Portsmouth Hospitals NHS Trust Research Articles

Temperature-controlled Laminar Airflow (TLA) in symptomatic severe asthma – a post hoc analysis of severe exacerbations, quality of life and health economics

PurposeUncontrolled severe asthma constitutes a major economic burden to society. Add-ons to standard inhaled treatments include inexpensive oral corticosteroids and expensive biologics. Nocturnal treatment with Temperature-controlled Laminar Airflow (TLA; Airsonett®) could be an effective, safe and cheaper alternative. The potential of TLA in reducing severe asthma exacerbations was addressed in a recent randomised placebo-controlled trial (RCT) in patients with severe asthma (Global Initiative for Asthma (GINA) step 4/5), but the results were inconclusive. We re-analysed the RCT with severe exacerbations stratified by the level of baseline asthma symptoms and Quality of Life.MethodsMore uncontrolled patients, defined by Asthma Control Questionnaire 7 (ACQ7) > 3, EuroQoL 5-Dimension Questionnaire Visual Analogue Scale (EQ5D-VAS) ≤ 65 and Asthma Quality of Life Questionnaire (AQLQ) ≤ 4 were selected for re-analysis. The rates of severe asthma exacerbations, changes in QoL and health-economics were analysed and compared between TLA and placebo.ResultsThe study population included 226 patients (113 TLA / 113 placebo.) The rates of severe asthma exacerbations were reduced by 33, 31 and 25% (p = 0.083, 0.073, 0.180) for TLA compared to placebo, dependent on selected control measures (ACQ7, EQ5D-VAS, AQLQ, respectively). For patients with less control defined by AQLQ≤4, the difference in mean AQLQ0-12M between TLA and placebo was 0.31, 0.33, 0.26 (p = 0.085, 0.034, 0.150), dependent on selected covariate (AQLQ, EQ5D-VAS, ACQ7, respectively). For patients with poor control defined by ACQ7 > 3, the difference in EQ5D-5 L utility scores between TLA and placebo was significant at 9 and 12 months with a cost-effective ICER. The results from the original study did not demonstrate these differences.ConclusionThis post hoc analysis demonstrated an effect of TLA over placebo on severe exacerbations, asthma control and health economics in a subgroup of patients with more symptomatic severe allergic asthma. The results are consistent with the present recommendations for TLA. However, these differences were not demonstrated in the full study. Several explanations for the different outcomes have been outlined, which should be addressed in future studies.FundingNIHR Health Technology Assessment Programme and Portsmouth Hospitals NHS Trust.

Early warning score adjusted for age to predict the composite outcome of mortality, cardiac arrest or unplanned intensive care unit admission using observational vital-sign data: a multicentre development and validation

ObjectivesEarly warning scores (EWS) alerting for in-hospital deterioration are commonly developed using routinely collected vital-sign data from the whole in-hospital population. As these in-hospital populations are dominated by those over...

Successful Introduction of A Robotic Multispecialty Program At Portsmouth Hospitals NHS Trust

Successful Introduction of A Robotic Multispecialty Program At Portsmouth Hospitals NHS Trust

Modern Innovative Solutions in Improving Outcomes in Chronic Obstructive Pulmonary Disease (MISSION COPD): Mixed Methods Evaluation of a Novel Integrated Care Clinic.

BackgroundChronic obstructive pulmonary disease (COPD) is the second-leading cause of death in the United Kingdom and accounts for 1.7% of bed days in acute hospitals. An estimated two-third of patients with COPD remain undiagnosed.ObjectiveModern Innovative Solutions in Improving Outcomes in Chronic Obstructive Pulmonary Disease (MISSION COPD) aimed to proactively identify patients from primary care who were undiagnosed or had uncontrolled COPD and to provide a comprehensive integrated multidisciplinary clinic to address the needs of this complex group for improving diagnosis, personalizing therapy, and empowering patients to self-manage their condition.MethodsThis clinic was led by a respiratory specialist team from Portsmouth Hospitals NHS Trust working with five primary care surgeries in Wessex. A total of 108 patients were reviewed, with 98 patients consenting to provide additional data for research. Diagnoses were changed in 14 patients, and 32 new diagnoses were made.ResultsReductions were seen across all aspects of unscheduled care as compared to the prior 12 months, including in emergency general practitioner visits (3.37-0.79 visits per patient, P<.001), exacerbations (2.64-0.56 per patient, P=.01), out-of-hours calls (0.16-0.05 per patient, P=.42), and hospital admissions (0.49-0.12 per patient, P=.48). Improvements were observed in the quality of life and symptom scores in addition to patient activation and patient-reported confidence levels.ConclusionsThis pilot demonstrates that the MISSION model may be an effective way to provide comprehensive gold-standard care that is valued by patients and to promote integration across sectors.

Can we cure type 2 diabetes?

Can we cure type 2 diabetes?

A little less conversation, a little more high impact action

NHS Improvement's ‘ Eight high impact actions to improve the working environment for junior doctors’ 1 has provided a framework for the majority of the improvement initiatives we have implemented as chief registrars (CRs) at Portsmouth Hospitals NHS Trust. Additional projects have largely centred around improving patient safety and junior doctor (JD) morale. A survey was conducted in August 2017 to identify issues threatening doctors’ efficiency and enjoyment in their clinical roles. A monthly JD Forum was also initiated giving JDs a regular opportunity …

A five-year follow-up observational study of the T-14 paediatric throat disorders outcome measure in tonsillectomy and adenotonsillectomy.

The T-14 questionnaire is a validated outcome measurement tool to assess the value of paediatric tonsillectomy from a parent's perspective. There is a paucity of data regarding the long-term postoperative effects of tonsillectomy on quality of life in the paediatric population. Our previous study assessed T-14 scores up to year 2 postoperatively, with this study extending follow-up to 5 years. We undertook a prospective uncontrolled observational study examining 54 paediatric patients undergoing tonsillectomy at Portsmouth Hospitals NHS Trust. Parents of children undergoing surgery were invited to complete a T-14 questionnaire preoperatively, as well as at 3 months, 6 months, 1 year, 2 years and now 5 years postoperatively. In total, 44 of 54 patients completed questionnaires preoperatively and at all postoperative time points, with 46 being completed at 5 years. There was a highly significant (P < 0.001) difference between the preoperative scores and all other measured T-14 scores postoperatively. The mean score preoperatively was 33.3 compared with 1.0 at 5 years. This is the first study to assess long-term quality of life following paediatric tonsillectomy using the T-14 questionnaire. The benefits of tonsillectomy on long-term quality of life further confirms its value within the paediatric population.

'Always believe in yourself'.

What is your job? Consultant nurse for acuity out of hours at Queen Alexandra Hospital, Portsmouth Hospitals NHS Trust. I lead the hospital at-night service, which delivers emergency out-of-hours care to 1,100 inpatients. I work clinically as part of this team while managing and developing the service. I am also responsible for the strategic and quality improvement aspects of out-of-hours care.

'Always believe in yourself'.

What is your job? As a consultant nurse for acuity out of hours at Queen Alexandra Hospital, Portsmouth Hospitals NHS Trust, I lead the hospital at-night service, which delivers emergency out-of-hours care to 1,100 inpatients. I work clinically as part of this team while managing and developing the service. I am also responsible for the strategic and quality improvement aspects of out-of-hours care.

Diabetic maculopathy screening in England; are we seeing too much?

PurposeThe England screening service classification of diabetic retinopathy has strict, quality assured criteria to identify potential diabetic maculopathy termed ‘M1’. All new M1 cases identified by the screening service are referred to a hospital service. We aimed to evaluate the effectiveness of the England National Diabetic Eye Screening R1M1 classification of diabetic maculopathy as a criteria for secondary care referral in Portsmouth, UK.MethodsRetrospective audit of all patients referred to Portsmouth Hospitals NHS Trust with R1M1 pathology from April 2013 to January 2014. The total number of referrals received for this period was noted as well as the number of patients followed up in subsequent care pathways. Follow‐up data on those who remained under hospital care is presented for three years.ResultsA total of 306 diabetic patients were referred to Portsmouth Hospitals NHS Trust for R1M1 pathology over a 10 month period. At the first hospital appointment 135 (44%) had no fluid present on macular SD OCT and were either referred back to screening if the M1 features had resolved (65) or followed up with retinal images (70). 115 (38%) patients were considered to require further follow‐up in secondary care. Of those patients remaining in secondary care 70 remained in active follow up 3 years later.ConclusionsThese results would suggest that 44% of those with M1 features have no evidence of diabetic maculopathy on OCT at the initial hospital appointment and were discharged to community screening. Follow‐up for over three years in a secondary care setting is required by 23%. Secondary service could be better utilised by streamlining referrals either by refining the R1M1 classification or developing community based OCT service.

Causation in stroke case not demonstrated: Choudhury v South Central Ambulance Service NHS Trust and Portsmouth Hospitals NHS Trust (High Court, 13 May 2015—Cox J)

Causation in stroke case not demonstrated: <i>Choudhury v South Central Ambulance Service NHS Trust and Portsmouth Hospitals NHS Trust</i> (High Court, 13 May 2015—Cox J)

A two-year follow-up observational study of the T-14 paediatric throat disorders outcome measure in tonsillectomy and adenotonsillectomy.

The T-14 questionnaire is a validated patient reported outcome measure used to assess the value of paediatric tonsillectomy from the patient's perspective. There are currently limited data revealing the long-term postoperative effects of tonsillectomy on quality of life in the paediatric population. A previously published study was therefore extended to provide additional data at 12 and 24 months following surgery. A prospective uncontrolled observational study was undertaken examining 54 paediatric patients undergoing tonsillectomy at Portsmouth Hospitals NHS Trust. Parents of children having surgery were invited to complete a T-14 questionnaire preoperatively as well as at 3, 6 (previously published), 12 and 24 months postoperatively. The questionnaire was completed for 50 of the 54 patients preoperatively as well as at 3, 6 and 12 months postoperatively, with 44 being completed at 24 months. The mean difference between the preoperative T-14 scores and the scores at 3, 6, 12 and 24 months following surgery were highly statistically significant (p<0.001). This is the first study published in the literature to assess the T-14 questionnaire at 12 and 24 months following paediatric tonsillectomy, providing evidence of the ongoing benefit of patient reported outcome measures. This further confirms the value of tonsillectomy in the paediatric population and demonstrates its ongoing positive effects on quality of life.

OC-052 Universal Screening For Alcohol Misuse In Acute Medical Admissions Is Feasible And Identifies Patients At High Risk Of Liver Disease

IntroductionThe 2013 NCEPOD report into deaths from Alcohol Related Liver Disease (ARLD) highlighted missed opportunities for detecting alcohol misuse in recurrent hospital admissions. Universal screening of medical patients was advised...

Educational internship at Portsmouth Hospitals NHS Trust

In September 2013, following informal requests for mentoring from various staff members, Portsmouth Hospitals NHS Trust decided to set up a formal internship scheme. This article introduces the scheme created by the trust’s nursing and midwifery education team. Its aim is to provide successful applicants with a part-time internship opportunity to complete a teaching qualification within a supportive educational environment. This approach provides individual staff members with personal development and broadens the number of people within the trust who can support or ‘buddy’ their colleagues. BJHCA Board Member, Chrissy Cowan, began her internship in January 2014 and explains why she took up the option and what she hopes to gain from it.

The use of bipolar electrocautery in adult epistaxis management: Using audit of one hundred and twenty‐four cases to define a standardised protocol

Clinical OtolaryngologyVolume 38, Issue 6 p. 554-558 Correspondence: Our Experience The use of bipolar electrocautery in adult epistaxis management: Using audit of one hundred and twenty-four cases to define a standardised protocol A.H. Henderson, Corresponding Author A.H. Henderson Department of ENT, Queen Alexandra Hospital, Portsmouth Hospitals NHS Trust, Portsmouth, UKCorrespondence: A.H. Henderson, Department of ENT, Queen Alexandra Hospital, Cosham, Portsmouth P06 3LY, UK. Tel.: +44 02392 286000; Fax: +44 02392 286708; e-mail: [email protected]Search for more papers by this authorA. Larkins, A. Larkins Department of ENT, Queen Alexandra Hospital, Portsmouth Hospitals NHS Trust, Portsmouth, UKSearch for more papers by this authorC. Repanos, C. Repanos Department of ENT, Queen Alexandra Hospital, Portsmouth Hospitals NHS Trust, Portsmouth, UKSearch for more papers by this author A.H. Henderson, Corresponding Author A.H. Henderson Department of ENT, Queen Alexandra Hospital, Portsmouth Hospitals NHS Trust, Portsmouth, UKCorrespondence: A.H. Henderson, Department of ENT, Queen Alexandra Hospital, Cosham, Portsmouth P06 3LY, UK. Tel.: +44 02392 286000; Fax: +44 02392 286708; e-mail: [email protected]Search for more papers by this authorA. Larkins, A. Larkins Department of ENT, Queen Alexandra Hospital, Portsmouth Hospitals NHS Trust, Portsmouth, UKSearch for more papers by this authorC. Repanos, C. Repanos Department of ENT, Queen Alexandra Hospital, Portsmouth Hospitals NHS Trust, Portsmouth, UKSearch for more papers by this author First published: 18 October 2013 https://doi.org/10.1111/coa.12191Citations: 5Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat Citing Literature Volume38, Issue6December 2013Pages 554-558 RelatedInformation

OC-062 Low Incidence of Aspiration Events during Home Nasogastric Feeding: A Safe Strategy for Long Term Feeding?

Introduction Nasogastric (NG) pump feeding is associated with risks of aspiration and subsequent pneumonia with previous studies in adult inpatients suggesting 2.4 aspiration episodes per 1000 tube-feeding days. However, there is little published data on outcomes of patients receiving home NG feeding. We analysed our long term home NG feeding cohort for evidence of aspiration related hospital admission. Methods This was a retrospective service evaluation of the home enteral tube feeding cohort at Portsmouth Hospitals NHS Trust. Data was obtained from hospital electronic databases, patient clinical notes and PAS patient management software. Data was analysed in SPSS 20. Results A total of 117 patients who had received home NG feeding over previous 5 years were evaluated. 30 patients (26%) were excluded due to incomplete datasets. 87 patients were recruited (Male [48%], Female [52%], age [mean 55.6; 95% confidence interval 51.8–59.2]) with a total of 12957 tube-feeding days (mean 150; 95% confidence interval 110–191 days). Indications include upper aerodigestive tract cancer, 32; malnutrition, 25; neurodegenerative disorders, 6; connective tissue disorders, 2; stroke, 1; lymphoma, 1; metabolic stabilisation of short bowel and or high output stoma, 16. Eight hospital admissions in separate patients were recorded; however, only 1 episode of pneumonia was recorded (0.08 aspiration episodes per 1000 tube-feeding days). There were no hospital admissions relating to misplaced/displaced NG tubes. Conclusion Home NG pump feeding represents a safe long-term alternative to gastrostomy feeding when supported by a robust specialist enteral tube feeding support service (ETFSS), in those deemed unsuitable for gastrostomy placement. A 30-fold lower incidence of aspiration episodes compared with published inpatient literature (0.08 vs. 2.4 episodes/1000 tube feeding days) reflects expertise of clinical nutrition nurse specialists within the ETFSS, with appropriate patient selection and outreach management. A daytime walk in service prevents unplanned hospital admissions through tube displacement. Disclosure of Interest None Declared

Tu1482 High Definition White Light Endoscopy and I-SCAN for in-Vivo Characterisation of Small Colonic Polyps: No Need to Push the Button

a conventional image, the lesion was each observed by NBI magnification. The diagnosis of NBI magnification was based on Sano’s classification. Also irregular findings of microvessels including “caliber change of microvessel” (CCM), “long irregular vessel” (LIV) and “decline of microvessel density” (DMD) were analyzed. When type V pit pattern was suspected, the lesion was observed after crystal-violet dye-stain. The diagnosis of chromoendoscopic magnification was based on Kudo’s classification. Both capillary pattern and pit pattern were compared with final histological diagnosis. This study was performed retrospectively and consecutively. Histological diagnosis on resected specimen was determined according to Vienna classification. Submucosal massively invasive cancer (SM-M) was defined as an invasive depth greater than 1000 m. Results: As to histological diagnoses, there were 380 intramucosal cancers, 60 submucosal slightly invasive cancers, and 81 cancers with submucosal massively invasion. The values of the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) and accuracy of type IIIB for the diagnosis of SM-M were 70.4%, 98.6%, 90.5%, 94.8% and 94.3%, respectively. Those of VI highly irregular and VN were 81.5%, 98.4%, 90.4%, 96.7% and 95.8%, respectively. Type IIIB was observed in 19 (73.1%) of 26 protruded type SM-M, 8 (40.0%) of 20 flat type SM-M and 30 (85.7%) of 35 depressed type SM-M. The values of specificity of CCM, LIV and DMD for the diagnosis of SM-M were 99.1%, 99.8% and 99.5%, respectively. CCM was observed in 14 (51.9%) of 26 protruded type SM-M. And DMD were observed in 23 (67.6%) of 35 depressed type SM-M. Conclusion: NBI magnification would have clinical advantage to diagnose the invasion depth of early colorectal cancers. Submucosal massively invasive cancers had characteristic irregular findings that depended on the morphological type. These irregular findings had high specificity for the diagnosis of submucosal massively invasive cancers. Tu1482 High Definition White Light Endoscopy and I-SCAN for in-Vivo Characterisation of Small Colonic Polyps: No Need to Push the Button Peter J. Basford*, Gaius R. Longcroft-Wheaton, Pradeep Bhandari Gastroenterology, Portsmouth Hospitals NHS Trust, Portsmouth, United Kingdom Introduction: Standard definition white light endoscopy is inadequate for in-vivo characterisation of small colonic polyps. Chromoendoscopy and electronic imaging techniques are shown to improve accuracy. The ASGE has identified prediction of polyp surveillance intervals and negative predictive value for adenomatous histology of diminutive recto-sigmoid polyps as key targets for new technologies. High definition white light endoscopy incorporating charge coupled device chips with resolution in excess of 1 million pixels are now available but there is little data on their use. Aims&Methods: We aimed to examine the in-vivo characterisation accuracy of high definition white light endoscopy (HDWL) plus a novel electronic imaging modality i-Scan (Pentax, Japan). Patients undergoing colonoscopy through the UK Bowel Cancer Screening Programme were prospectively recruited. All colonoscopies were performed by a single expert endoscopist with extensive experience in in-vivo diagnosis. Procedures were performed with Pentax EC-3890Li 1.2 Megapixel HD colonoscopes and EPKi processor. An initial classification & validation exercise was carried out to determine the optimum i-Scan settings for in-vivo diagnosis, and to develop a novel in-vivo diagnosis assessment tool. All polyps 10mm in size were assessed sequentially with HDWL and i-Scan. Optical magnification was not used. Predicted histology (non-neoplastic, adenoma, cancer) was recorded for both modalities and compared to the final histopathological diagnosis as reported by an expert gastrointestinal pathologist. Predictions were rated as high or low confidence assessments. Results were analysed for sensitivity and specificity for neoplasia, overall accuracy, and negative predictive value for rectosigmoid polyps 5mm as recommended by the ASGE PIVI statement. Results: 84 patients were recruited, in whom 209 polyps 10mm were included. Mean polyp diameter was 4.3mm, median 4mm. 134 polyps were neoplastic and 75 non-neoplastic. There were no significant differences in sensitivity (95.5% vs 97.0%) and specificity (89.3% vs 90.7%) for neoplasia and overall diagnostic accuracy (93.3% vs 94.7%) between HDWL and i-Scan. Negative predictive value for adenomatous histology of rectosigmoid polyps 5mm was 100% with both modalities. Polyp surveillance intervals using in-vivo assessment of diminutive polyps were correct in 95% and 97% of patients with HDWL and i-Scan respectively. Conclusion: 1) Excellent in vivo diagnostic accuracy, in excess of 90% can be achieved with HDWL alone.2) No significant gains in accuracy over HDWL were noted with i-Scan when used with a 1.2Megapixel HD colonoscope therefore, there is no need to push the button or spray dye to improve accuracy. 3) Both HDWL and i-Scan fulfill the ASGE criteria for ‘resect and discard’ and ‘do not resect’ strategies for diminutive polyps

006 Tuning fork testing on ankle injuries: does it improve the accuracy of the Ottawa ankle rules?

Objectives and BackgroundsAnkle injuries account for 8% of all minor injuries attending EDs in the UK. The Ottawa ankle rules (OARs) were introduced to assess the need for x-ray in...

Risk of significant gynaecological pathology in women with ?glandular neoplasia on cervical cytology

To review the risk of pre-invasive and invasive gynaecological pathology in women referred with cervical cytology reporting ?glandular neoplasia. Review of the case notes of all women referred with cervical cytology reported as ?glandular neoplasia between January 1999 and December 2008 at two UK hospitals: Portsmouth Hospitals NHS Trust and Queen Mary's Hospital Sidcup. The category of 'borderline nuclear change in endocervical cells', result code 8 according to the national health service cancer screening programme (NHSCSP), was excluded from the study. A total of 200 women were identified using the hospitals' pathology computer systems. Invasive carcinoma was found in 48 women (24%): 28 endocervical adenocarcinomas, eight squamous cell carcinomas (SCC), ten endometrial and two ovarian adenocarcinomas. Pre-invasive neoplasia was found in 115 (57.5%), including 14 cervical glandular intraepithelial neoplasia (CGIN), 31 cervical intraepithelial neoplasia (CIN) grade 2/3 and 70 concomitant CGIN and CIN2/3. CIN1/HPV was found in 25, simple endometrial hyperplasia in three and no histological abnormality in three. Thirty-four (70.8%) of 48 invasive carcinomas (of which 23 were endocervical adenocarcinomas) were in asymptomatic women investigated for abnormal cytology. Fourteen of 34 (41.4%) of those with ?glandular neoplasia thought to be endometrial were CGIN or CIN2/3. Colposcopic appearances were normal in 47.6% of women with pure cervical glandular neoplasia (adenocarcinoma or CGIN) compared with 12.8% with squamous cell lesions (CIN2/3 or SCC): P = 0.0001. Thus, colposcopy was more sensitive for detecting squamous cell abnormalities than their glandular counterparts. Although cervical adenocarcinomas are less amenable to prevention by screening than cervical SCC, in our study cervical cytology predominantly detected these abnormalities at their early asymptomatic stages. At least CIN2 was found in 81.5% in women referred with cervical cytology reporting ?glandular neoplasia. A thorough evaluation of the whole genital tract is needed if colposcopy is negative.

Mo1539 High Resolution Endoscopy in the Evaluation of Diminuitive Polyps: Does It Effect Our Diagnostic Ability?

Mo1539 High Resolution Endoscopy in the Evaluation of Diminuitive Polyps: Does It Effect Our Diagnostic Ability? Gaius R. Longcroft-Wheaton, Pradeep Bhandari Gastroenterology, Portsmouth Hospitals NHS trust, Portsmouth, United Kingdom Introduction: In recent years the resolution of endoscopes has been increasing. Modern fujinon colonoscopes have a CCD pixel density of 850,000 pixels compared to a standard definition 410,000 pixel CCD. However, acquiring high definition (HD) scopes represents a significant capital investment and their clinical value remains uncertain. This study aims to investigate the impact of high resolution endoscopy on the in-vivo histology prediction of colonic polyps Methods: Procedures were performed using fujinon colonoscopes and EPX 4400 processor. Fujinon standard definition (SD) EC 530 and high resolution (HD) EC530 and EC 590 colonoscopes were used. Polyps 10 mm were assessed using white light (WLI), FICE, and indigo carmine (IC) spray, with the predicted diagnosis recorded with each modality of imaging. In each case the kind of colonoscope (SD or HD) was recorded. Polyps were removed and sent for histological analysis, with the pathologist blinded to the diagnosis made by the endoscopist. The predicted diagnosis for WLI FICE and IC were compared to the true histology to calculate the accuracy, sensitivity and specificity of in vivo assessment using either SD or HD scopes. Mcnemear’s test was used for the statistical comparison of modalities of imaging. Results: 232 polyps 10 mm were examined, 89 polyps with standard definition endoscopes and 143 polyps high definition endoscopes. The true histology consisted of 155 neoplastic and 77 hyperplastic polyps. HD endoscopessignificantly improved the ability of the endoscopist to make an in vivo diagnosis using FICE but had no effect on the WLI or IC predicted diagnosis. See table 1. Conclusion: In-vivo diagnosis of small polyps is very important for the correct management of patients. We can conclude from our work that: 1) In-vivo prediction of polyp histology is poor with WLI and this does not improve with HD scopes2) In-vivo prediction of polyp histology is good with FICE and improves significantly with HD scopes3) In-vivo prediction of polyp histology with IC is very good and is unaffected by HD scopes