines of The Management and Outcomes of Acute Pancreatitis in A London District General Hospital

Abstract Introduction Acute pancreatitis (AP) is a potentially life-threatening condition. The audit looks at its management and compares it versus the British Society of Gastroenterology guidelines. Method The study retrospectively assessed plans and results for patients with AP over 4 months. Targets were mortality rate below 10% (&amp;lt;30% for severe cases), correct diagnosis at 48h from admission, ultrasound examination of the gallbladder within 24h of diagnosis, severity stratification within 48h of diagnosis, cause established in over 80%, management involving intensive care settings for severe cases and definitive treatment of gallstone pancreatitis in less than 14 days. Results 34 patients were identified, 3(8.6%) had severe acute pancreatitis (SAP). Mortality was 2.9% overall (33.3% in SAP). AP was diagnosed within 48h of presentation in all cases with severity stratification undertaken in 91.2%. Determination of aetiology was achieved in 82.4% with the rest documented as unknown/idiopathic/requiring further investigations post-discharge. Ultrasound studies were undertaken in 58.8% of cases but, as the hospital did not offer ultrasonography on the weekend, 41.2% actually had this type of imaging performed within 24h. Within those who did not have ultrasound at 24h, 50% had had computer tomography imaging. All SAP cases were discussed with intensivists and 7.1% of gallstone pancreatitis underwent definite treatment within 2 weeks. Conclusions Current practice in the hospital mostly meets the reference standards. However, the percentage undergoing definitive treatment of gallstone pancreatitis is low. We aim to re-audit in 4 months following meetings with local surgical leads to discuss implementation of a suitable pathway.

1437 Histological Examination in Search of Helicobacter Pylori in Iron Deficiency Anaemia: An Unnecessary Expense?

Abstract Aim The British Society of Gastroenterology guidelines recommend Helicobacter pylori (HP) testing in patients with iron deficiency anaemia (IDA). This quality improvement project evaluates the utility of histological examination for HP in IDA patients, the consequent expenditure and whether a more cost-effective alternative exists. Method A retrospective search was conducted of patients within a four-month period who underwent an oesophago-gastroduodenoscopy (OGD) for IDA. Patients with an identifiable cause of IDA, ferritin &amp;gt;40ug/mL and haemoglobin (Hb) &amp;gt;12g/L in women or &amp;gt; 13g/L in men were excluded. The costings of a single tissue biopsy and HP stool testing were sought from our local departments. Results Ninety-nine patients’ results were analysed after exclusions (n = 99/127, 78.0%). All patients had biopsies taken at OGD. On average, three biopsies were obtained per patient. Forty-two patients had no abnormalities visualized on OGD and all ninety-nine patients were HP negative. A single biopsy costs £70; £65 per hematoxylin and eosin based histological examination and £5 per single-use biopsy forceps. Accounting for forty-two patients with macroscopically normal OGDs leads to a total expenditure of £8820. A HP stool test costs £14. Conclusions Guidelines recommend HP testing either non-invasively or at OGD as an alternative strategy, based on weak evidence that HP may cause IDA. HP prevalence is falling; histological examination of biopsies obtained at OGD therefore appears expensive and unnecessary. It is more cost effective to perform a stool test in the case of a normal OGD and commence treatment accordingly with biopsies reserved when otherwise clinically indicated and not solely for HP testing.

Early detection of gastric neoplasia: is artificial intelligence the solution?

Major efforts have focused on earlier endoscopic detection of gastric cancer, due to associated improved outcomes and reduced mortality. 1 Banks M Graham D Jansen M et al. British Society of Gastroenterology guidelines on the diagnosis and management of patients at risk of gastric adenocarcinoma. Gut. 2019; 68: 1545-1575 Crossref PubMed Scopus (130) Google Scholar Unfortunately, endoscopic detection remains inadequate, with potentially one in ten gastric cancers being missed. 2 Pimenta-Melo AR Monteiro-Soares M Libânio D Dinis-Ribeiro M Missing rate for gastric cancer during upper gastrointestinal endoscopy: a systematic review and meta-analysis. Eur J Gastroenterol Hepatol. 2016; 28: 1041-1049 Crossref PubMed Scopus (67) Google Scholar Furthermore, the current endoscopic standard of care, which uses white light imaging, has suboptimal sensitivity for early gastric cancer. 3 Yoshida N Doyama H Yano T et al. Early gastric cancer detection in high-risk patients: a multicentre randomised controlled trial on the effect of second-generation narrow band imaging. Gut. 2021; 70: 67-75 Crossref PubMed Scopus (17) Google Scholar Effect of a deep learning-based system on the miss rate of gastric neoplasms during upper gastrointestinal endoscopy: a single-centre, tandem, randomised controlled trialThe use of an AI system during upper gastrointestinal endoscopy significantly reduced the gastric neoplasm miss rate. AI-assisted endoscopy has the potential to improve the yield of gastric neoplasms by endoscopists. Full-Text PDF

P128 Depression, anxiety and stress among Inflammatory Bowel Disease patients during COVID-19: A UK cohort study

BackgroundPatients with chronic diseases, particularly those requiring immunosuppression, are thought to be at increased risk of poor mental health during the COVID-19 pandemic. However, few studies have assessed the mental health of such patients during the current or past pandemics.We aimed to assess the incidence of depression, anxiety & stress in a cohort of inflammatory bowel disease (IBD) patients early during the COVID-19 pandemic, & explore for association with risk of severe COVID-19 based on British Society of Gastroenterology guidelines, & other factors.MethodsA survey including the Patient Health Questionnaire-9, General Anxiety Disorder-7, & Perceived Stress Scale tools for depression, anxiety & stress, respectively, was administered to a cohort of IBD patients from a tertiary centre in London, United Kingdom, in June 2020.Results274 patients responded to the survey (57% response rate), including 54 low risk, 152 moderate risk, & 68 high risk for severe COVID-19. Moderate-severe depression was observed in 61 (22.5%), moderate-severe anxiety in 49 (18%), while 39 (14%) had both diagnoses (Table). Mean (SD) stress score was 16.2 (7.4). There was no association between degree of severe COVID-19 risk & psychological morbidity. Flare symptoms & fatigue were associated with worse psychological morbidity across all measures, while accessibility of information regarding COVID-19 risk & reducing that risk was protective for depression (OR 0.56 [0.33–0.94], p=0.03), anxiety (OR 0.62 [0.4–0.96], p=0.03), & stress (standardized β-coefficient -0.15 [-0.28--0.03], p=0.02) (Figure). 79 (30%) respondents were interested in receiving psychological support during the pandemic, while 200 (76%) expressed interest beyond the pandemic.Table:Depression, anxiety & stress, stratified by risk category Low Risk (n=52) Moderate Risk (n=151) High Risk (n=68) Between groups p-value p-value for trend Depression None-Mild, n (%)43 (82.6)120 (79.4)47 (69.1)0.560.06Moderate-Severe, n (%)9 (17.3)31 (20.5)21 (30.8) Anxiety None-Mild, n (%)42 (80.7)127 (84.1)52 (76.5)0.800.58Moderate-Severe, n (%)10 (19.2)24 (15.9)15 (22.1) Perceived Stress Scale Score Mean (SD)16.9 (7.7)15.6 (7.3)17 (7.6)0.300.69Figure:Association between access to COVID-19 risk information & at least moderate depression (A), anxiety (B), & Perceived Stress Scale score (C)ConclusionDepression, anxiety & stress among IBD patients during the pandemic are common, however their frequency is similar to pre-pandemic rates & general population levels reported during the same period. Ensuring easy access to personalized risk information with targeted psychological support may mitigate psychological burden as patients reintegrate into society & deal with future COVID-19 waves or variants.

708 Examining the Management of Acute Lower GI Bleeds in Order to Improve Policies and Reflect Safe and Updated Guidance

Abstract Introduction Acute lower gastrointestinal bleeding (LGIB) tends to occur in elderly patients with complex comorbidities. At North Middlesex University Hospital (NMUH), LGIB patients are primarily managed by the surgical department. We amended local policies by integrating aspects of new guidelines published by the British Society of Gastroenterology (BSG). Method Handover documentation between November 2019 and January 2020 established patients admitted with LGIB (n = 45). Further data regarding the management of these patients was collated from clinical software and compared to standards set from BSG guidelines. Results We found NMUH to be efficient in ruling out upper GI bleeds via 24-hour OGDs and had low surgical intervention rates (0.02%). 40% of patients were transfused with an admission haemoglobin above suggested NICE thresholds, accounting for cardiovascular comorbidities. 56% of patients were discharged without a documented anticoagulation plan. Over 50% of patients did not have BSG recommended inpatient investigations. Conclusions Updated Trust guidelines aim to uphold areas that NMUH were shown to excel in, while reiterating NICE transfusion thresholds and include guidance regarding anticoagulant and antiplatelet medications. The Oakland score and shock index have been integrated into local protocols and will aid clinicians in making safe decisions in the management of LGIB patients.

522 Audit of Acute Lower Gastrointestinal Bleed Management in a District General Hospital

Abstract Introduction Acute Lower Gastrointestinal Bleed (ALGIB) is a common emergency surgical referral. This project aims to audit current practice at a district general hospital against new British Society of Gastroenterology guidelines, which gives recommendations regarding assessment (Oakland score), investigation and management. Method A retrospective study was undertaken over one year (2019) of patients presenting to A&amp;E or referred via GP with ALGIB. Patients were identified through the coding department. An online proforma was used for data collection, which was analysed with SPSS. Results 76 appropriate patients identified. Median length of hospital stay was 1 day. 10 patients (13.2%) scored ≤8 (probability of safe discharge 95%), 19 (11.8%) patients scored ≤9 (probability of safe discharge 93%) and 57 patients (75%) scored ≥10. 19 patients discharged the same day, of which 3 (15.8%) scored ≤8 and 8 (42.1%) scored ≤9. 23 patients admitted overnight, of which 5 (21.7%) scored ≤8 and 6 (26.1%) scored ≤9. Of 66 patients classified as ‘major’, 41 (62.1%) did not have a colonoscopy. Conclusions Introduction of a scoring mechanism and disseminating guidelines will enable GPs and A&amp;E doctors to safely discharge ALGIB patients with appropriate outpatient investigations and reduce surgical admissions. There is currently poor compliance with inpatient investigations.

British Society of Gastroenterology guidelines on the management of irritable bowel syndrome

Irritable bowel syndrome (IBS) remains one of the most common gastrointestinal disorders seen by clinicians in both primary and secondary care. Since publication of the last British Society of Gastroenterology...