IntroductionJoint Advisory Group (JAG) certification in endoscopy is awarded when trainees attain minimum competency standards for independent practice. A national evidence-based review was undertaken to update standards for training and certification in flexible sigmoidoscopy (FS).MethodsA modified Delphi process was conducted between 2019 and 2020 with multisociety representation from experts and trainees. Following literature review and Grading of Recommendations, Assessment, Development and Evaluations appraisal, recommendation statements on FS training and certification were formulated and subjected to anonymous voting to obtain consensus. Accepted statements were peer-reviewed by national stakeholders for incorporation into the JAG FS certification pathway.ResultsIn total, 41 recommendation statements were generated under the domains of: definition of competence (13), acquisition of competence (17), assessment of competence (7) and postcertification support (4). The consensus process led to revised criteria for colonoscopy certification, comprising: (A) achieving key performance indicators defined within British Society of Gastroenterology standards (ie, rectal retroversion >90%, polyp retrieval rate >90%, patient comfort <10% with moderate-severe discomfort); (B) minimum procedure count ≥175; (C) performing 15+ procedures over the preceding 3 months; (D) attendance of the JAG Basic Skills in Lower gastrointestinal Endoscopy course; (E) satisfying requirements for formative direct observation of procedural skill (DOPS) and direct observation of polypectomy skill (SMSA level 1); (F) evidence of reflective practice as documented on the JAG Endoscopy Training System reflection tool and (G) successful performance in summative DOPS.ConclusionThe UK standards for training and certification in FS have been updated to support training, uphold standards in FS and polypectomy, and provide support to the newly independent practitioner.

Introduction The 2013 national colonoscopy audit found that pain or looping were the most common reasons for incomplete colonoscopy. Sigmoid colon intubation is the most painful part of colonoscopy and looping may occur even in the hands of expert endoscopists. Magnetic endoscope imaging (MEI) facilitates loop identification and resolution. The aim of this study was to identify components of looping and, from these, reach consensus on which should form sigmoid looping domains for an MEI-based sigmoid looping score. Methodology A panel of 12 endoscopists from across the UK, with a range of experience in colonoscopy, took part in a modified Delphi consensus process. A detailed PubMed literature search was performed to identify prior studies. Potential components of sigmoid looping were extracted and provided to the panel as statements, along with an evidence summary. Statements were voted and commented on anonymously and adjusted through subsequent voting and discussion rounds to achieve consensus. Consensus was defined in advance as >80% agreement. Results 46 relevant papers were identified. One paper described a classification for sigmoid looping. A total of 4 Delphi rounds took place. 12/12 panel members took part in Delphi rounds 1 and 2, 11/12 in round 3 and 10/12 in round 4. Initially, consensus was gained on categories, followed by subcategories as the Delphi progressed. Consensus was reached for 7 domains and for potential categorisation within each domain. Loop Type (with definitions for each) Scope shaft angulation (<90, 90–180, 180–270, >270 degrees, excluding scope tip) Loop Size (Small, Medium, Large) Loop duration (Minutes and seconds) Loop Recurrence (Yes, No) Extent of intubation on MEI (colonic segment) MEI image quality (Adequate, Inadequate) Results are summarised in Table 1. Conclusion This is the first effort to develop consensus-based categorisation of sigmoid looping, as identified on MEI. It highlights components of looping that are measurable on MEI and provides a platform for further research into looping and pain. We now plan to validate each component by testing for interrater reliability. The score can then be used to research looping and pain in different contexts.

Background and Aims In July 2019, the fecal immunochemistry test (FIT) replaced the fecal occult blood test (FOBT) in England as the Bowel Cancer Screening Program (BCSP) screening tool. We aimed to assess the impact of this on healthcare resources at our BCSP center. Methods Two 6-month periods were initially analyzed for stool sample return and positivity rates. A subsequent comparative analysis of patient screening episodes assessed utilization of specialist screening practitioner (SSP) time, endoscopy, histology, radiology, surgical, and oncology service usage. Results A total of 42,234 patients received FOBT and 42,545 patients received FIT stool kits, with FIT showing higher return (61.8% vs 58.58%, FIT vs FOBT, P < .001) and sample positivity rates (2.41% vs 1.45%, FIT vs FOBT, P < .001). Four hundred patients commenced FOBT and 616 FIT screening episodes, a 54% increase. The FIT group had of a lower mean age (67.5 vs 69.5 years, FIT vs FOBT, P = .0001) with a lower nonattendance rate (.16% vs 1.5%, FIT vs FOBT, P = .01). With higher patient numbers, the FIT group required 69% more endoscopic procedures, 58% increased SSP time, 40% more radiologic tests, and 68% higher surgical procedures. FIT also led to a 109% increase in endoscopy-derived histology samples from an increase in the proportion of patients with polyps with FIT (54.8% vs 47.2%, P = .020) and a greater number of polyps per patient in whom polyps were found (3.00 vs 2.50 polyps, P = .017). This additional service burden equated to additional financial costs of approximately $558,000 per annum. Conclusions The implementation of FIT led to notable increases in SSP time, endoscopy procedures, radiology tests, surgical procedures, and histopathology services, resulting in considerable ongoing financial implications on the organization. Findings can be used to aid workforce and service planning in National Health Service sites delivering BCSP and countries that have already adopted or are considering FIT within their national screening programs.

Introduction In November 2019 new national guidelines were issued for colonoscopy surveillance post polypectomy and colorectal cancer (CRC). 1 Their implementation has been strongly encouraged by JAG due to anticipated significant reduction in colonoscopy workload, although previous low quality colonoscopy should preclude any surveillance changes.1 Similarly Public Health England encouraged their uptake within BCS. We applied these guidelines to the surveillance waiting list of our symptomatic and BCS cohort, aiming to compare reduction in surveillance colonoscopies within the two groups and assess the impact on our services. Methods We analysed data from Wolverhampton BCS Hub for BCS patients awaiting surveillance between January to March 2020. A similar number of patients were analysed from the current surveillance waiting list at The Royal Wolverhampton NHS Trust. Surveillance vetting was undertaken by a single clinician for BCS and 5 healthcare professionals for the symptomatic service. Patients were contacted with any change in surveillance strategy. Results 182 BCS patients were vetted with the new guidelines. This led to a 48.9% (n=89) reduction in colonoscopy procedures required in that year (surveillance discontinuation in 35.7% (n=65) and deferred surveillance interval in 13.2% (n=24)). In the symptomatic cohort 203 patients were vetted with the new guidelines. Indications for surveillance in this cohort were post polypectomy surveillance (79.4%, n=161), post CRC surveillance (16.7%, n=34) and confirmed family history of CRC (3.9%, n=8). There was a 73.9% (n=150) reduction in colonoscopy procedures required in that year in the symptomatic service cohort (surveillance discontinuation in 65% (n=132) and deferred surveillance interval in 8.9% (n=18)). The indications for discontinuation were age (>75 years old) in 44.7% (n=59) and no high risk features in 55.3% (n=73). This table 1 describes the differences observed between high and low/intermediate risk groups, as per old guidance, in both populations. Conclusions The new guidelines significantly reduced colonoscopy workload mainly through surveillance discontinuation. This reduction was greater for the symptomatic service largely due to new suggested age cut off. Implementation of current guidelines will lead to decreased workload for endoscopy units and risk reduction for patients avoiding exposure to unnecessary procedures. Reference Rutter MD, East JE, Rees C, et al. BSG/ACPGBI/PHE Post-polypectomy and post-colorectal cancer resection surveillance guidelines. Gut 2020;69:201–223.

Editor – We write in support of the process outlined by Satta et al in their recent commentary which explored the methods for creating an expert multidisciplinary team (MDT) to support decision making and governance around therapeutic options during the COVID-19 pandemic.[1][1] Within our own

Introduction From July 2019, FIT replaced Faecal Occult Blood Test (FOBt) as the BCSP screening tool for individuals aged 60 to 75. As FIT detects and quantifies human haemoglobin in stool, changes in service demands were expected due to increased sensitivity. Additionally, pilot testing noted increased screening uptake from 59.3% to 66.4%.1 The extent of the change upon service demand has not been assessed in the full BCSP. We aimed to assess the impact of this change on BCS associated resources at our screening centre. Methods Data was analysed from all patients attending appointments with a Specialist Screening Practitioner (SSP) after either a positive FOBt (March to May 2019) or FIT (September to November 2019) test. The June to August 2019 period was excluded due to a cross over period between the 2 kits. Endoscopy, radiology and surgical procedures as well as histology and SSP time were recorded. 45’ slots of SSP time were allocated for each of initial consultations, attendance at colonoscopy and colorectal multidisciplinary team meeting (if applicable); 20’ slots for flexible sigmoidoscopy and EMR consent. Subsequent follow up telephone or clinic consultations were allocated 10’. Statistical testing was undertaken with an unpaired t-test. Results 164 patients attended in the FOBt group and 216 patients in FIT- a increase of 32% (n=52) in patients with positive tests attending for appointments. Comparing the 3 month periods, FIT testing required 63 more endoscopic procedures (212 vs 149 colonoscopies and 4 vs. 7 flexible sigmoidoscopies). There were 102 hours of additional SSP time required and a 112% increase in the endoscopic polyp/biopsy samples with 190 extra specimens. There were significantly more polyps found within the FIT group (n=337 vs. 154, p=0.004). Total numbers of radiological investigations remained similar (31 FIT vs. 28 FOBt). Patients with malignancy requiring surgery (13 vs. 6) or palliative oncologogical treatment (2 vs. 1) were higher in the FIT group thereby doubling surgery and oncology resource needed. Estimation of financial impact is underway. Conclusions The change to FIT testing within our service has led to notable increases in service demand on SSP time, endoscopy procedures and histopathology services. There has also been a doubling of cancers resulting in impact on surgery and oncology resource. Analysis of this impact aids workforce and service planning in NHS sites delivering BCS. Reference Sue Moss, Christopher Mathews, T J Day, Steve Smith, Helen E Seaman, Julia Snowball, Stephen P Halloran. Increased uptake and improved outcomes of bowel cancer screening with a faecal immunochemical test: results from a pilot study within the national screening programme in England. GutSep 2017;66 (9):1631–1644.

IntroductionGastroenterologists are typically expected to be competent in endoscopic haemostasis for acute upper gastrointestinal bleeding (AUGIB), with the Certificate of Completion of Training (CCT) often heralding the onset of participation in on-call AUGIB rotas. We analysed the volume of haemostasis experience recorded by gastroenterology CCT holders on the Joint Advisory Group on Gastrointestinal Endoscopy Training System (JETS) e-portfolio, the UK electronic portfolio for endoscopy, and assessed for variations in exposure to haemostasis.MethodsUK gastroenterologists awarded CCT between April 2014 and April 2017 were retrospectively identified from the specialist register. Credentials were cross-referenced with JETS to retrieve AUGIB haemostasis procedures prior to CCT. Procedures were collated according to variceal versus non-variceal therapies and compared across training deaneries.ResultsOver the 3-year study period, 241 gastroenterologists were awarded CCT. 232 JETS e-portfolio users were included for analysis. In total, 12 932 haemostasis procedures were recorded, corresponding to a median of 42 (IQR 21–71) per gastroenterologist. Exposure to non-variceal modalities (median 28, IQR 15–52) was more frequent than variceal therapies (median 11, IQR 5–22; p<0.001). By procedure, adrenaline injection (median 12, IQR 6–23) and variceal band ligation (median 10, IQR 5–20) were most commonly recorded, whereas sclerotherapy experience was rare (median 0, IQR 0–1). Exposure to haemostasis did not differ by year of CCT (p=0.130) but varied significantly by deanery (p<0.001), with median procedures ranging from 20–126.ConclusionExposure to AUGIB haemostasis during UK gastroenterology training varied across deaneries and procedural modalities which should prompt urgent locoregional review of access and delivery of training. Endoscopy departments should ensure the availability of supportive provisions in haemostasis (i.e. training/upskilling, supervision, mentorship) during the early post-CCT period.

Introduction In the UK, endoscopy certification is administered by the Joint Advisory Group on Gastrointestinal Endoscopy (JAG). Since 2011, certification for upper and lower gastrointestinal endoscopy has been awarded via a national (JETS) e-portfolio to the main training specialties of: gastroenterology, gastrointestinal surgeons (GS) and non-medical endoscopists (NME). Trends in endoscopy certification and differences between trainee specialties were analyzed. Methods This prospective UK-wide observational study identified trainees awarded gastroscopy, sigmoidoscopy, colonoscopy (provisional and full) certification between June 2011 – 2017. Trends in certification, procedures and time-to-certification, and key performance indicators (KPIs) in the 3-month pre- and post-certification period were compared between the three main training specialties. Results Three thousand one hundred fifty-seven endoscopy-related certifications were awarded to 1928 trainees from gastroenterology (52.3 %), GS (28.4 %) and NME (16.5 %) specialties. During the study period, certification numbers increased for all modalities and specialties, particularly NME trainees. For gastroscopy and colonoscopy, procedures-to-certification were lowest for GS (P < 0.001), whereas time-to-certification was consistently shortest in NMEs (P < 0.001). A post-certification reduction in mean cecal intubation rate (95.2 % to 93.8 %, P < 0.001) was observed in colonoscopy, and D2 intubation (97.6 % to 96.2 %, P < 0.001) and J-maneuver (97.3 % to 95.8 %, P < 0.001) in gastroscopy. Overall, average pre- and post-certification KPIs still exceeded national minimum standards. There was an increase in PDR for NMEs after provisional colonoscopy certification but a decrease in PDR for GS trainees after sigmoidoscopy and full colonoscopy certification. Conclusion Despite variations among trainee specialties, average pre- and post-certification KPIs for certified trainees met national standards, suggesting that JAG certification is a transparent benchmark which adequately safeguards competency in endoscopy training.

IntroductionUpper gastrointestinal bleeding (UGIB) is a common life-threatening emergency. Gastroenterologists are typically expected to be competent in delivering endotherapy for UGIB, with the Certificate of Completion of Training (CCT) often heralding the onset of participation in on-call UGIB rotas. We aimed to analyse the volume of haemostasis experience recorded by gastroenterology CCT holders on the JAG Endoscopy Training System (JETS) e-Portfolio.MethodsIn this retrospective UK-wide study, gastroenterologists awarded CCT between April 2014-April 2017 were identified from the specialist register. Credentials were cross-referenced with JETS to retrieve UGIB endotherapy experience prior to CCT. Subjects without e-portfolio involvement or those not identified on cross-referencing were excluded. Sensitivity analyses were undertaken using the lifetime gastroscopy count to evaluate validity of JETS data. Haemostasis experience was measured only for JETS-supported modalities and collated according to variceal and non-variceal therapies. The outcome measured was the number of recorded procedures requiring haemostasis, e.g. a procedure in which 3 clips were applied was considered as 1 procedure. Comparisons of continuous variables were made using Mann-Whitney (2 groups) and Kruskal-Wallis tests (>2 groups).ResultsOver the 3-year study period, 241 gastroenterologists were awarded CCT. After exclusions (N=9), 232 were included for analysis. Sensitivity analysis revealed a median lifetime gastroscopy count of 854 (IQR 60–214), without variation over the three years (P=0.817), attesting to data integrity. A total of 12,932 endotherapy procedures for UGIB were recorded, corresponding to a median of 42 (IQR 2–1) per gastroenterologist. Exposure to non-variceal modalities (median 28, IQR 1–2) was more frequent than variceal therapies (median 11, IQR –2; P<0.001). By modality (Abstract PWE-113 Figure 1), adrenaline injection (median 12, IQR –3) and variceal band ligation (median 10, IQR –0) were most commonly recorded, whilst sclerotherapy experience was rare (median 0, IQR –). Exposure to UGIB haemostasis did not differ by year of CCT (P=0.130). However, there was significant variation by deanery (P<0.001), with medians of pre-CCT endotherapy procedures ranging from 1–26.ConclusionBased on JETS data, exposure to UGIB endotherapy prior to CCT appears to vary between gastroenterologists, by training deanery and by procedural modality. Implementation of standardised UGIB hands-on training courses and certification may help to support and quality assure training in endotherapy.

Introduction It is recognised that training in the endoscopic management of upper gastrointestinal bleeding (UGIB) is not delivered in a standardised form in gastroenterology training programmes. A standardised Upper GI Haemostasis course was developed as part of the BSG EQIP initiative in conjunction with JAG. Methods Following pilot courses at the West of Scotland Endoscopy Training Centre, 3 one-day industry-subsidised haemostasis courses were run at 2 sites (West Midlands Endoscopy Training Centre, Sheffield Endoscopy Teaching Centre) between July-October 2018. The programme included lecture-based components on risk assessment, pre-endoscopic management, management of variceal, non-variceal and atypical UGIB, role of interventional radiology and surgery, report writing and rebleed plan. In addition, hands-on model training was delivered via porcine or plastic models covering adrenaline injection, thermocoagulation, clip placement, variceal banding, haemostatic powder and Sengstaken tube placement. Feedback questionnaires were offered to trainees to provide self-assessed pre and post course ratings in knowledge, skills and behaviours relevant to UGIB. Pairwise comparisons were made using Wilcoxon rank tests. Results The haemostasis courses were attended by 27 trainees who varied in seniority between ST–. 25 had JAG certification in UGI endoscopy with an average lifetime procedure count of 553. Feedback datasheets were returned by 22 trainees. Following the course, significant improvements were reported in knowledge-based, hands-on skills and behavioural elements, and in the outcome of being "confident in independently managing UGIB" (table 1). Conclusions Delegate confidence in understanding and delivering key aspects of management of UGIB haemostasis improved significantly with this one-day course. Integrating the course to form a part of mandatory registrar training may help to improve management of this patient cohort within the UK.

Introduction Peptic ulcer disease (PUD) accounts for 25%–56% of acute upper gastrointestinal bleeding (AUGIB) cases and is associated with high rates of mortality and rebleeding. We aimed to assess the rates and factors associated with 1 year mortality and rebleeding in patients with bleeding PUD. Methods This was a single-centre study of patients with AUGIB and endoscopic confirmation of PUD between November 2012–2014. All patients received at least 1 year of retrospective follow-up after endoscopy. Electronic records were scrutinised for outcomes of mortality and bleeding, with time-to-event analyses performed using a Kaplan-Meier plots and Cox-regression. Results 91 patients (median age 78.4, 65.9% male) were included. 63.7% were admitted with AUGIB and 36.3% bled during their inpatient stay. Mortality at 30 days and 1 year were 12.1% and 34.1% respectively, with 1 year mortality comprising: cardiovascular (20.0%), bleeding (20.0%), other (33.3%), unknown (26.7%). On univariate analysis, predictors of 1 year mortality included inpatient bleeding (hazard ratio [HR] 2.38, 95% CI: 1.18–4.83, p=0.016) [Figure 1], age (HR 1.036 per increase, 95% CI 1.009–1.065, p=0.009), Forrest classification (HR 2.22 for class 1 and 2 vs. 3, p=0.04), Rockall Score (HR 1.64 per increase, 95% CI 1.28–2.10, p<0.001), Charlson index (HR 1.34 per increase, p<0.001), aspirin use (HR 3.05, p=0.003), rebleeding (HR 5.52, p<0.001). The effect of inpatient bleeding on mortality was not significant (p=0.19) after adjusting for Charlson index. H. pylori was positive in 35.7%; eradication was associated with reduced mortality even after adjusting for Forrest classification and age (HR 0.30, p=0.007). Multivariable analyses to account for age are shown in table 1. The 1 year rebleeding rate was 7.8%. Higher haemoglobin on discharge (HR 0.940 per 10 g/dL increment, p=0.04), Forrest 3 ulcers (HR 0.18, p=0.02) and H. pylori eradication (HR 0.214, p=0.02) were significantly associated with reduced rates of rebleeding.Abstract PTU-011 Figure 1 Survival Following Ulcer BleedingAbstract PTU-011 Table 1 Factor Comparison Hazard Ratio 95% CI p-value Inpatient AUGIB Admitted with AUGIB 1.91 0.93–3.93 0.077 Forrest 1–2 Forrest 3 2.81 1.28–6.15 0.010* Rockall Score Per increase§ 1.67 1.26–2.21 <0.001* Charlson Index Per increase§ 1.30 1.07–1.58 0.008* Aspirin on admission No aspirin 2.07 0.92–4.67 0.081 H. pylori eradication Not ascertained 0.26 0.11–0.61 0.002* Conclusion Increasing age, higher Rockall and Charlson scores, Forrest 1 or 2 lesions, inpatient bleed, and rebleeding were factors associated with mortality in bleeding PUD. Higher rates of inpatient mortality may be explained by age and co-morbidities. Eradication of H. pylori was associated with improved outcomes and should be considered in all cases of bleeding PUD.

Objective The aim was to assess the financial and operational impact of our new gastroenterology referral pathway model on our services. Design An electronic ‘Clinical Assessment Service’ (CAS) proforma and an information platform were developed, and all data were analysed retrospectively. Setting Royal Wolverhampton NHS Trust. Patients 14 245 general practitioner (GP) referrals were received during January 2014–December 2016 with 9773 of them being triaged via our CAS. Main outcome measures We looked into patients’ clinical outcome along with departmental performance and finances. Results A new outpatient appointment was offered to 60.1% (n=5873) of the CAS referred patients. Endoscopic or radiological investigations were requested for 29.2% (n=2854) of patients prior to deciding on further management plan. Out of those, 27% (n=765) went on to receive another gastroenterology (GI) clinic appointment. The remaining 21.3% (n=2089) of the CAS patients were discharged back to their GP following initial investigations. 5.5% (n=538) were discharged back to primary care with a letter of advice, whereas 5.2% (n=509) were deemed inappropriate for GI clinic and were redirected to other specialists. Overall, 32% (n=3127) of patients were managed without a face to face consultation in the GI clinic. This corresponds to 3136 less outpatient appointments with estimated reduced expenditure by the Clinical Commissioning Group (CCG) of £481K. The 18-week performance and waiting times remained stable despite the increasing referral population. The DNA rate dropped from 14% pre to 8.5%. Conclusions Our clinical assessment model has, in addition to the clinical benefits, a considerable positive financial impact to the health economy.

Aims To prospectively evaluate whether between-assay variability of different faecal calprotectin (f-Cp) assays influences diagnostic accuracy for inflammatory bowel disease (IBD) in a cohort of patients with confirmed IBD and irritable bowel syndrome (IBS). To also evaluate the diagnostic accuracy of faecal S100A12 (f-S100A12) against f-Cp in the same patient cohort and assess whether f-S100A12 offers additional diagnostic value. Methods F-Cp using four commercially available f-Cp assays, f-S100A12 and blood biomarkers were measured in patients, recruited from the local IBD clinic, who had established IBS or active ulcerative colitis (UC) and Crohn’s disease (CD). Diagnostic sensitivities and specificities for each assay and biomarker were calculated and compared. Results Median f-Cp levels in all assays were significantly higher in UC (347–884 µg/g; n=28) and CD (377–838 µg/g; n=15) compared with IBS (6–27 µg/g; n=17). Sensitivities and specificities at 50 µg/g were 94%–100% and 82%–100%, respectively. Median f-S100A12 levels were significantly higher in UC (81.0 µg/g; IQR 38.3–159.8) and CD (47.2 µg/g; IQR 5.3–108.9) compared with IBS (0.7 µg/g; IQR 0.5–0.8). At 2.8 µg/g, f-S100A12 had a sensitivity of 97% and specificity of 94%. The blood biomarkers demonstrated sensitivities and specificities of 44%–63% and 80%–92%, respectively. Conclusions The diagnostic sensitivity of the calprotectin assays was similar despite inter-kit variability in absolute values. There is a need for f-Cp assay standardisation, but in its absence assay-specific cut-off values may optimise their diagnostic performance. F-S100A12 demonstrated comparable sensitivity and specificity to f-Cp and although a research tool at present, may have a future role to play in the diagnosis and management of these patients.

Background and aims The literature on colorectal cancer (CRC) screening and ethnic diversity is dominated by studies from the USA. There are no such published data from the UK bowel cancer screening programme (BCSP) population. The Wolverhampton Bowel Cancer Screening Centre serves a population of 900 000 in the Black Country and South Staffordshire. South Asians (SA) comprise 9% of the population. We aimed to determine the effects of ethnicity and sex on the risk for cancer or adenoma detected by colonoscopy following a positive faecal occult blood test over a 5-year period (2007–2011). Methods Data were collected from the prospectively maintained BCSP cohort. South Asian patients were identified and compared with those of non-South Asian ethnicity, and colonoscopy outcomes were determined. Results A total of 3552 participants underwent BCSP colonoscopy (non-South Asian=3363; SA=189). There were 271 cancers (7.6%) detected within the non-South Asian group and seven cancers (0.2%) in the South Asian population (P<0.05). The probability of colon cancer is higher [odds ratio (OR)=3.84, P<0.05] in non-South Asians compared with South Asians. Patients in the 65–70-year age group have the highest risk (OR=1.60; P<0.05) for CRC. During the study 1313 adenomas were detected. A total of 771 high-risk and intermediate-risk adenomas were detected in the non-South Asian group, and 14 were detected in the South Asian group. The risk of adenoma in non-South Asians is six times higher than in South Asians (OR=5.99, P<0.001) following positive faecal occult blood testing. Conclusion There are fewer colorectal cancers in South Asians compared with the non-South Asian population in this regional study. This is the first such study in the BCSP population.

Background and study aim Although colonoscopy is reliable in identifying colorectal cancer (CRC), studies have demonstrated incorrect tumour localization in 21-34% of colonoscopies when compared with surgical localization. The aim of this study was to determine our accuracy in determining the position of CRCs detected at colonoscopy with the aid of the ScopeGuide endoscope positioning device.Patients and methods Cancers identified within the English National Bowel Cancer Screening Programme were studied. Retrospective analysis was undertaken of all patients diagnosed with CRC during the first screening round in Wolverhampton Bowel Cancer Screening Centre, England. ScopeGuide was used in all cases. Data from colonoscopy reports, computed tomography reports and surgical resection specimens were analysed.Results A total of 82 cancers were identified within the surgical resection specimen in 80 patients. Two proximal cancers were not identified at colonoscopy due to obstruction by the distal cancers. Colonoscopy with the aid of the endoscopy positioning device correctly identified the tumour location in 93.75% of cases in which the tumour could be reached endoscopically. Abdominopelvic computed tomography localized 82.5% of CRC.Conclusion The ScopeGuide endoscopy positioning device enables accurate localization of cancers at colonoscopy. Tattooing of suspected cancer remains to be a best practice for localization during laparoscopic resection. The use of the endoscopic-positioning device may, however, result in greater confidence for localization of polypectomy sites, which have not been tattooed, in cases when cancer was not suspected but found histologically. Eur J Gastroenterol Hepatol 23: 488-491 (C) 2011 Wolters Kluwer Health vertical bar Lippincott Williams & Wilkins.

It may be possible to identify several ‘levels’ of polypectomy service, each requiring a different range of polypectomy skills: flexible sigmoidoscopy screening, non-screening colonoscopy, screening colonoscopy and the specialist endoscopy service. This requires a definition of ‘difficulty levels’ of polyps, to reflect the four levels of service, each with clearly defined parameters that represent the bare minimum that an endoscopist operating at a particular level should be able to deal with competently.

Background: Despite its ubiquitous use over the past 4 decades, there is no structured, formal method with which to assess polypectomy.Objective: To develop and validate a new method with which to assess competency in polypectomy.Design: Polypectomy underwent task deconstruction, and a structured checklist and global assessment scale were developed (direct observation of polypectomy skills [DOPyS]). Sixty bowel cancer screening polypectomy videos were randomly chosen for analysis and were scored independently by 7 expert assessors by using DOPyS. Each parameter and the global rating were scored from 1 to 4 (scores >= 3 = competency). The scores were analyzed by using generalizability theory (G theory).Setting: multicenter.Results: Fifty-nine of the 60 videos were assessable and scored. The majority of the assessors agreed across the pass/fail divide for the global assessment scale in 58 of 59 (98%) polyps. For G-theory analysis, 47 of the 60 videos were analyzed. G-theory analysis suggested that DOPyS is a reliable assessment tool, provided that it is used by 2 assessors to score 5 polypectomy videos all performed by 1 endoscopist. DOPyS scores obtained in this format would reflect the endoscopist's competence.Limitations: Small sample and polyp size.Conclusions: This study is the first attempt to develop and validate a tool designed specifically for the assessment of technical skills in performing polypectomy. G-theory analysis suggests that DOPyS could reliably reflect an endoscopist's competence in performing polypectomy provided a requisite number of assessors and cases were used. (Gastrointest Endosc 2011;73:1232-39.)

Introduction Peptic ulcer disease (PUD) accounts for 25%– 56% of acute upper gastrointestinal bleeding (AUGIB) cases and is associated with high rates of mortality and rebleeding. We aimed to assess the rates and factors associated with 1 year mortality and rebleeding in patients with bleeding PUD. Methods This was a single-centre study of patients with AUGIB and endoscopic confirmation of PUD between November 2012–2014. All patients received at least 1 year of retrospective follow-up after endoscopy. Electronic records were scrutinised for outcomes of mortality and bleeding, with timeto-event analyses performed using a Kaplan-Meier plots and Cox-regression. Results 91 patients (median age 78.4, 65.9% male) were included. 63.7% were admitted with AUGIB and 36.3% bled during their inpatient stay. Mortality at 30 days and 1 year were 12.1% and 34.1% respectively, with 1 year mortality comprising: cardiovascular (20.0%), bleeding (20.0%), other (33.3%), unknown (26.7%). On univariate analysis, predictors of 1 year mortality included inpatient bleeding (hazard ratio [HR] 2.38, 95% CI: 1.18–4.83, p=0.016) [Figure 1], age (HR 1.036 per increase, 95% CI 1.009–1.065, p=0.009), Forrest classification (HR 2.22 for class 1 and 2 vs. 3, p=0.04), Rockall Score (HR 1.64 per increase, 95% CI 1.28–2.10, p<0.001), Charlson index (HR 1.34 per increase, p<0.001), aspirin use (HR 3.05, p=0.003), rebleeding (HR 5.52, p<0.001). The effect of inpatient bleeding on mortality was not significant (p=0.19) after adjusting for Charlson index. H. pylori was positive in 35.7%; eradication was associated with reduced mortality even after adjusting for Forrest classification and age (HR 0.30, p=0.007). Multivariable analyses to account for age are shown in table 1. The 1 year rebleeding rate was 7.8%. Higher haemoglobin on discharge (HR 0.940 per 10 g/dL increment, p=0.04), Forrest 3 ulcers (HR 0.18, p=0.02) and H. pylori eradication (HR 0.214, p=0.02) were significantly associated with reduced rates of rebleeding. Conclusion Increasing age, higher Rockall and Charlson scores, Forrest 1 or 2 lesions, inpatient bleed, and rebleeding were factors associated with mortality in bleeding PUD. Higher rates of inpatient mortality may be explained by age and comorbidities. Eradication of H. pylori was associated with improved outcomes and should be considered in all cases of bleeding PUD. Abstract PTU-011 Figure 1 Survival Following Ulcer Bleeding