Objective The COVID-19 pandemic has placed increased strain on healthcare systems worldwide with enormous reorganisation undertaken to support 'COVID-centric' services. Non-COVID-19 admissions reduced secondary to public health measures to halt viral transmission. We aimed to understand the impact of the response to COVID-19 on the outcomes of upper gastrointestinal (UGI) bleeds. Design/methods A retrospective observational multicentre study comparing outcomes following endoscopy for UGI bleeds from 24 March 2020 to 20 April 2020 to the corresponding dates in 2019. The primary outcome was in-hospital survival at 30 days with secondary outcomes of major rebleeding within 30 days postprocedure and intervention at the time of endoscopy. Results 224 endoscopies for 203 patients with UGI bleeds were included within this study. 19 patients were diagnosed with COVID-19. There was a 44.4% reduction in the number of procedures performed between 2019 and 2020. Endoscopies performed for UGI bleeds in the COVID-19 era were associated with an adjusted reduced 30-day survival (OR 0.25, 95% CI 0.08-0.67). There was no increased risk of major rebleeding or interventions during this era. Patients with COVID-19 did not have reduced survival or increased complication rates. Conclusion Endoscopy for UGI bleeds in the COVID-19 era is associated with reduced survival. No clear cause has been identified but we suspect that this is a secondary effect of the response to the COVID-19 pandemic. Urgent work is required to encourage the public to seek medical help if required and to optimise patient pathways to ensure that the best possible care is provided.

Background The COVID-19 pandemic has placed increased strain on healthcare systems worldwide with enormous reorganisation undertaken to support 'COVID-centric' services. Non-COVID-19 admissions have been shown to have reduced due to public health measures to halt viral transmission. We aimed to understand the impact of the response to the COVID-19 pandemic on the outcomes of upper gastrointestinal bleeds (UGI). Methods A pan-London retrospective observational multi-centre study comparing outcomes following endoscopy for UGI bleeds from 24th March 2020 to 20th April 2020 to the corresponding dates in 2019. Primary outcome was in-hospital survival at 30 days with secondary outcomes of major re-bleeding within 30 days post-procedure and intervention at time of endoscopy. Results 224 endoscopies for 203 patients with UGI bleeds were included within this study. 19 patients were diagnosed with COVID-19. There was a 44.4% reduction in the number of procedures performed between 2019 and 2020. Endoscopies performed for UGI bleeds in the COVID-19 era were associated with an adjusted reduced 30-day survival (OR 0.25, 95% CI 0.08–0.67) (figure 1). There was no increased risk of major re-bleeding or interventions during this era. Patients with COVID-19 did not have adjusted reduced survival or adjusted increased complication rates. Conclusions Endoscopy for UGI bleeds in the COVID-19 era is associated with reduced survival. No clear cause has been identified but we suspect this is a secondary effect of the response to the COVID-19 pandemic. Urgent work is required to encourage the public to seek medical help if required and to optimise patient pathways to ensure that the best possible patient care is provided.

The British Society of Gastroenterology (BSG) has recently updated its guideline for post-polypectomy surveillance.[1][1] The now defunct 2010 guideline recommended that patients with low-risk adenomas (LRAs) should be offered either 5-year colonoscopy or no surveillance. In our experience, clinical

Introduction The benefit of colonoscopy surveillance for low risk adenomas (LRAs) is unclear. The BSG currently recommends either no surveillance or 5-year colonoscopy. It has recently been shown that following removal of LRAs, patients are not at increased risk of colorectal cancer compared to the general population. This suggests colonoscopy surveillance in these patients may not be necessary. In particular, patients aged 6–4 years when surveillance is due are eligible for biennial stool testing in the national bowel cancer screening programme (BCSP), which provides a potential alternative for follow up. We aimed to estimate the cost savings and endoscopy capacity that could be generated by discontinuing colonoscopy surveillance for LRAs. Methods We conducted a retrospective endoscopy database analysis of patients for whom 5-year colonoscopy surveillance had been requested for LRAs between 2013 and 2018 at a London teaching hospital. Patients with inflammatory bowel disease, previous colorectal cancer or Lynch syndrome were excluded. The age at which colonoscopy surveillance was due was calculated. We calculated the annual cost savings and endoscopy capacity that could be generated for our trust by ceasing colonoscopy surveillance for LRAs in patients aged 6–4 years and in all patients, using the 2018 NHS tariff for diagnostic colonoscopy of £406. Results 1035 patients were booked for colonoscopy surveillance for LRAs during the 5-year study period. 51.7% were male. The mean age at which colonoscopy surveillance was due was 63.5 years (SD 12.6). Discontinuing colonoscopy surveillance in patients aged 6–4 years with LRAs would save our trust £34,997 per year and generate an additional 87 colonoscopy appointments per year. Discontinuing colonoscopy surveillance in all patients with LRAs would save our trust £84,042 per year and generate an additional 207 colonoscopy appointments per year.Abstract PTU-104 Table 1 Annual cost savings and capacity generated by ceasing colonoscopy surveillance in patients with LRAs Model Patients offered colonoscopy surveillance over 5 years (n (%)) Cost of colonoscopy surveillance over 5 years Cost saving per year Colonoscopy capacity generated per year (n) Colonoscopy surveillance for LRAs 1035 (100) £420,210 £0 0 No colonoscopy surveillance for LRAs if aged 6–4 years 604 (58) £245,224 £34,997 87 No colonoscopy surveillance for LRAs 0 (0) £0 £84,042 207 Conclusions Significant cost savings can be made, and endoscopy capacity generated, by discontinuing colonoscopy surveillance for LRAs. In the increasingly financially constrained NHS environment this approach should be explored, particularly in patients who are eligible for participation in the BCSP.

Introduction Gastrointestinal (GI) bleeding is associated with a mortality of 10–30%. An NCEPOD report recently recommended that management of GI bleeds should be directed by a named GI bleed clinician, although wasn’t implicit that procedures be performed by a consultant.1 In SW London, 5 hospitals developed a network service to cover out-of-hours emergency endoscopy requirements for the region. It is a registrar-delivered, consultant-supported service. We present the key service outputs over a 10 month period in 2015. Methods OGDs were performed by registrars accredited with appropriate skills in upper endoscopy. Endoscopists prospectively collected data on all out-of-hours OGDs performed including age and sex of patient, Rockall score, time to OGD, primary endoscopic findings and therapeutic intervention. Data on mortality and re-bleed rates were retrospectively collected for the last 2 months of the study. Results 172 out-of-hours OGDs were performed between March and December 2015. 57% occured during the weekend, giving rise to a procedure rate of 1.12 OGD/weekend day and 0.33 OGD/week day. Mean age of patient was 59.5 years (range 16–94). 64% were male. Median Rockall score was 4. Mean time to OGD was 4hrs 15 mins (range 1 hr-16hrs). Table 1 shows the primary pathologies at OGD. Therapeutic intervention was needed in 52% of cases. Failure to achieve haemostasis endoscopically occured in 1.7%. Consultant assistance was required in 3 cases. Data from Nov to Dec 2015, which included 40 OGDs (mean age 59 years, 63% males, intervention rate 53%) indicated an inpatient re-bleed rate of 10% (NCEPOD audit rate 23%), an interventional radiology requirement in 6% (NCEPOD 8%) and a surgical intervention rate of 2.5% (NCEPOD 6%). All-cause 30 day mortality rate was 15%, although only one patient (2.5%) died as a direct result of uncontrolled bleeding.Abstract PWE-128 Table 1 Primary diagnosis Duodenal ulcer Gastric ulcer Variceal Non-variceal oesophageal pathology Foreign body Gastritis/duodenitis Cancer Other Normal % 23 18 17 10 3 5 2 11 11 Conclusion The results indicate that an effective and safe regional out-of-hours emergency GI bleed service can be provided via a registrar-delivered, consultant-supported model. This has important implications when considering the development of consultant on-call rosters, and maximising training opportunities for registrars. Reference 1 NCEPOD ‘Time to get control’ – a review of the care received by patients who had a severe gastrointestinal haemorrhage 2015. Disclosure of Interest None Declared

Introduction Gastrointestinal (GI) bleeding is associated with a mortality of 10–30%. An NCEPOD report recently recommended that management of GI bleeds should be directed by a named GI bleed clinician, although wasn’t implicit that procedures be performed by a consultant. 1 In SW London, 5 hospitals developed a network service to cover out-of-hours emergency endoscopy requirements for the region. It is a registrar-delivered, consultant-supported service. We present the key service outputs over a 10 month period in 2015. Methods OGDs were performed by registrars accredited with appropriate skills in upper endoscopy. Endoscopists prospectively collected data on all out-of-hours OGDs performed including age and sex of patient, Rockall score, time to OGD, primary endoscopic findings and therapeutic intervention. Data on mortality and re-bleed rates were retrospectively collected for the last 2 months of the study. Results 172 out-of-hours OGDs were performed between March and December 2015. 57% occured during the weekend, giving rise to a procedure rate of 1.12 OGD/weekend day and 0.33 OGD/week day. Mean age of patient was 59.5 years (range 16–94). 64% were male. Median Rockall score was 4. Mean time to OGD was 4hrs 15 mins (range 1 hr-16hrs). Table 1 shows the primary pathologies at OGD. Therapeutic intervention was needed in 52% of cases. Failure to achieve haemostasis endoscopically occured in 1.7%. Consultant assistance was required in 3 cases. Data from Nov to Dec 2015, which included 40 OGDs (mean age 59 years, 63% males, intervention rate 53%) indicated an inpatient re-bleed rate of 10% (NCEPOD audit rate 23%), an interventional radiology requirement in 6% (NCEPOD 8%) and a surgical intervention rate of 2.5% (NCEPOD 6%). All-cause 30 day mortality rate was 15%, although only one patient (2.5%) died as a direct result of uncontrolled bleeding. Conclusion The results indicate that an effective and safe regional out-of-hours emergency GI bleed service can be provided via a registrar-delivered, consultant-supported model. This has important implications when considering the development of consultant on-call rosters, and maximising training opportunities for registrars. Reference 1 NCEPOD ‘Time to get control’ – a review of the care received by patients who had a severe gastrointestinal haemorrhage 2015. Disclosure of Interest None Declared