Introduction Radio-frequency ablation (RFA) for the treatment of Barrett’s oesophagus (BE) related neoplasia has become the preferred ablative intervention after endoscopic resection (ER) over the past decade. For circumferential BE, the 3 cm HALO 360 balloon can be used to treat large areas. A new device, HALO 360 Express self-sizing catheter was recently launched and can potentially allow quicker ablation times and better coverage of the mucosa due to the improved tissue/catheter contact and 4 cm balloon length. Method Specialist centres in the UK and Ireland submitted cases where Halo 360 express had been used. Patients returned for follow up at 3 months after index RFA express treatment. They were analysed for surface area regression of BE and stricture formation. For those patients who went on to complete RFA treatment histological regression of intestinal metaplasia (EoT (End of Treatment) CR-IM) and dysplasia (EoT CR-D) were analysed. Results 11 centres across the UK and Ireland submitted 116 patients treated with the Halo 360 Express Catheter. The mean age was 66 years+/-9.8. 83% were male. 38 patients had low grade dysplasia as baseline histology (32.7%); 59 patients had high grade dysplasia (50.8%) and 19 patients had intra-mucosal carcinoma (16.5%). The mean pre-treatment circumferential length of BE (C) was 5.5 cm +/-4.3 cm and the mean maximal length (M) was 7.7 cm +/-3.6 cm. 47% had had previous ER. 80/116 had at least 3 month follow up. In these, the mean% reduction in C was 77.4%+/-36.8% and the mean% reduction in M was 53.2%+/-38.2%. 11/80 (14%) patients developed strictures that required dilation at 3 months. 2/11 had been treated with 12J dose and 2/11 had had previous ER. The median number of dilations required was 2 (IQR 1–3). 19 patients had reached end of treatment biopsies. 16/19 (84%) had achieved CR-D and 16/19 (84%) had achieved CR-IM. Conclusion Early experience from the UK and Ireland suggest that the new RFA express is effective in reducing the SA of visible BE by 50% after the index treatment. However, the stricture rate appears high. Although the EoT numbers are small disease eradication in patients with BE neoplasia is good following index RFA express application. Disclosure of Interest None Declared

Introduction Vedolizumab (VDZ) is an α4β7 anti-integrin licensed to treat UC and CD. We aimed to assess clinical outcomes and safety of VDZ in IBD patients treated in several hospitals across northern England. Method We retrospectively collected data of patients treated with VDZ at 8 UK centres since 2014. We evaluated clinical response at 12 and 52 weeks using the Physician Global Assessment (PGA), Harvey-Bradshaw Index (HBI) or Mayo score. We collected C reactive protein (CRP) and faecal calprotectin (FC) at baseline and follow-up. Fisher exact test and student’s t-test were used to determine statistical significance. Results Of 183 patients (mean 41 years, F/M ratio 1.4:1) 120 (65.6%) had CD, 61 (33.3%) UC, and 2 (1.1%) IBD-U. 18 patients were active smokers. 57 (31%) received immunomodulators, 68 (37%) steroid bridging therapy and 27 (15%) patients were anti-TNF naïve. PGA remission was observed in 33 (31%) CD, 26 (44.8%) UC and 2 (100%) IBD-U patients at 12 weeks and in 6/48 (12.5%) CD and 16/36 (44.4%) UC patients at 52 weeks. A partial response was observed in 51 (48%) CD and 25 (43.1%) UC patients at 12 weeks and in 8/48 (16.6%) CD and 10/36 (27.7%) UC patients at 52 weeks. At 52 weeks, VDZ was more effective in maintaining remission in UC than CD (p<0.05). In CD patients, mean CRP, FC and HBI significantly improved at 12 weeks, with a further improvement of HBI at 52 weeks. In UC, mean FC and Mayo score significantly decreased at 12 weeks, whereas CRP did not improve. Non-smoking status was associated with better response (p<0.05). 43 patients (23.5%) discontinued VDZ (average exposure 4.5 months). Reported side effects occurred in 21 cases (11%): 3 urticarial rashes, 6 pneumonias, 3 nasopharyngitis, 2 skin infections, 2 sepsis, 1 viral meningitis, 1 EBV infection, 1 urinary tract infection, and 2 abnormal liver function tests. Overall incidence of infection was 12 per 100 person-years of VDZ exposure. Conclusion VDZ is a safe and effective therapy even in this cohort of predominantly anti-TNF exposed patients. Induction data are similar for CD and UC, but VDZ seems to be more successful in maintaining remission for UC. The incidence of infectious complications was comparable to that seen with anti-TNF therapies (average 14 per 100 person-years). Disclosure of Interest M. Lenti: None Declared, S. Levison: None Declared, E. Eliadou: None Declared, R. Robert Willert: None Declared, K. Kemp: None Declared, C. Stansfield: None Declared, A. Assadsangabi: None Declared, S. Singh: None Declared, B. Crooks: None Declared, S. Tattersall: None Declared, C. Kenneth: None Declared, S. Subramanian: None Declared, C. Probert: None Declared, D. Storey: None Declared, B. Gregg: None Declared, P. Smith: None Declared, E. Liu: None Declared, J. Limdi: None Declared, A. Johnston: None Declared, PJ Hamlin: None Declared, C. Selinger Conflict with: Warner Chilcott, and Abbvie, Conflict with: Warner Chilcott, Dr Falk, Abbvie, Janssen and Takeda

Introduction Small bowel malignancies are uncommon worldwide and account for only 1–2% of all gastrointestinal malignancies.1 However there is evidence of the rising incidence of small bowel malignancies through the last decades, with increases as high 2.3 per 100 000 population from 1973 to 20042.2-3 We sought to investigate the number of small bowel malignancies diagnosed by double balloon enteroscopy (DBE) and the 1 year outcomes at our institution. Methods We retrospectively reviewed all the DBEs performed at our UK tertiary centre from 2009 to 2015. Demographics, indications for DBE investigation, prior investigations, DBE findings and 12 month mortality were analysed. Results 294 DBEs were performed where 19 small bowel cancers were discovered. The original symptoms were anaemia (83.3%, n = 15), vomiting (11.1%, n = 2), and weight loss (5.6%, n = 1). All patients had undergone radiological imaging (76.5%, n = 13) or capsule endoscopy (58.8%, n = 10) prior to DBE. In 33.3% (n = 6) both radiological imaging and capsule endoscopy had been performed. The indication for DBE was abnormal capsule (41.2%, n = 7), abnormal imaging (52.9%, n = 9) and abnormal capsule and imaging (5.9%, n = 1). The histology findings were jejunal adenocarcinoma in 52.9% (n = 9), distal duodenal adenocarcinoma in 29.4% (n = 5), jejunal GIST in 11.8% (n = 2) and enteropathy associated T cell lymphoma in 5.9% (n = 1). 11 patients (57.9%) had capsule endoscopy prior to DBE, capsule endoscopy failed to diagnoses a malignancy in 3 patients (27.3%) who were subsequently found to have a malignancy on DBE (2 patients with Jejunal GIST and 1 patient with jejunal adenocarcinoma). In these 3 patients the capsule finding was reported as showing angiodysplasia. All the malignancies were deemed suitable for therapy by a multidisciplinary team. The treatment was surgery alone in 52.9% (n = 9), surgery and chemotherapy in 23.5% (n = 4) and chemotherapy alone in 17.6% (n = 3). The survival rate at 3 months was 88.2% and 66.7% at 1 year. In the patients with a diagnosis of adenocarcinoma the 1 year survival rate was 85.7%. Conclusion The 1 year survival of 85.7% is significantly higher than previous reports (survival rate of 30% at 1 year from small bowel adenocarcinoma)4 and may reflect the improved outcomes from earlier diagnosis using capsule and DBE. DBE also aided in the diagnosis of tumours not seen on video capsule endoscopy, as described in literature.5 References 1 Chow JS, et al. Int J Epidemiol 1996;35:722–728 2 Haselkorn T, et al. Cancer Causes Control. 2005;16:781–7. 3 Shack LG, et al. Aliment Pharmacol Ther. 2006;23:1297–306. 4 MH Fargat, A Shamseddine and K Barada. Small Bowel Tumours: Clincial presentation, prognosis and outcomes in 33 patients in a tertiary care centre. Journal of Oncology 2008. 5 Chong AK, et al. Gastrointest Endosc. 2006;64:445–9. Disclosure of Interest None Declared

Introduction The efficacy of Adalimumab (ADA) in ulcerative colitis (UC) has been demonstrated in controlled trials. However there is little information on the real data of steroid free remission within UK clinical practice. Method This was a retrospective multicentre cohort study of 4 hospital Trusts within the NorthWest region of the UK. Demographic data, concomitant therapy, CRP and faecal calprotectin were recorded at baseline. Baseline glucocorticosteroids (GS) was compared at week 8 and 12 and 6 month outcomes following induction of ADA, 160 mg, 80 mg, 40 mg EOW. Results 43 patients were identified from the 4 sites who received a minimum of 12 weeks treatment. Of these 26 were on GS at induction. 3 patients remained on GS at week 8 and all patients were steroid free at week 12. There was 6 month data on 15 of the 43 patients that had received ADA. 6 of 15 patients had discontinued ADA by 6 months of treatment with 1 skin infection and 5 loss of response with 1 requiring colectomy. Number of males (%) was 27 (63%), median age (SD) (range) 54 yrs (16.3) (20–74yrs). Conclusion Real life data of ADA within this cohort demonstrates that all the patients were steroid free at week 12 with only just over half (60%) continued ADA beyond 6 months. Disclosure of interest K. Kemp Speaker Bureau of: Abbvie, MSD, Takaeda, Actavis, Dr Falk, D. Byrne: None Declared, R. Campbell: None Declared, T. Law Speaker Bureau of: MSD, W. McManus: None Declared, R. Willert Speaker Bureau of: Abbvie, MSD, Takaeda.

Introduction Endoscopic therapy with Endoscopic mucosal resection (EMR) followed by Radiofrequency ablation (RFA) is now recommended as first line treatment for patients with Barrett’s oesophagus (BE) related neoplasia confined to the mucosa. Method We examine prospective data from the United Kingdom registry of patients undergoing RFA/EMR for BE neoplasia to examine eventual outcomes of patients who do not have disease reversal at 12 months. All patients were treated with a recommended 12 month treatment protocol where before RFA, visible lesions and nodularity were entirely removed by EMR. Thereafter patients underwent RFA every 3 months until all visible BE was ablated. Biopsies were taken at around 12 months to access for treatment success. Those with residual dysplasia at this stage were offered further treatment and analysed here. Patients with a minimum of 24 months follow up were reviewed. Results 283 patients (81% male, mean age 70 years, 72% HGD, 24% IMC, 4% LGD) completed the 12 month treatment protocol and the majority 90% (255 patients) had reversal of neoplasia (CR-D) at 12 months with 2–3 RFA treatments. Of these with CR-D only one patient has subsequently progressed to invasive cancer (31 months after treatment). 28 patients had refractory neoplasia and were offered further endoscopic treatment. In these CR-D has been achieved in 67% (19/28) after 1–3 RFA treatments and all are free of neoplasia at median follow up of 46 months form initiating treatment. 3 patients in this cohort of non-responders progressed to invasive disease and the remainder (n = 6) are undergoing on going treatment. Conclusion The majority of patients with BE neoplasia will achieve successful disease reversal within a structured 12 month treatment program. However in the few that have residual neoplasia at this stage further RFA can be successfully used to eradicate neoplasia. Surgery for those fit remains a definitive treatment choice for the minority who do not respond to initial treatment or progress to invasive disease despite further treatment. All collaborators of the UK RFA registry are acknowledged for their contributions to data collection for this work Disclosure of interest None Declared.

Background Barrett's oesophagus (BE) is a premalignant condition leading to oesophageal adenocarcinoma (OAC). Treatment of neoplasia at an early stage is desirable. Combined endoscopic mucosal resection (EMR) followed by radiofrequency ablation (RFA) is an alternative to surgery for patients with BE-related neoplasia.Methods We examined prospective data from the UK registry of patients undergoing RFA/EMR for BE-related neoplasia from 2008 to 2013. Before RFA, visible lesions were removed by EMR. Thereafter, patients had RFA 3-monthly until all BE was ablated or cancer developed (endpoints). End of treatment biopsies were recommended at around 12 months from first RFA treatment or when endpoints were reached. Outcomes for clearance of dysplasia (CR-D) and BE (CR-IM) at end of treatment were assessed over two time periods (2008-2010 and 2011-2013). Durability of successful treatment and progression to OAC were also evaluated.Results 508 patients have completed treatment. CR-D and CR-IM improved significantly between the former and later time periods, from 77% and 56% to 92% and 83%, respectively (p<0.0001). EMR for visible lesions prior to RFA increased from 48% to 60% (p=0.013). Rescue EMR after RFA decreased from 13% to 2% (p<0.0001). Progression to OAC at 12 months is not significantly different (3.6% vs 2.1%, p=0.51).Conclusions Clinical outcomes for BE neoplasia have improved significantly over the past 6 years with improved lesion recognition and aggressive resection of visible lesions before RFA. Despite advances in technique, the rate of cancer progression remains 2-4% at 1 year in these high-risk patients.

Introduction Endoscopic therapy with combined Endoscopic mucosal resection (EMR) followed by Radiofrequency ablation (RFA) is now the recommended first line treatment for patients with Barrett’s (BE) related neoplasia confined to the oesophageal mucosa. Method We examine prospective data from the United Kingdom registry of patients undergoing RFA/EMR for BE neoplasia since 2008. Before RFA, visible lesions and nodularity were entirely removed by EMR. Thereafter patients underwent RFA 3 monthly until all visible BE was ablated or cancer developed (endpoints). Biopsies were taken at 12 months or when endpoints reached. Follow up endoscopies were performed periodically in all patients to check for recurrences thereafter. All patients who had completed at least 12 months of follow up after successful treatment were included in the analysis to examine durability of disease reversal long term. Results 282 patients (81% male, mean age 70 years) have completed the 12 month treatment protocol with a minimum of 12 months follow up thereafter. At median follow up of 37 months (IQR 29–49), 93% of patients with successful disease reversal were still free of neoplasia and 88% free of intestinal metaplasia recurrence. Cancer progression at this same time was seen in 1.4% of patients. Kaplan Meier (KM) statistics demonstrated a predicted 3 year neoplasia free survival in 88% of patients. At 5 and 6 years this was 86%. Similarly KM analysis showed that at 3 years 81% of patients would be free form BE and at 5 and 6 years this figure was 73%. Conclusion We report long term outcomes of a large cohort of patients with BE neoplasia who have had successful endoscopic therapy with RFA/EMR. This approach appears to have a lasting disease free benefit in the majority of patients. Recurrences do occur in a minority of patients and highlights the need for follow up in those fit for endoscopy. All collaborators of the UK RFA registry are acknowledged for their contributions to data collection for this work. Disclosure of interest None Declared.

Aim UK cancer guidelines recommend patients with colonic obstruction due to suspected malignancy be considered for stenting with a self-expanding metal stent (SEMS). Considerable variation in practice exists due to a lack of expertise, technical difficulties and other, as yet ill-defined features. This retrospective multi-centre study aims to determine the outcome following colonic stenting for large bowel obstruction and identify factors associated with successful intervention.Method A regional programme of colonic stenting for large bowel obstruction, in five UK centres from 2005 to 2010 was evaluated for outcome including technical and clinical success, survival, complications and reoperation.Results A SEMS was inserted in 334 patients, including 264 (79.0%) for palliation and 52 (15.6%) as a bridge to surgery. Technical success was achieved in 292 (87.4%) patients, with 46 (13.8%) experiencing a complication or technical failure. Reoperation was required in 39 (14.8%) patients stented for palliation of colorectal cancer of whom 16 (6.1%) subsequently required a colostomy. A one-stage primary anastomosis was achieved in 35 (67.3%) of the 52 patients undergoing stenting as a bridge to resection. Technical success did not vary by indication or site of obstruction (P = 0.60) but was higher for operators who had performed more than 10 procedures (OR 3.34, P = 0.001). ASA grade >= 3 predicted a worse clinical outcome (OR 0.43, P = 0.04). The through-the-scope (TTS) endoscopy technique was more successful than radiological placement alone (90.3% vs 74.8%, P < 0.001).Conclusion Experienced operators using a TTS technique achieved a better outcome for the emergency management of large bowel obstruction. Older, sicker patients and those with extracolonic and benign strictures fared less well.

Introduction Barrett’s oesophagus (BE) can lead to oesophageal adenocarcinoma (OAC). BE is more prevalent in males. Endoscopic mucosal resection (EMR) for visible lesions followed by Radiofrequency ablation (RFA) have become first line treatment for patients with BE related neoplasia. Recurrence after treatment can occur in up to 25% of patients. Risk factors for recurrence are unclear. Methods We examine prospective data from United Kingdom (UK) registry of patients undergoing RFA/EMR over past 5 years. We examine if recurrence after treatment is influenced by gender, baseline histology, BE length and prior EMR. Before RFA, visible lesions were removed by EMR. Thereafter patients underwent RFA 3 monthly. Biopsies were taken at 12 months and outcomes for clearance of dysplasia (CR-D) and BE (CR-IM) were assessed. After successful treatment patients were followed up 3 monthly for the first year, 6 monthly for second year and annually thereafter. Biopsies were taken from 1cm below neo z-line and previously treated BE segment. Results A total of 412 males and 95 females have been treated with no statistical difference in baseline BE length, histology or prior EMR in both groups. CR-D in Males was 84% and CR-IM 80%. In females CR-D was 86% and CR-IM 64% and not significantly different (p = 0.61 and p = 0.22, respectively). Progression to cancer was 3% in both cohorts at 12 months. There were 21 patients from both groups with recurrent dysplasia on follow up biopsy after successful treatment. Median time to recurrence in these after successful RFA was 380 days (IQR 177–615). Twenty recurrences were in males compared to one in female group which was statistically significant (p = 0.04). There were 11 recurrences of IM alone in patients who had confirmed CR-IM at 12 months. All were in male patients (median time to recurrence of 626 days, IQR 237–822). Baseline BE length, histology, prior EMR did not influence risk of recurrence of dysplasia or IM. Conclusion RFA for BE related neoplasia is equally effective in both males and females. Recurrence of neoplasia after successful eradication although uncommon overall is more common in males. The much lower recurrence rate in women raises the possibility that they could be discharged from follow up after successful treatment or have prolonged surveillance intervals compared to men. This could reduce the burden of surveillance endoscopy on overstretched services. All collaborators of UK RFA registry are acknowledged for their contributions to this work. Disclosure of Interest None Declared.

Introduction Radiofrequency ablation (RFA) for patients with Barrett’s oesphagus (BE) related mucosal neoplasia has been shown to be safe and effective. Endoscopic mucosal resection (EMR) for visible lesions followed by RFA is now recommended practice for these patients. Although success rates are high for disease reversal at 12 months it is appreciated that recurrence after eradication of dysplasia and intestinal metaplasia (IM) can occur in up to 25% of patients. There is still debate as to what are the optimum endoscopic follow up intervals after successful treatment. Methods We examine prospective data from United Kingdom (UK) registry of patients undergoing RFA/EMR for BE related neoplasia over the past 5 years. We aim to establish the frequency and time of recurrences after successful treatment. Before RFA, visible lesions were removed by EMR. Thereafter patients underwent RFA every 3 months. Biopsies were taken at 12 months for clearance of dysplasia (CR-D) and BE (CR-IM). Durability and recurrence for those with successful eradication was analysed. After successful treatment patients were followed up at 3 monthly for the first year, 6 month intervals for second year and annually thereafter. Biopsies were taken from 1cm below the neo z-line and from the previously treated BE segment. Results A total 508 patients have been treated. At 12 months CR-D was 85% (428/508) and CR-IM 70% (354/508). For those with successful outcomes at 12 months who remain in follow up, median time to their most recent biopsy is 20 months from start of treatment (range 2–72). Kaplan Meier survival statistics predict that at 5 years 75% of patients are likely to be free of dysplasia and 74% free of IM. Median time to recurrence for dysplasia is 380 days (IQR 177–619), and IM 573 days (IQR 237–816). There were 21 patients with recurrent dysplasia, 48% occurred within the first year after successful treatment, 29% in the second year, 14% in the third year and only 9% after 4 years. Conclusion The majority of recurrences after successful RFA occur within the first 2 years (16/21–76%). These date support the practice of vigilant long term follow of patients who are fit for endoscopy after treatment with RFA. More intensive and frequent follow up should take place in the first 2 years when the majority of recurrences occur. Thereafter annual follow up appears adequate. All collaborators of the UK RFA registry are acknowledged for their contributions to this work. Disclosure of Interest None Declared.

Introduction Mucosal neoplasia arising in Barrett’s oesophagus (BE) can be treated with combined radiofrequency ablation (RFA) and endoscopic mucosal resection (EMR). Once there is submucosal invasion the risk of lymph node metastases increases and surgery is favoured. High grade dysplasia (HGD) and intramucosal carcinoma (IMC) arising from the mucosal layer in BE are defined as separate entities in the revised Vienna classification (category 4.1 and 4.4 respectively). Methods We examine prospective data from United Kingdom (UK) registry of patients undergoing RFA/EMR for BE neoplasia over past 5 years to compare outcomes between HGD and IMC patient cohorts. Histological confirmation of HGD or IMC was required on two separate occasions by specialist histopathologists prior to treatment. Before RFA, visible lesions were removed by EMR. Thereafter patients underwent RFA 3 monthly following which biopsies were taken at 12 months for clearance of dysplasia (CR-D) and BE (CR-IM). Twelve month outcomes, frequency of EMR, cancer progression and long term durability in both groups were examined. Results To date 367 patients with HGD and 125 with IMC have been treated. There is no difference in age, sex, baseline BE length between the 2 groups. EMR prior to RFA is far more prevalent in IMC cohort than HGD patients (78 vs. 45%, P < 0.0001). Patients had an average of 2–3 RFA treatments over 12 months (range 1–6) in both cohorts. Rescue EMR after starting RFA for new lesions was similar in both groups (HGD 7%, IMC 6.5%). CR-D and CR-IM in the HGD cohort was 85 and 69% respectively at 12 months. This was not significantly different in the IMC cohort (86 and 71%, p = 0.7). Overall progression to invasive cancer was not significantly different in either cohort (HGD 4.1%, IMC 7.2%). Kaplan Meir survival statistics did not show any difference in long term durability of successful neoplasia treatment in both groups (p = 0.9, log rank test), median follow up 20 months. Conclusion We report one of the largest series of patients undergoing endoscopic therapy for IMC arising in BE. Patients with IMC are more likely to have visible lesions that require EMR prior to RFA than those with HGD. However, once all visible lesions are removed, there is no statistical difference in clinical outcomes between the cohorts. Minimally invasive endoscopic therapy with RFA/EMR is a safe and effective treatment in patients with IMC. All collaborators of the UK RFA registry are acknowledged for their contributions to this work Disclosure of Interest None Declared.

Introduction Barrett’s oesophagus (BE) is the recognised pre-cursor to oesophageal adenocarcinoma (OAC). Combined endotherapy with endoscopic mucosal resection (EMR) and Radiofrequency ablation (RFA) have emerged as alternatives to surgery for curative treatment of patients with BE related neoplasia over the past 5 years. Methods We examine prospective data from United Kingdom (UK) registry of patients undergoing RFA/EMR for early neoplasia arising in BE since the launch of the registry in 2008. Primary outcomes for clearance of dysplasia (CR-D) and BE (CR-IM) at 12 months were assessed over two time periods, between 2008–2010 and from 2011–2013. In addition durability of successful treatment, progression to invasive OAC and changes in endoscopic practices were also analysed between the time periods. Before RFA, visible lesions were removed by EMR. Thereafter patients underwent RFA every 3 monthly and biopsies were taken at 12 months. New lesions appearing during RFA treatment were removed by rescue EMR. This treatment algorithm has remained unchanged over past 5 years. Results We report on 510 patients who have completed treatment with 12 month histology over past 5 years. CR-D and CR-IM have improved significantly between the former and later time periods from 77% and 56% to 91% and 82% respectively (p < 0.0001). The use of EMR for visible lesions prior to initiating RFA has also increased from 48% to 60% (p = 0.013). Conversely need for rescue EMR has decreased significantly to 3% over the last two and half years compared to 13% during initial time period (p < 0.0001). Progression to invasive OAC is not significantly different (2.8% in 2011–2013 vs. 4% 2008–2010, p = 0.56). Conclusion We report one of the largest series of patients undergoing RFA for BE neoplasia. Clinical outcomes have improved significantly over the past 5 years as endoscopists have more experience with improved lesion recognition, and more attention to resection of all visible lesions before RFA. As a result the requirement for rescue EMR during RFA has reduced. Although rate of progression to OAC is lower in the later part of the registry experience, this is not statistically significant and implies that despite advances in endoscopic imaging and technique the rate of progression remains in the region of 2–4% in these high risk patients. All collaborators of the UK RFA registry are acknowledged for their contributions to this work. Disclosure of Interest None Declared.

Introduction Colonic polyp size is a factor in determining management and prognosis of patients. Polyp diameters greater than 9 mm require ongoing colonoscopic surveillance.1 Accurate endoscopic estimation of polyp size can be affected by depth perception and parallax errors. We compared endoscopic versus histological size assessments to determine if accurate estimation was operator-dependent. Methods Symptomatic and asymptomatic (bowel screening) patients were identified from hospital databases. Endoscopic and histological polyp diameters were reviewed. Agreement levels between these were analysed by deriving intraclass correlation coefficient (ICC) using SPSS software (Version 20). Results Sixteen colonoscopists were included: 5 bowel screening, 7 non-bowel screening and 4 trainees. Five hundred and ten polyps (n = 510) were found among 299 patients (186 males, 104 females). Two hundred eighteen polyps were enbloc resected, retrieved whole and analysed. Overall accuracy of polyp size assessment was good (ICC > 0.70) with variability between skill levels (Table 1). Accuracy was best among polyps ≥20 mm diameter (ICC 0.99, p < 0.001); all removed by bowel screening colonoscopists. Polyps between 8 to 12 mm demonstrated poor correlation (ICC (absolute agreement) 0.535, P = 0.002). Conclusion While endoscopic estimation of polyp diameter is accurate, variability exists. Estimations are more accurate among bowel screening endoscopists suggesting experience and/or colonoscopy workload contribute to this skill. Poor diameter estimations among polyps 8–12 mm has implications for polyp surveillance intervals. Standardising diameter using against closed or open biopsy forceps (width 2.2 and 8 mm respectively) to optimise accuracy should be used. Reference 1 Cairns, et al. Guidelines for colorectal cancer screening and surveillance in moderate and high risk groups (update from 2002). Gut 2010;59:666–690 Disclosure of Interest None Declared.

Introduction Bowel cancer is the third most common cancer in the United Kingdom forming up to 13.6% of all newl1y diagnosed cancers (1). Bowel cancer screening colonoscopy allows early polyp detection at a curable stage. Complete resection and follow-up of large polyps is crucial to prevent malignant progression. The aim of this study was to review the management of polyps with diameters ≥2 cm, particularly of sessile polyps, to assess the enbloc resection rates, completeness of resection using endoscopic mucosal resection (EMR) vs surgery and the incidence of malignant polyps. Methods Patients were identified retrospectively from a regional bowel screening programme database. Details of index colonoscopy including polyp characteristics, method of resection and complications were recorded. Histology results were reviewed for all polyps. Outcomes from follow-up endoscopic surveillance were analysed. Results One hundred and fifty-eight patients (102 males, 56 females, mean age 66.2 years) with polyps ≥2 cm were identified from 2182 screening colonoscopies from January 2010 to August 2013. Caecal intubation rate was 96.8% in this group. Largest polyp size for each patient ranged from 20 to 60 mm (mean 26.6 mm). The incidence of adenocarcinoma was 11.9% (n = 19), all located within the left colon, with 12 requiring surgical resection. One hundred thirty nine patients (n = 139) had 155 non-malignant large polyps, mostly tubulovillous or villous histology (n = 110, 79%). Thirty-six patients had 37 sessile polyps which underwent primary resection by EMR (n = 26) or surgery (n = 11). Polyp diameter was larger in the surgery group with mean polyp diameter of 40.4 vs. 28.0 mm (p < 0.05). EMR enbloc resection rate was 11.5% (n = 3 out of 26). Completeness of excision was 38.4% (n = 10) at 3 months and 92.3% (n = 24) at 1 year. EMR complications included 1 perforation, 1 post polypectomy syndrome and 1 bleed. Surgical resection included: anterior resection in 2, TEMS excision in 7 and right hemicolectomy in 3. Conclusion Sessile polyps ≥2 cm are relatively uncommon in an asymptomatic bowel cancer screening programme (37 in 2182 colonoscopies). They can be successfully resected by EMR without recurrence in 92.3% at 1 year providing a 3 month site check is performed in all piecemeal polypectomies. Reference Cancer for National Statistics 2010. Office for National Statistics. http://www.ons.gov.uk/ons/dcp171778_263537.pdf Disclosure of Interest None Declared.

Introduction Young males with iron deficiency (IDA) routinely undergo endoscopy. There is paucity of data on the diagnostic yield of bi-directional endoscopy, level of HB that requires investigation and the yield in symptomatic vs. asymptomatic young men. We aim to study the diagnostic yield of bi-directional endoscopy in young males and the influence of gastrointestinal symptoms and HB level on yield. Methods Data was collected from UNISOFT endoscopy software for all male patients referred for iron deficiency anaemia. Strict inclusion criteria were set and defined as: 1. Age 20–50 years 2. No prior gastrointestinal (GI) diagnosis 3. Blood indices - hypoferritinemia confirming IDA at the time of referral A total of 36 patients were identified from January 2010 to July 2012. A retrospective review of blood parameters, symptoms, non-steroidal anti-inflammatory drug (NSAID) use, endoscopic findings and histologies were recorded. Data was recorded on an excel sheet and analysed using SPSS version 15. Results A total of 36 patients were included in the study. The median age was 42 years. Eleven percent (n = 4) were referred from general medicine, 22% (n = 8) from general surgery and 67% (n = 24) from Gastroenterology for endoscopic investigations. Median HB level was 10g/dL. There were 4 patients on NSAIDs prior to referral. Gastroscopy was performed in all patients and was normal in 94% (n = 34). The remaining 6% (n = 2) were diagnosed with h pylori gastritis (n = 1), and benign pyloric stenosis (n = 1). Duodenal (D2) biopsies were performed in 32 patients (89%), of which 1 patient was diagnosed with coeliac disease on histology. Three of the 4 patients with no D2 biopsies had a normal coeliac blood screen. Lower GI endoscopy (colonoscopy n = 30, flexible sigmoidoscopy n = 3) was performed in 33 (92%), of which 85% (n = 28/33) were macroscopically normal. Five patients had pathology encountered at endoscopy, these included adenomas (n = 3), ulcerative colitis (n = 1) and caecal carcinoma (n = 1). Patients with IDA and no GI symptoms (n = 21); endoscopic diagnostic yield was 5% (n = 1) for gastroscopy and 11% (n = 2/19) for colonoscopy. The diagnostic yield in symptomatic patients was 7% (n = 1) for gastroscopy and 21% (n = 3/14) for colonoscopy. There were 11 patients with IDA and an HB level over 11g/dL. All patients underwent gastroscopy with D2 biopsies and 10 patients underwent colonoscopy. All endoscopic investigations including D2 biopsies were normal. Conclusion IDA in young males should always be investigated with bi-directional endoscopy, irrespective of symptoms. Although a small cohort, our study shows that the diagnostic yield is higher amongst patients with IDA and GI symptoms as well as IDA with an HB level below 11g/dL. Disclosure of Interest None Declared.

Introduction Oesphageal SCC carries a poor prognosis. Squamous HGD is the precursor lesion to SCC. Risk of progression to SCC with HGD can be 65% at 5 years. RFA is a minimally invasive technique with proven efficacy for early neoplasia arising in Barrett’s oesophagus. We present prospective data from 10 centres in the United Kingdom (UK) HALO registry. Methods Superficial lesions were removed by endoscopic mucosal resection (EMR) before RFA. Treatment consisted of a single ablation at 12J/cm2. Patients were followed up 3 months after treatment with biopsies. Those with residual dysplasia underwent further RFA until 12 months when they were assessed for treatment success or failure. Recurrent dysplasia was retreated with EMR/RFA. Primary outcomes were reversal of dysplasia (CR-D) at 12 months. Results 26 patients had RFA. Mean length mucosa ablated was 5.3 cm (1–14). 7/26 (27%) had EMR before RFA. Prior EMR did not confer benefit to outcome, nor did baseline disease length. Following first RFA, 6/26 patients (23%) progressed to invasive disease. Only one more patient progressed later in treatment course. CR-D was achieved in 50% at protocol end, mean 1.7 RFA treatments (1–4). 10/13 (77%) with successful RFA at 12 months remain disease free at most recent follow up (median 21 months). Kaplan Meier statistics show 2 years post treatment 68% patients are likely to remain in remission from dysplasia for those with successful outcome at 12 months. 5 patients (19%) required dilatations for oesophageal stricturing. Conclusion Squamous HGD & CIS are aggressive pathologies as evidenced by the fact that 23% patients in our cohort progressed to invasive disease despite RFA. However the majority who do not progress early (13/19 patients) achieve benefit & are more likely to have a successful & durable outcome. There is limited experience in the UK with RFA in these patients. Pre RFA EMR for visible lesions is limited in our series. As a result some patients may be under staged prior to RFA which may account for the high rate of progression after first treatment. Disclosure of Interest None Declared

Introduction BE is the pre-cursor to oesophageal adenocarcinoma (OAC). High grade dysplasia (HGD) & early mucosal neoplasia in BE have a 40–60% risk of progressing to OAC. Endoscopic mucosal resection (EMR) & RFA are alternatives to surgery for curative treatment of these patients. We present prospective data from 19 centres in the UK HALO RFA registry. Methods Before RFA, superficial lesions were removed by EMR. Patients then underwent RFA 3 monthly until all BE was ablated or cancer developed (endpoints). Biopsies were taken at 12 months for Primary outcomes (clearance for HGD (CR-HGD), all dysplasia (CR-D) & BE (CR-BE)). Results 630 patients have outcomes recorded. We report on 370 who have completed treatment. 81% male, mean age 68 years (40–91). Patient’s underwent mean 2.5 ablations (1–6) during protocol. 70% baseline histology HGD, 27% IMC & 3% LGD. Mean length baseline BE 5.6cm (1–20). At 12 months CR-HGD was 87% patients, CR-D 82%, & CR-BE 64%. 97% with no dysplasia at 12 months remain disease free at most recent follow up (median 18 months,range 2–68). Kaplan Meier statistics predict CR-D is durable at 5 years with 88% remaining disease free. Logistic regression demonstrate each extra 1 cm of BE reduces chances of attaining CR-D by 15.7% (OR 1.156, SE 0.048, CI 1.07–1.26, p = 0.0003) & for each extra RFA treatment likelihood of CR-D increases by 31.7% (OR = 0.683, SE 0.95, CI 0.52–0.89, p = 0.0006). Progression to invasive cancer at 12 months is 2.7%. Symptomatic strictures requiring dilatation occurred in 9% after treatment. Conclusion End of protocol CR-D is encouraging at 83% & successful eradication appears durable. Patients with shorter segment BE respond better & multiple treatments are more likely to achieve CR-D. Our data represent real life outcomes of integrating novel endotherapy into demanding endoscopy service commitments Disclosure of Interest None Declared