Introduction: Radiation Personal Protective Equipment (RPPE) is the subject of safety guidance from the British Orthopaedic Association (BOA). This pilot study aimed to examine potential performance differences in Trauma and Orthopaedic (T&O) Higher Surgical Trainees (HST) undertaking simulated Dynamic Hip Screw (DHS) surgery related to different RPPE attire. Methods: Fourteen Higher Surgical Trainees took part in a randomised, repeated-measures, crossover study (8 male, 6 female HSTs) performing two simulated DHS procedures wearing two RPPE attire styles (One Piece (OP) tabard 0.35 mm thickness, and Two-Piece skirt/top (TP), with a 0.5 mm thyroid guard). Primary outcome measures included continuous Heart Rate (HR) monitoring, body temperature, and Visual Analogue Scales (VAS) for comfort and fatigue before and after simulations. Results: Mean (SD) HR in OP and TP were HR OP 98.8 bpm (10.3) vs. TP 98.1 bpm (10.8, p G 0.001), Maximum HR OP 115.1 bpm (SD 12.4) vs. TP 113.4 bpm (SD 11.9) (p G 0.001). Mean change in temperature were OP 0 degrees C and TP -0.03 degrees C (p G 0.001). Mean temperature VAS scores in OP were 1.9 (1.7) vs. TP 2.0 (1.4, p G 0.001). Mean Comfort VAS scores were OP 3.1 (2.4) vs. TP 1.7 (2.1, p G 0.001) and Fatigue OP 1.4 (1.9) vs. TP 0.8 (1.5, p = 0.120). Discussion: Important differences in surgeon physiological measures (HR, temperature) and self-reported measures of comfort and temperature were found related to RPPE style. Understanding the effects that specific RPPE attire has on performance should influence RPPE choice and the findings help inform future research into this important topic.

Gamification in medical education offers medical escape rooms (MERs) as an innovative, learner-centred adjunct to traditional simulation teaching. Similar simulation-based education demonstrated improvements in communication skills and knowledge retention. This study aimed to assess the acceptability and effectiveness of MERs to deliver key curricula to undergraduate medical students. Final-year medical students completed two time-limited MER challenges, utilising medical frameworks and abstract clues to manage simulated emergency scenarios. Participants completed anonymous pre- and post-course questionnaires, utilising a 5-point Likert scale to assess their confidence in managing acutely unwell patients. Data analysed with non-parametric Wilcoxon signed rank tests. Medical students numbering 33 completed all elements of the immersive simulation; all were familiar (21;64%) or very familiar (12;36%) with the escape room concept, whilst 31(94%) either agreed or strongly agreed that simulation was a useful learning adjunct. There were significant increases in the reported ability to manage acutely unwell patients (Median[range] 3[2-4] pre. Vs. 4[3-5] post; p<0.001) and ability to manage surgical emergencies (3[2-4] pre. Vs. 4[2-5] post; p<0.001) following the MERs. All respondents strongly agreed (24;73%) or agreed (9;27%) that MERs were relevant for their training grade. 24(73%) strongly agreed and 8(24%) agreed the session was interactive and engaging, with a single participant neutral on this question. Escape rooms are a familiar concept and hence MERs are a relevant delivery method. MERs can significantly increase students' reported ability to manage real-life medical and surgical emergencies and hence should form part of modern undergraduate curricula.

INTRODUCTION:The aim of this study was to investigate the effect of body mass index (BMI, kg/m2) on outcomes of high-volume low-complexity (HVLC) general surgery procedures and to determine critical values for BMI when selecting patients into HVLC programmes. METHODS:A systematic review was conducted of studies looking at patients in different BMI categories undergoing HVLC general surgery procedures (laparoscopic cholecystectomy, inguinal hernia repair and umbilical or paraumbilical hernia repair), in accordance with the PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) guidelines. A comparison meta-analysis model was constructed to compare the outcomes using random-effects modelling. The QUIPS (Quality In Prognosis Studies) tool and GRADE (Grading of Recommendations Assessment, Development and Evaluation) system were used to assess bias. RESULTS:A total of 26 studies including 486,392 patients were examined. In laparoscopic cholecystectomy, BMI ≥40 was associated with higher conversion to open surgery (odds ratio [OR]: 1.33, p=0.040) but did not affect complications (OR: 0.69, p=0.400) or length of hospital stay (mean difference [MD]: -0.01 days, p=0.900). In inguinal hernia repair, BMI ≥35 was associated with longer operative time (MD: 18.00 minutes, p<0.00001), and higher risk of wound complications (OR: 3.01, p<0.00001) and hospital readmission (OR: 1.46, p=0.0008). In umbilical or paraumbilical hernia repair, BMI ≥30 was associated with higher risk of wound complications (OR: 6.45, p<0.0001) and hospital readmission (OR: 5.56, p<0.00001), and longer operative time (MD: 4.01 minutes, p=0.030). CONCLUSIONS:Obesity was associated with longer operative time (up to 23 minutes) and higher risk of postoperative morbidity (up to 4-fold) in HVLC procedures. BMI <40 (moderate GRADE certainty - laparoscopic cholecystectomy) and BMI <35 (moderate GRADE certainty - inguinal hernia) appear to represent optimal critical values for perioperative safety metrics.

INTRODUCTION:Parathyroid localisation is now routine before first-time surgery for patients with primary hyperparathyroidism (PHPT). The aim of this study was to investigate the contribution of intraoperative parathyroid hormone (PTH) (ioPTH) in patients in whom localisation was either not undertaken or negative for a tumour. METHODS:This was a retrospective study of patients undergoing first-time parathyroidectomy for PHPT in a regional endocrine centre. Data were collected prospectively (Microsoft Excel) and the all-Wales electronic patient record portal was used to retrieve missing data. Statistical analysis appropriate for nonparametric data was undertaken, with statistical significance reached when p<0.05. RESULTS:Between 1 July 2002 and 31 December 2022, 1,490 patients underwent a first-time parathyroidectomy for PHPT. Of this cohort, 1,133 patients had at least one positive imaging modality; the study group consisted of 343 patients that had negative imaging, and 13 that had no preoperative localisation. Patients with MEN-1 (n=26), an incorrect diagnosis (n=4), or less than six months follow-up (n=6) were excluded. Of the remaining 321, 106 patients underwent surgery without ioPTH (Group A), 215 cases with ioPTH (Group B). In Group B there were more women (170 female/45 male; 79% vs 67 female/37 male; 63% p=0.002, chi-squared), lower calcium (median [range] 2.77 [2.63-3.24] mmol/l; vs 2.85 [2.60-4.52] p=0.001) and lower PTH (12.0pmol/l [3.4-39.5] vs 14.4 [3.9-97.0] p=0.001) and smaller weights of resected tissue (320mg [50-9,000] vs 454 [46-8,280] p=0.02) (Student's t-test). The rate of multiple gland disease was similar (Group A 29%; Group B 27%). The rate of normocalcaemia at 6 months was significantly higher when ioPTH was used (Group B 202/215; 94% vs Group A 90/106; 85%) (p=0.014, chi-square test). The sensitivity and specificity of ioPTH was 98.5% [confidence interval (CI) 96.2-99.6] and 91.2% [80.7-97.0] (positive predictive value 99.9%, CI 93.6-100.0). CONCLUSION:Despite milder hyperparathyroidism and smaller tumour weight, the outcome in patients in whom ioPTH was used was superior, with failure rates 2.5-fold higher in the cohort where ioPTH was not utilised. The results of this study demonstrate that ioPTH is a valuable adjunct for the surgeon in cases where localisation has failed or not been undertaken.

Introduction: Socio-Economic Deprivation has long been associated with many gastrointestinal diseases yet its influence on esophago-gastro-duodenoscopy (EGD) diagnosis has not been evaluated. The aim of this study was to investigate the influence of deprivation on outcomes of EGD irrespective of referral reason. Method: Two-thousand consecutive patients presenting to four Health Boards in Wales from June 2019 were studied retrospectively with deprivation scores calculated using the Wales Indices of Multiple Deprivation (WIMD). Patients were sub-classified into quintiles for analysis (Q1 most, Q5 least Deprived). Results: Inhabitants of the most deprived areas were more likely to be diagnosed with Peptic Ulcer (Q1 7.9%, Q5 4.7%; OR 0.498, p=0.018), Severe Esophagitis (LA4, Q1 2.7% v Q5 0%, OR 0.089, p=0.002), Helicobacter Pylori infection (Q1 5.4%, Q5 1.7%; OR 0.284, p=0.002), but less likely to be diagnosed with Barrett’s Eesophagus (Q1 6.3% v Q5 12.3%, OR 2.146, p=0.004) than those from least deprived areas. New cancer diagnoses numbered 53 and were proportionately higher after Urgent Suspected Cancer (USC, n=35, 4.6%) than routine referral (n=3, 0.6%, p<0.001). Deprivation was associated with more advanced staged cancer (stage III Q1 16.7% v Q5 5.6%, OR 0.997, p=0.006: stage IV Q1 16.7% v Q2 38.9% v Q5 22.2%, OR 0.998, p=0.049). Conclusion: Deprivation was associated with two-fold more peptic ulcer disease, three-fold more Helicobacter Pylori infection, and 12-fold more severe esophagitis, and more advanced cancer stage.

AIMS:The aims of this study are to determine the long-term overall survival (OS) after surgically treated malignant struma ovarii (MSO) and to evaluate prognostic effect of adjuvant thyroid-related therapy (ATRT) in this setting. METHODS:A systematic review in compliance with Preferred Reporting Items for Systematic reviews and Meta-Analyses standards was conducted. MEDLINE, CINAHL, CENTRAL, Scopus, trial registries, and gray literature were searched. Due to rarity of the disease, all case reports including patients with surgically treated MSO were pooled to create a single cohort which was then compared with the eligible case series. The OS and survival time were primary outcomes. The OS was determined using Kaplan-Meier survival statistics, and the predictors of OS were determined using the stepwise Cox proportional-hazards regression model. RESULTS:The study included 376 patients (95 from case reports and 281 from case series). The median age was 44 years; 79% (75/95) were symptomatic. In terms of ATRT, 39% (37/95) received thyroidectomy, 28% (27/95) radioactive iodine, 28% (27/95) hormone suppression therapy, and 55% (52/95) received no therapy. Recurrence occurred in 27% (26/95) with the median time to recurrence of 4 years. The pooled OS was 91% at 10 years and 87% at 20 years. The OS was not predicted by age (p = 0.320), symptomatic status (p = 0.371), follicular histology (p = 0.934), metastatic disease (p = 0.981); omentectomy (p = 0.523), total thyroidectomy (p = 0.371), radioactive iodine therapy (p = 0.285), and thyroid hormone therapy (p = 0.994). CONCLUSIONS:Surgically treated MSO may have excellent long-term prognosis with or without ATRT. It is possible that thyroid-specific treatments in MSO constitute overtreatment, with no demonstrable survival benefit. Limitations in the evidence base limit the ability to produce definitive conclusions.

Background and study aims Socioeconomic deprivation has long been associated with many gastrointestinal diseases, yet its influence on esophagogastroduodenoscopy (EGD) diagnosis has not been evaluated. The aim of this study was to investigate the influence of deprivation on outcomes of EGD irrespective of referral reason. Patients and methods Two thousand consecutive patients presenting to four Health Boards in Wales beginning in June 2019 were studied retrospectively with deprivation scores calculated using the Wales Indices of Multiple Deprivation (WIMD). Patients were subclassified into quintiles for analysis (Q1 most, Q5 least deprived). Results Inhabitants of the most deprived areas were more likely to be diagnosed with peptic ulcer (Q1 7.9%, Q5 4.7%; odds ratio [OR] 0.498, P =0.018), severe esophagitis (LA4, Q1 2.7% v Q5 0%, OR 0.089, P 0.002), Helicobacter pylori infection (Q1 5.4%, Q5 1.7%; OR 0.284, P =0.002), but less likely to be diagnosed with Barrett's esophagus (Q1 6.3% v Q5 12.3%, OR 2.146, P =0.004) than those from the least deprived areas. New cancer diagnoses numbered 53 and were proportionately higher after presentation for urgent suspected cancer (USC, n=35, 4.6%) than for routine referrals (n=3, 0.6%, P < 0.001). Deprivation was associated with more advanced stage cancer (stage III Q1 16.7% v Q5 5.6%, OR 0.997, P =0.006: stage IV Q1 16.7% v Q2 38.9% v Q5 22.2%, OR 0.998, P =0.049). Conclusions Deprivation was associated with two-fold more peptic ulcer disease, three-fold more H. pylori infection, and 12-fold more severe esophagitis, and more advanced cancer stage.

Journal Article Love all, trust a few, do wrong to none Get access Christopher R Bowman, Christopher R Bowman Department of Surgery, Ysbyty Gwynedd, Bangor LL57 2PW, Gwynedd, United Kingdom Corresponding author. Department of Surgery, Ysbyty Gwynedd, Penrhosgarnedd, Bangor LL57 2PW, Gwynedd. E-mail: chris.bowman@wales.nhs.uk Search for other works by this author on: Oxford Academic Google Scholar Mollie Kearns, Mollie Kearns Department of Surgery, Morriston Hospital, Swansea SA6 6NL, United Kingdom Search for other works by this author on: Oxford Academic Google Scholar Richard J Egan, Richard J Egan Department of Surgery, Morriston Hospital, Swansea SA6 6NL, United KingdomDepartment of Medicine, Health and Life Sciences, Swansea University, Swansea SA2 8PP, United Kingdom Search for other works by this author on: Oxford Academic Google Scholar Wyn G Lewis Wyn G Lewis Department of Surgery, University Hospital of Wales, Cardiff CF14 4XW, United Kingdom Search for other works by this author on: Oxford Academic Google Scholar Postgraduate Medical Journal, qgad122, https://doi.org/10.1093/postmj/qgad122 Published: 23 December 2023 Article history Received: 22 September 2023 Revision received: 16 November 2023 Accepted: 17 November 2023 Published: 23 December 2023

Abstract Background Endoscopy training is sub-optimal (two thirds of dedicated training lists fall short of demand) and if competency trajectories are to improve, capacity must amplify. The aim was to develop a semi-automated web-based Application (App) to maximise training. Methods A blended Clinical and Digital Services App team used integrated list planning, built with open-source PHP framework Laravel and TALL Stack, and cloud hosted with Microsoft Azure. User profiles were aligned with Joint Advisory Group on Endoscopy (JAG) Training terminology - six users with diverse functionality (Planner, Training Lead, Trainer, Trainee, Viewer, and Administrator) supplying endoscopy list planning linked to e-invitation, to create a prototype MEET tool. Results Real time prototype testing proved MEET was accessible on all modern web browser platforms (on-line wired, Wi-Fi and broadband) with an App icon available on iOS and Android. Endoscopy list use was assessed prospectively over two months, one before (114 lists, 22.8% training dedicated) and one after MEET tool introduction (108 lists, 22.2% training dedicated). MEET could improve full training list use from 19.2% (5 lists) before, to 41.7% (10 lists) after introduction (Chi2 46.4, p<0.001; Cramer’s V 0.457, p<0.001). Moreover, the potential for ad-hoc training improved from 10.4% (10 lists) to 48.9% (44 lists, p<0.01). Conclusion MEET tool assessment within a development test area was workable with two- to four-fold better training opportunity. MEET has important promise and roll-out potential to all medical training - an opportune COVID recovery tool.

Introduction Engagement is increasingly perceived as a key National Health Service (NHS) performance factor. The aim of this study was to characterise surgical trainees’ experiences of the 13 engagement behaviours recommended by the NHS Leadership Academy. Methods A perception survey of engagement behaviours (grouped into 4 hierarchical levels as “essential”, “proficient”, “strong” and “exemplary”) was disseminated to surgical trainees in a UK statutory education body. Trainees’ perceived experiences of these behaviours being demonstrated by their consultant trainers were graded using a four-point Likert scale. Results Responses were received from 121 trainees (75 core surgical trainees [CSTs], 46 higher surgical trainees [HSTs]). The response rate was 52.1% for CSTs and 30.7% for HSTs. Survey responses suggested that the average consultant trainer demonstrates fewer than half (49.3%) of the 13 engagement behaviours “often” or “always”. Broken down by hierarchical group, 57.6% of essential behaviours, 46.3% of proficient behaviours, 43.8% of strong behaviours and 49.6% of exemplary behaviours were demonstrated “often” or “always”. Fewer than half (49.6%) of the trainees surveyed reported experiencing more than half of the engagement behaviours “often” or “always”. On multivariate analysis, the frequency with which trainees experienced engagement behaviour was associated with trainee seniority (odds ratio [OR]: 3.05, 95% confidence interval [CI]: 1.41–6.58, p = 0.004) and ethnicity (OR: 2.35, 95% CI: 1.07–5.17, p = 0.034). Conclusions Half of the trainees surveyed rarely experienced the full spectrum of engagement behaviours from clinical leaders, with approximately one in seven perceiving little or no engagement at all. Inferior performance in the General Medical Council’s fifth professional capability domain requires focused leadership correction.

INTRODUCTION:Core Surgical Training (CST) programs are associated with high burnout. This study aimed to assess the influence of Enhanced Stress Resilience Training (ESRT) over a 2-year period in a single UK Statutory Education Body. METHOD:CSTs participated in 5-weeks of formal ESRT to address work stressors. The primary outcome measure was career progression related to curriculum metrics and National Training Number (NTN) appointment. Secondary measures related to burnout using validated psychological inventories. RESULTS:Of 42 CSTs, 13 engaged fully with ESRT (31.0%; male 8, female 5, median age 28 year.), 11 engaged partially, and 18 did not. ESRT engagement was associated with better NTN appointment (ESRT 8/13 (61.5%) vs. not 1/18 (5.6%), p = 0.025), less burnout [aMBI; mean 5.14 (SD ± 2.35) vs. 3.14 (±2.25), F 6.637, p = 0.002, ηp2=0.167], less stress [PSS-10; 19.22 (±5.91) vs. 15.79 (±5.47), F 8.740, p < 0.001, ηp2=0.200], but more mindfulness [CAMS-R; 19.22 (±5.91) vs. 20.57 (±2.93), F 3.201, p = 0.047, ηp2=0.084]. On multivariable analysis, Improving Surgical Training (run-through CST) program (OR 5.2 (95% CI 1.42-28.41, p = 0.022), MRCS pass (OR 17.128 (95% CI 1.48-197.11, p = 0.023) and ESRT engagement (OR 13.249, 95% CI 2.08-84.58, p = 0.006) were independently associated with NTN success. DISCUSSION:ESRT was associated with less stress and burnout, better mindfulness, and most importantly 13-fold better career progression.

Introduction This study aimed to evaluate differential attainment during higher surgical training (HST; all specialties) related to three ethnic cohorts: White UK (WUKG), Black and Minority Ethnic UK Graduates (BMEUKG), and International Medical Graduates (IMG). Method Anonymised records of 266 HSTs (126 WUKG, 65 BMEUKG, 75 IMG; 7 years) in a single UK Statutory Education Body were examined. Primary effect measures were Annual Record of Competency Progression Outcome (ARCPO) and Fellowship of the Royal College of Surgeons (FRCS) pass. Results ARCPOs related to ethnicity and specialty were similar with the exception of general surgery (GS) trainees, four of whom received ARCPO 4 (GS 4.9% (75% BME; p=0.025) vs all other 0%). ARCPO 3 was commoner in women (22/76, (28.9%) than men 27/190 (14.2%), OR 2.46, p=0.006). FRCS pass rates (WUKG vs BMEUKG vs IMG) were 76.9%, 52.9% and 53.9% respectively (p=0.064) but unrelated to gender (M 70.4% vs F 64.3%). On multivariable analyses: ARCPO 3 was associated with Female gender and Maternity Leave (OR 8.05, p=0.001); FRCS pass with ethnicity (OR 0.21, p=0.028) and Hirsch Indices of ≥5 (OR 11.17, p=0.001). Conclusion Differential attainment was plain with BMEUKG FRCS performance almost a third poorer than WUKG, and women twofold more likely to receive adverse ARCPOs, with return from statutory leave independently associated with training extension. Focused counter measures targeted at non-operative technical skills (including academic reach), Keeping in Touch, Return to Work, and re-induction programmed support are urgently needed for trainees at risk.

BACKGROUND:This study aimed to evaluate core surgical training (CST) differential attainment related to coronavirus disease 2019 (COVID-19), gender and ethnicity. The hypothesis was that COVID-19 adversely influenced CST outcomes.METHODS:A retrospective cohort study of 271 anonymised CST records was undertaken at a UK Statutory Education Body. Primary effect measures were Annual Review of Competency Progression Outcome (ARCPO), Membership of the Royal College of Surgeons (MRCS) examination pass and Higher Surgical Training National Training Number (NTN) appointment. Data were collected prospectively at ARCP and analysed with non-parametric statistical methods in SPSS.RESULTS:CSTs numbering 138 completed training pre-COVID and 133 peri-COVID. ARCPO 1, 2 and 6 were 71.9% pre-COVID versus 74.4% peri-COVID ( P =0.844). MRCS pass rates were 69.6% pre-COVID versus 71.1% peri-COVID ( P =0.968), but NTN appointment rates diminished (pre-COVID 47.4% vs. peri-COVID 36.9%, P =0.324); none of the above varied by gender or ethnicity. Multivariable analyses by three models revealed: ARCPO was associated with gender [m:f 1:0.87, odds ratio (OR) 0.53, P =0.043] and CST theme (Plastics vs. General OR 16.82, P =0.007); MRCS pass with theme (Plastics vs. General OR 8.97, P =0.004); NTN with the Improving Surgical Training run-through programme (OR 5.00, P <0.001). Programme retention improved peri-COVID (OR 0.20, P =0.014) with pan University Hospital rotations performing better than Mixed or District General-only rotations (OR 6.63, P =0.018).CONCLUSION:Differential attainment profiles varied 17-fold, yet COVID-19 did not influence ARCPO or MRCS pass rates. NTN appointment fell by one-fifth peri-COVID, but overall training outcome metrics remained robust despite the existential threat.

Background Endoscopy training is sub-optimal (two thirds of dedicated training lists are not used to full potential). If competency trajectories are to improve, additional training and ad hoc list capacity and more efficient use of training opportunities are required. We developed a semi-automated web-based Application (App) to maximise training and assess contributory factors to sub-optimal list use. Methods A blended Clinical and Digital Services App team used integrated list planning, built with open-source PHP framework Laravel and TALL Stack, and cloud hosted with Microsoft Azure. User profiles were aligned with Joint Advisory Group on Endoscopy (JAG) Training terminology - six users with diverse functionality (Planner, Training Lead, Trainer, Trainee, Viewer, and Administrator) supplying endoscopy list planning linked to e-invitation, to create a prototype MEET tool. Results Real time prototype testing proved MEET was accessible on all modern web browser platforms (on-line wired, Wi-Fi and broadband) with an App icon available on iOS and Android. Endoscopy list use was assessed prospectively in a District General Hospital setting over two months, one before (114 lists, 22.8% training dedicated) and one after MEET tool introduction (108 lists, 22.2% training dedicated). MEET could improve full training list use from 19.2% (5 lists) before, to 41.7% (10 lists) after introduction (Chi2 46.4, p<0.001; Cramer's V 0.457, p<0.001). Moreover, the potential for ad-hoc training improved from 10.4% (10 lists) to 48.9% (44 lists, p<0.01). The tool will prospectively collect reasons for trainee and trainer absence from endoscopy lists; along with notification timing, and identify potential backfill opportunities to preserve training and service delivery. Conclusion MEET tool assessment within a development test area was workable with two- to four-fold better training opportunity. MEET showed important promise to provide detailed insights into barriers to training and roll-out potential to optimise training opportunities across wider areas of specialty training.

Abstract Introduction Differential Attainment (DA) refers to divergent achievements when related to protected traits. Annual Review of Competency Progression (ARCP) panels play a key role which compositions should reflect, yet no guidance exists on panel profile related to protected traits. This study aimed to evaluate the influence of panel profile on DA. Methods Anonymised ARCPs numbering 1090 in a UK Statutory Education Body (SEB) were examined and primary effect measure was ARCP Outcome (ARCPO) with satisfactory ARCPO classified as 1, 2 or 6, and unsatisfactory as 3 or 4. Results Satisfactory ARCPOs numbered 1005 and unsatisfactory 85. Median panel number was 7 (range 1-15, p<0.001). Median female percentage consultant representation was 18.2% (0% (Urology, Plastic & Paediatric Surgery) to 40% (Core Surgery) and median ethnicity (BME) consultant representation 14.3% (0% (Vascular & Neurosurgery) to 80% (Cardiothoracic Surgery). Multivariable analysis revealed: Trainee seniority (OR 0.800, p<0.001), SAC Liaison Member gender (OR 0.720, p=0.013) and Panel gender balance (N ARCP panel females, OR 10.695, p=0.003) to be independently associated with adverse ARCPO. Discussion Important two to five-fold variance in ARCP panels were found related to gender and ethnicity profile respectively with apparent significant impact on DA.

discharged from A&E. 80% of these discharged patients had an Oakland Score >8. 21 (17.2%) of admitted patients received an inpatient lower GI endoscopy; 19% of which received endoscopic therapy. The most commonly identified cause of LGIB was diverticulosis (23.8%). Overall, 82.8% of admitted patients received no inpatient lower GI endoscopy and were managed conservatively. Comparing those who underwent LGI endoscopy versus a watch and wait approach, there was no difference in inpatient mortality (0% vs 4%, p=1.0) or 30-day re-admission rate (9.5% vs 22.8%, p= 0.24). However, undergoing inpatient LGI endoscopy was associated with greater median length of stay (8 days vs 3 days, p=0.0002)

Abstract Introduction Socio-Economic Deprivation has long been associated with many gastrointestinal diseases yet its influence on OesophagoGastroDuodenoscopy (OGD) findings has not been evaluated. The aim of this study was to investigate the influence of deprivation on outcomes of OGD irrespective of referral reason. Method Two-thousand consecutive patients presenting to four Health Boards in Wales (June 2019-) were studied retrospectively with deprivation scores calculated using the Wales Indices of Multiple Deprivation (WIMD). Patients were subclassified into Quintiles for analysis (Q1 most, Q5 least Deprived). Results Inhabitants of the most deprived areas were more likely to be diagnosed with Peptic Ulcer (Q1 7.9%, Q5 4.7%; OR 0.498, p=0.018), Severe Oesophagitis (LA4, Q1 2.7% v Q5 0%, OR 0.089, p=0.002), Helicobacter Pylori infection (Q1 5.4%, Q5 1.7%; OR 0.284, p=0.002), but less likely to be diagnosed with Barrett’s Oesophagus (Q1 6.3% v Q5 12.3%, OR 2.146, p=0.004) than those from least deprived areas. New cancer diagnoses numbered 53 and were proportionately higher after Urgent Suspected Cancer (USC) referral (n=35, 4.6%) with three diagnosed after routine OGD (0.6%, p<0.001). Deprivation was associated more advanced radiological perceived Stage III Cancer (Q1 16.1% v Q2 55.6% v Q5 5.6%, OR 0.007, p=0.005). Conclusion Deprivation was associated with two-fold more peptic ulcer disease, three-fold more Helicobacter Pylori infection, and 12-fold more severe oesophagitis, which correlated with up to 10-fold more advanced cancer stage at diagnosis.