Introduction Nasojejunal tubes (NJT) are traditionally inserted endoscopically (via oral route with subsequent mouth to nose transfer) or radiologically. The oral route is uncomfortable for patients and is technically more challenging. Transnasal endoscopy (TNE) is an emerging technique, performed with an ultrathin endoscope inserted via nasal passages. This circumvents the need for mouth to nose transfer of NJT, and can be placed with less sedation. It is a safe and effective alternative to traditional or fluoroscopic insertion (1-3). We aim to review the current practice of transnasal insertion of NJT service in South Tyneside District Hospital. Method We reviewed data retrospectively of transnasal NJT insertion from December 2013 to October 2016. We included 38 procedures, from 25 patients, of which 9 required repeat procedures (2–4 repeat procedures). Patients were aged 22 to 81, and were mostly men (M: 16, F: 9). Results The main indications for NJT insertion were pancreatitis, gastroparesis and malignancy. Patients received received topical anaesthesia (17), topical anaesthesia in combination with sedation (17), sedation only (3), and no sedation or topical anaesthesia (1). The mean midazolam dose for those under and above 70 was 2 mg. Post pyloric position of NJT was confirmed via AXR or endoscopically, this occurred in 37 cases (97.4%). Successful NJT placement was defined by its post pyloric position. Of all NJT insertions, successful placements occurred in 68.4% (26 of 38) of cases. Successful post pyloric insertion of NJT per patient was 76% overall (19 of 25). Based on indications, our success rate per patient was 91% for pancreatitis (10 of 11), 60% for gastroparesis (3 of 5), 75% for malignancy (3 of 4), 60% for other indications (3 of 5). Our NJT insertion has improved year on year. Conclusion At present, STDH is the only hospital delivering TNE in the North East of the United Kingdom. As far as we know this is the first attempt at reviewing transnasal placement of NJT in the UK. Our successful post pyloric insertion is comparable to those in the literature when similar indications (pancreatitis) is compared. Our yearly improvement in successful post pyloric insertion of NJT via TNE is encouraging, and proves that transnasal NJT insertion is a valuable service. References . Külling D, Bauerfeind P, Fried M. Transnasal versus transoral endoscopy for the placement of nasoenteral feeding tubes in critically ill patients. Gastrointest Endosc. 2000;52(4):506–10 . Zhihui T, Wenkui Y, Weiqin L, et al. A randomised clinical trial of transnasal endoscopy versus fluoroscopy for the placement of nasojejunal feeding tubes in patients with severe acute pancreatitis. Postgrad Med J2009; 85:59–63 . Qin Hua, Xiao-Yun Lu, Qiu Zhao, et al. Evaluation of a new method for placing nasojejunal feeding tubes. WJG 2012; 18(37): 5295–99 Disclosure of Interest None Declared

Introduction South Tyneside Hospital has been a referral centre for capsule endoscopy since 2005, performing over 1000 studies. We have previously shown that the diagnostic yield (DY) of the PillCam SB3 capsule (Given Imaging, Israel) is significantly higher than that of the PillCam SB2.1Here we present additional data on “learning curve” and offer suggestions for practice. Method Previous work compared the DY of the last 100 SB2 capsules with the first 100 SB3s. To assess for a “learning curve” effect we reviewed our first 100 SB2 capsules (Oct 2007–Aug 2008). Indications, completion rates, small bowel recording times and pathology were recorded. Pathology was classed as significant if it related directly to indication. Results 46 of the first 100 SB2 capsules were abnormal, of which 31 had significant pathology; almost identical to the last 100 SB2s (45 abnormal, 30 significant). Most tests (255/300, 85%) were for unexplained anaemia or Crohn’s disease assessment. More capsules are now done for acute GI bleeding; 4 of the first 100 SB2 capsules, 12 of the last 100 SB2s and 15 of the first 100 SB3s. There were 23 incomplete SB2 capsules (11.5%) of which 18 (9%) were in small bowel at the end of recording and 5 were held up by pathology (2.5%). Only 5 SB3 studies (5%) were incomplete, with 4 (4%) not entering the colon and 1 (1%) held up by pathology. On average SB3 capsules had a longer recording time of 9 h and 24 min compared to 8 h and 2 min for the SB2s. Conclusion 219 capsules were reported before the SB2 was introduced. Between the first hundred and last hundred SB2 capsules there were 1003 SB2 studies. This suggests that the increased DY is not due to a “learning curve”, supporting our finding of increased DY with the SB3. Any “learning curve” is likely to be from the first 200 studies. Most studies are for iron deficiency anaemia and Crohn’s disease assessment but there is a trend towards using capsules as a diagnostic tool in overt GI bleeds. Fewer SB3 studies were incomplete compared to SB2s. Our unit is now more proactive in monitoring gastric transit and colonic entry using the real time viewer and this change in practice may have helped with this. Longer recording times due to increased battery life may also play a part. We recommend monitoring capsules in real time and leaving the recorder on for longer if gastric transit is delayed or colonic entry is not clear. Disclosure of interest None Declared. Reference Dunn, S. et al. PTU-053 Is It Worth Repeating Previous Unremarkable Sb2 Capsules With The New Sb3? Gut 63 Suppl 1(2014):A61–A62

Introduction South Tyneside Hospital has been a referral centre for capsule endoscopy since 2005, performing over 1000 studies. We have previously shown that the diagnostic yield (DY) of the PillCam SB3 capsule (Given Imaging, Israel) is significantly higher than that of the PillCam SB2.1Here we present additional data on “learning curve” and offer suggestions for practice. Method Previous work compared the DY of the last 100 SB2 capsules with the first 100 SB3s. To assess for a “learning curve” effect we reviewed our first 100 SB2 capsules (Oct 2007–Aug 2008). Indications, completion rates, small bowel recording times and pathology were recorded. Pathology was classed as significant if it related directly to indication. Results 46 of the first 100 SB2 capsules were abnormal, of which 31 had significant pathology; almost identical to the last 100 SB2s (45 abnormal, 30 significant). Most tests (255/300, 85%) were for unexplained anaemia or Crohn’s disease assessment. More capsules are now done for acute GI bleeding; 4 of the first 100 SB2 capsules, 12 of the last 100 SB2s and 15 of the first 100 SB3s. There were 23 incomplete SB2 capsules (11.5%) of which 18 (9%) were in small bowel at the end of recording and 5 were held up by pathology (2.5%). Only 5 SB3 studies (5%) were incomplete, with 4 (4%) not entering the colon and 1 (1%) held up by pathology. On average SB3 capsules had a longer recording time of 9 h and 24 min compared to 8 h and 2 min for the SB2s. Conclusion 219 capsules were reported before the SB2 was introduced. Between the first hundred and last hundred SB2 capsules there were 1003 SB2 studies. This suggests that the increased DY is not due to a “learning curve”, supporting our finding of increased DY with the SB3. Any “learning curve” is likely to be from the first 200 studies. Most studies are for iron deficiency anaemia and Crohn’s disease assessment but there is a trend towards using capsules as a diagnostic tool in overt GI bleeds. Fewer SB3 studies were incomplete compared to SB2s. Our unit is now more proactive in monitoring gastric transit and colonic entry using the real time viewer and this change in practice may have helped with this. Longer recording times due to increased battery life may also play a part. We recommend monitoring capsules in real time and leaving the recorder on for longer if gastric transit is delayed or colonic entry is not clear.Abstract PTH-031 Table 1 Pathology by capsule group Capsule Type First 100 SB2 Last 100 SB2 First 100 SB3 Angioectasia 7 6 18 Blood 4 3 4 Coeliac changes 2 3 1 Polyp/Mass 1 1 4 Stricture 1 3 1 Ulcers/erosions 16 14 20 Other 0 0 1 Total 31 30 49 Disclosure of interest None Declared. Reference Dunn, S. et al. PTU-053 Is It Worth Repeating Previous Unremarkable Sb2 Capsules With The New Sb3? Gut 63 Suppl 1(2014):A61–A62

Introduction Small bowel capsule endoscopy (SBCE) has become a valuable tool for investigating the small bowel and technology is rapidly advancing. One of the most recent devices available for capsule endoscopy (Pillcam® SB3, Given Imaging) has improved image resolution and a variable frame rate. The aim of this work is to address whether these innovations lead to increased mucosal visualisation and diagnostic yield in clinical practice and therefore whether a repeat SB3 capsule should be considered in those patients with an equivocal SB2 result. Methods A review was undertaken of the last 100 Pillcam® SB2 capsules and the first 55 Pillcam® SB3 capsules to be performed at South Tyneside District Hospital (14/01/13–12/12/13). Visualisation of the ampulla was used as a surrogate marker of mucosal visualisation and diagnostic yield was assessed by reviewing the reports. Statistical significance was calculated using Fisher’s exact test. Results Results are summarised in Table 1 below. The ampulla was visualised in 14% of SB2 capsules and 18% of SB3 capsules (p > 0.05). 44% of SB2 capsules were abnormal and SB3 capsules were abnormal in 62% of cases (p < 0.05). Conclusion It is recognised that the views obtained by SBCE can be compromised in the duodenum due to “rapid transit” and previous studies have suggested that due to this the ampulla of Vater is not often seen.1 Variable frame rates aim to address this by capturing more images when the capsule is moving quicker. We showed no statistically significant difference between ampullary visualisation of the SB2 and SB3 capsules, although the trend was to a higher percentage visualisation with the SB3 capsule. The overall yield of pathology from SB3 capsules was significantly higher than that in SB2 capsules. Given the overall increased yield of pathology it may be beneficial to repeat an SB3 capsule in someone with a previously equivocal SB2 result. Reference Koulaouzidis A, Rondonotti E, Karargyris A. Small-bowel capsule endoscopy: A ten-point contemporary review. World Journal of Gastroenterology 2013;19(24):3726–2840 Disclosure of Interest S. Dunn Grant/research support from: Aquilant Endoscopy, R. Bevan Grant/research support from: Aquilant Endoscopy, L. Neilson: None Declared, R. Keay: None Declared, C. Davison: None Declared, F. Butt: None Declared, S. Panter: None Declared.

BACKGROUND:M30 and M65 enzyme-linked immunosorbent assays detect circulating cytokeratin 18 fragments released during caspase-dependent or total cell death, respectively, and have potential as biomarkers in epithelial cancers. While these assays have been validated, their robustness for routine clinical use is unknown.PATIENTS AND METHODS:M30 and M65 were measured in matched serum and plasma samples from 31 lung cancer patients and 18 controls.RESULTS:Time allowable between sample acquisition and processing is critical for assays in clinical use. A 4-h delay in processing at room temperature increased M30 (P < 0.0001), an effect minimised by incubation on ice. M30 and M65 in serum were resistant to processing variations including delays. Serum and plasma measurements correlated well although M30 but not M65 was lower in serum (P < 0.0005). Less variation between duplicate assays was observed in serum. Prolonged storage (-80 degrees C) led to increased M30 (12%, 6 months; 34%, 1 year). Sample dilution in the supplied assay diluent proved non-linear, whereas dilution in donor serum or porcine plasma restored linearity up to a ratio of 1 : 6.CONCLUSION:We present recommendations that improve the reliability of these assays for clinical use and recommend serum as the preferred matrix with data more resistant to variations in collection.

PURPOSE:M30 and M65 ELISAs are proposed as surrogate biomarkers of tumour cell death in patients and are being applied increasingly in the pharmacodynamic (PD) evaluation of anticancer drugs during clinical trials. In the absence of such data, we have studied the long-term stability of the antigens of both assays in plasma of cancer patients stored at -80 degrees C over 2 years.RESULTS:No evidence was detected of degradation in the M65 antigen. However, in a proportion of patients significant increases in levels of M30 antigen were detectedCONCLUSION:Plasma samples for M65 analysis can be stored at -80 degrees C for 2 years; however, caution is recommended when considering long-term storage of samples for the M30 assay.