INTRODUCTION:The European Society of Gastrointestinal Endoscopy has recently defined important performance measures for endoscopy in inflammatory bowel disease (IBD). The role of patient experience in quality assessment of endoscopy in IBD has yet to be defined. We undertook an observational study based on analysis of a large multi-center dataset with national coverage in Ireland. The aim was to analyze individual and composite metrics that reflect patients' experience with endoscopic procedures for IBD. METHODS:Anonymized data were extracted from electronic procedure records of patients who underwent colonoscopy in 24 Irish hospitals. The performance indicator of colonic intubation (PICI), a novel composite score reflecting sedation rates and patient comfort, and IBD-specific endoscopic domains were evaluated. RESULTS:Data from 261 524 colonoscopies were analysed from 2014 to 2020. Crohn's disease (CD) patients had a significantly lower odds ratio (OR) of achieving PICI compared to non-IBD patients (0.69, 0.65-0.74, P < .001). Severe colitis was also associated with a significantly lower OR of achieving PICI (OR 0.53, 0.38-0.74, P < .001). In total, 80.2% of CD patients had a comfort score ≤2 compared to 87.8% of those with ulcerative colitis (UC) and 84.2% without IBD. Additionally, 60.7% of patients with CD required a midazolam dose of 3 mg or more compared to 50.4% of those with UC and 76.7% of those without IBD. In total, 50% of CD patients required fentanyl doses >50 µg compared to 34% of UC patients and 30.3% of patients without IBD. CONCLUSION:This analysis of a large national endoscopy dataset highlights variability in quality metrics for IBD endoscopy and underscores the need for a metric such as PICI to more accurately capture and reflect patient endoscopic experience with IBD.

OBJECTIVE:To evaluate the progression rate of Barrett esophagus (BE) to esophageal adenocarcinoma (EAC) using a prospectively maintained national registry, quality-assured endoscopy, and expert pathology. BACKGROUND:BE is the sole pathologic precursor of EAC. Targeting prevention and early diagnosis through quality-assured BE programs has a compelling rationale. METHODS:A Barrett's Registry and Bioresource was founded in 2011, and data to November 2024 were prospectively documented in a web-based system (Dendrite, UK). Endoscopy and pathology (of specialized intestinal metaplasia) were strictly quality assured per current guidelines. Expert gastrointestinal pathologists classified non-dysplastic BE (NDBE), indefinite for dysplasia (IND), low-grade dysplasia (LGD), and high-grade dysplasia (HGD). Endoscopic eradication therapies were monitored. Multivariable regression models evaluated risk factors for progression, and Kaplan-Meier curves were constructed for overall progression, and progression excluding the first year after the index biopsy. RESULTS:Nine thousand four hundred thirty-six patients were registered, with a median follow-up of 4.4 years, and 5331 had at least one follow-up endoscopy. Overall, 252 cases (4.7%, 95% CI: 1.70-2.18) of HGD and 255 cases (4.7%, 95% CI: 1.72-2.20) of EAC were diagnosed. Among these, 150 cases (2.8%. 95% CI: 1.05-1.44) of HGD and 148 (2.7%, 95% CI: 1.05-1.44) of EAC were diagnosed more than 1 year after the index endoscopy. The overall incidence of HGD/EAC combined was 2.42% (95% CI: 2.14-2.73), 6.59% (95% CI: 5.14-8.46), and 13.79% (95% CI: 11.94-15.93) per year in NDBE, IND, and LGD, respectively. Independent risk factors include male sex [hazard ratio (HR): 0.655, 95% CI: 0.56-0.896, P <0.004], age (HR: 1.027, 95% CI: 1.02-1.04, P <0.001) and Barrett's length (HR: 1.635, 95% CI: 1.33-2.01, P <0.001). 604 (6.4%) patients underwent RFA, with a complete eradication of SIM in 80.5% and 10 (1%) patients required resectional surgery. Cancer-specific survival in the total cohort was 100%. CONCLUSIONS:A structured high-volume Barrett's program, underpinned by quality assurance, provides data that highlights a strategy that provides proof of concept in targeting prevention and early detection, and is anticipated to reduce mortality.

Abstract Background Ulcerative Colitis (UC) is a chronic inflammatory bowel disease (IBD) often leading to impaired quality of life in affected patients. Current treatment modalities include anti-tumour necrosis factor (anti-TNF) monoclonal antibodies including infliximab, adalimumab and golimumab (GLM). RCT show higher trough drug levels (DL) following induction are associated with enhanced rates of remission in maintenance. GOAL-ARC is a pragmatic RCT to examine if dose optimisation of GLM following induction in response to suboptimal DL or persistently raised faecal calprotectin (FCP) improves rates of patient continuous clinical response (pCCR) and reduces maintenance disease activity in UC Methods A pragmatic randomised, multi-centre two-arm investigator initiated trial (NCT0268772) . Population – Patients with moderate to severe UC requiring TNF inhibitor therapy. Intervention - one arm receiving GLM treatment as per SMPC and one arm with dose optimisation of GLM based on FCP and DL from week 6 according to a dedicated algorithm. Eligible patients were randomised in a 1:1 ratio to 1 of 2 treatment groups. Study Duration - 46 weeks. Primary end-point pCCR = absence of flare defined as no increase in modified partial Mayo (MPM) score of 2 points from week 14-46 (requiring treatment intervention). Secondary endpoints included rate of clinical response to induction (week 14), defined as a drop of MPM of 2 points or decrease of ≥30% from baseline and level of FCP and rate of mucosal healing (Mayo endoscopic subscore of 0/1) at Wk 46 Results 107 patients were enrolled (target enrolment n=135, study enrolment terminated early due to recruitment problems during and following C19 pandemic). 97 patients (median age 42) were randomised, with one patient subsequently excluded due to ineligibility. Of 96 evaluable patients, 46 were randomised to SMPC treatment and 50 were randomised to the intervention. Baseline characteristic were comparable. 28/46 (61%) achieved wk 14 clinical response with SMPC and 19/46 (41%) met the primary endpoint (pCCR wk 14-46). In the intervention arm 28/50 (56%) achieved wk 14 clinical response and 24/50 (48%) met the primary endpoint (pCCR wk 14-46). The difference between groups in the rates of pCCR was 6.7% (95% CI:-0.15,0.29) in favour of the intervention and was not statistically significant. No safety signal associated with the intervention was observed. Conclusion In a pragmatic RCT no significant increase in the rate of pCCR was observed with personalised dosing of GLM for treatment of moderate to severe UC. A numerical trend towards reduced loss of response during maintenance (20% with SMPC versus 8% with intervention) is observed with personalised dosing of GLM suggesting this strategy may be beneficial in some patients

BACKGROUND:Ustekinumab (UST), a human monoclonal antibody that binds the p40 subunit of interleukin 12 (IL-12) and IL-23, is licensed for induction and maintenance therapy of moderate to severe inflammatory bowel disease (IBD). To date, there is limited data published on any potential association between ustekinumab serum trough levels and mucosal healing in order to guide treatment strategies and appropriate dosing. AIM:This study aims to identify a relationship between maintenance ustekinumab serum trough levels and mucosal healing and/or response in patients with Crohn's disease in an observational cohort study. METHODS:Ustekinumab serum trough levels and antibody titres were analyzed in patients on maintenance drug using an ELISA drug-tolerant assay. Mucosal response (MR) was defined as ≥50% reduction in fecal calprotectin level (FC) and/or ≥50% reduction in the Simple Endoscopic Score for Crohn's Disease (SES-CD score). Mucosal healing (MH) was defined as FC ≤150 µg/mL and/or global SES-CD score ≤5. Median trough levels were analyzed using the Kruskal-Wallis test, and logistic regression was used to determine sensitivity and specificity of levels predicting mucosal response. RESULTS:Forty-seven patients on maintenance ustekinumab for Crohn's disease were included in this study. The majority were female (66%), with a median age of 40 years (21-78 years). The majority of patients were biologic-experienced (89.4%, n = 42). Patients with histologically confirmed Crohn's disease represented 100% (n = 47) of the cohort. Over one-third of patients (n = 18, 38.3%) were on higher than standard dosing of 90 mg every 8 weeks. Patients with mucosal healing (n = 30) had significantly higher mean serum ustekinumab levels (5.7 µg/mL, SD 6.4) compared with those with no response (1.1 µg/mL, SD 0.52; n = 7, P < .0001). A serum ustekinumab trough level greater than 2.3 µg/mL was associated with MH, with a sensitivity of 100% and specificity of 90.6% (likelihood ratio 10.7). Similarly, for patients with MR (n = 40), we observed a higher mean serum ustekinumab trough level (5.1 µg/mL, SD 6.1) compared with those with no response (1.1 µg/mL, SD 0.52; n = 7, P < .0001). Furthermore, a serum ustekinumab trough level greater than 2.3 µg/mL was associated with a 10-fold increased likelihood of mucosal response vs mucosal nonresponse (sensitivity 100%, specificity 90.5%, likelihood ratio 10.5). CONCLUSION:This study demonstrates that higher ustekinumab serum trough levels are associated with a greater likelihood of achieving mucosal healing and mucosal response in patients with Crohn's disease regardless of prior biologic exposure. Further prospective studies are required to correlate target maintenance trough levels and the optimal time to dose-escalate in order to improve patient outcomes.

Abstract Background Comprehensive assessment of endoscopic disease activity and mucosal healing is central to therapeutic decision making in IBD. Data suggests that IBD patients may have a poorer experience of endoscopy with a higher burden associated with bowel preparation, higher GI specific anxiety and increased procedure related pain. Existing KPIs may be inadequate in capturing appropriate patient outcomes in IBD patients. PICI is a novel composite endpoint incorporating patient safety and comfort to ensure targets are met without compromising patient safety. Methods The aims of this study were to assess the safety, tolerability, and feasibility of colonoscopy in patients with IBD compared to non-IBD patients in Ireland using PICI, defined as successful caecal intubation with nurse assisted comfort score ≤3 and midazolam dose ≤2. We reviewed de-identified national endoscopy procedure data on all colonoscopies performed over a 6 year period in 24 hospitals nationally using the EndoRAAD reporting system. Procedures were categorised into IBD and non-IBD procedures on the basis or procedure indication (IBD surveillance or assessment) or a new diagnosis of IBD. Results Procedure data from 261,889 colonoscopies from 2014-2020 were analyzed (IBD: n=18,675; non-IBD: n=243,214 procedures). The Odds Ratio (OR) of achieving PICI was significantly lower in IBD patients compared to non-IBD patients, particularly in patients with Crohn’s Disease (0.74, 0.68-0.81, p<0.001). Male gender was associated with a significantly higher OR of achieving PICI (1.32 (1.29-1.35, p<0.001). Poor bowel prep was associated with reduced PICI (OR 0.78, p<0.001). Additionally, procedures performed by supervised trainees had significantly reduced PICI (OR 0.69, p=0.032). The extent of colonic inflammation had no significant impact on PICI in IBD patients (OR moderate and severe inflammation 1.08 (p=0.66); and 1.06 (p=0.79) respectively). Mean procedure time was slightly longer for IBD patients (28.7 min versus 26.7 min, p<0.001), with 91.1% of IBD patients having mucosal biopsies compared to only 26.3% of non-IBD patients (p < 0.001). Conclusion This large retrospective cohort study utilises the novel composite measure of PICI to assess the safety, tolerability, and feasibility of colonoscopy in IBD patients compared to non-IBD patients. We have identified significantly poorer comfort scores and higher sedation rates required to achieve caecal intubation at colonoscopy in IBD patients, particularly in patients with Crohn’s Disease. Further exploration is required to identify factors to improve the safety and quality of endoscopy in IBD patients.

Aims Same session EUS and ERCP has the potential to streamline patient investigation and therapy, and to avoid the risk associated with ERCP if biliary pathology is not seen at EUS. We assessed the utility of same session EUS and ERCP in patients referred to our hospital.

Abstract Background Inflammatory Bowel Disease (IBD) in the elderly (>60yrs) is becoming more prevalent in concordance with the ageing population and the rising incidence of IBD. An increasing number of patients are receiving a diagnosis of IBD in later years in addition to those with known IBD transitioning to elderly. The presentation, disease course, risk of complications and choice of medical therapies differ in this group from younger cohorts. We aimed to examine patient demographics and the incidence of adverse effects/complications amongst elderly IBD patients. We also sought to identify appropriate vaccination rates and uptake with screening services. Methods In a single tertiary centre, IBD patients aged >60 attending the outpatient clinic or admitted acutely were invited to complete an anonymous written survey. Results 28 patients surveyed to date. 61% (n=17) had a diagnosis of UC. 54% were female (n=15). Mean age was 67.5, while mean age at diagnosis was 50 (range 19-65). 25% (n=7) received a diagnosis of IBD after 60 years, of which 57% were female. Mean BMI was 25.9. 25% (n=7) reported an infection in the last 6 months, all of whom required treatment with antibiotics. There was only one case of infection requiring hospitilisation, a patient on biologic therapy who developed a clostridium difficile infection. COVID-19 affected 39% (n=11), none required hospitilisation. 21% (n=6) report 2 or more comorbidities, of which 50% report a recent infection requiring treatment. All patients who required IBD surgery (n=5) had a high BMI. 57% (n=16) had a smoking history, with 14% (n=4) being active smokers. Infliximab and salofalk granules were the most prescribed IBD treatments. 46% were on biologics (n=13), with anti-TNF being the most common (29%). 25% (n=7) reported steroid use in the last year while 14% were not currently on IBD treatment. 21.4% (n=6) reported prior malignancy, skin cancer being most common. 50% of cancer sufferers were smokers. 100% have had a minimal of two COVID-19 vaccines. 64% (n=18) have had a flu-vaccine in the last 12 months with 75% (n=21) report annual flu-vaccine uptake. 61% (n=17) had the pneumococcal vaccine. Bowel screening participation was 46.5% (n=13). Conclusion Smoking, high BMI and multiple comorbidities were common in elderly IBD patients. Infections were common in this cohort and typically required treatment with antibiotics, however, were rarely severe or required hospitalisation. Severe infections were seen in those on biologic therapy. Biologics were commonly prescribed to elderly IBD patients. Skin cancer was the most common malignancy. There was suboptimal uptake with vaccinations and bowel screening.

Abstract BACKGROUND Due to a huge focus of healthcare resources on acute COVID-19 care during the early phase of the pandemic, endoscopy activity worldwide was significantly reduced. This subsequently led to a reduction in the number of Oesophageal and Gastric cancers diagnosed during this period, resulting in delayed diagnosis. AIM To measure the impact of COVID-19 pandemic on the diagnosis of Oesophageal and Gastric cancers in a single tertiary referral centre. METHODS This was a retrospective study. Patients were divided into three groups based on the period of diagnosis. Period A represented October 2019 – March 2020, B represented April 2020-June 2020, and C represented July 2020-October 2020. Patients were then further subdivided based on the stage of the cancer at diagnosis. RESULTS A total of 153 patients diagnosed between October 2019 and October 2020 were included. The mean age was 69.4. During period B, which correlates with the early phase of the pandemic, and reduced endoscopy activity, there was a reduction in the number of cancers diagnosed. 66 patients (43.1%) were diagnosed in Period A, 25 (16.3%) in Period B and 62 (40.5%) in Period C. In respect to Period B, in comparison to the same period in 2019, 40 patients were diagnosed. There was also an increase in the number of cancers diagnosed at an advanced stage in Period C, correlating with the recovery/decelerating phase of the first wave of the pandemic. CONCLUSION This study highlights the risk associated with delayed diagnosis of Upper GI Cancers due to the pandemic.

AIM:Surgery for Crohn's disease (CD) is characterized by an enhanced inflammatory response. While inflammation can induce hyperalgesia, post-operative pain following surgery for CD has not been characterized. This retrospective study compared a consecutive series of patients undergoing laparoscopic right hemicolectomy for CD and neoplasia performed by a single surgeon.METHOD:Elective resections performed between Jan-2016 and Aug-2017 managed in an enhanced recovery pathway were eligible for inclusion. Patients were excluded if open surgery was performed, an ileostomy was fashioned, no patient-controlled analgesia (PCA) was used or data were incomplete. Results : 38 cases were included, 20 for neoplasia and 18 for ileocolonic CD. There was no difference in patient gender (P=0.520). CD patients were younger (39.8±2.8 Vs 77.2±2.1 years, P<0.001) but had an equivalent length of resection (312.9±43.5 Vs 283.3±71.7 mm, P=0.915). CD patients had higher pain scores on post-operative day 1 (6.8±0.8 Vs 2.6±1.0, P<0.001), day 2 (5.0±0.5 Vs 1.6±0.9, P<0.001) and day 3 (4.1±0.6 Vs 1.3±0.7, P=0.008). CD patients used their PCA for longer (85.7±16.3 Vs 47.7±4.2 hours, P=0.017) and used a greater total amount of morphine (148.6±33.8 Vs 37.0±7.8 mg, P<0.001). Post-operative CRP was higher in patients with CD on day 1 (P=0.011), day 2 (P=0.001), day 3 (P=0.001) and day 4 (P=0.007), but no leak or intra-abdominal abscess occurred in either group.RESULTS:38 cases were included, 20 for neoplasia and 18 for ileocolonic CD. There was no difference in patient gender (P=0.520). CD patients were younger (39.8±2.8 Vs 77.2±2.1 years, P<0.001) but had an equivalent length of resection (312.9±43.5 Vs 283.3±71.7 mm, P=0.915). CD patients had higher pain scores on post-operative day 1 (6.8±0.8 Vs 2.6±1.0, P<0.001), day 2 (5.0±0.5 Vs 1.6±0.9, P<0.001) and day 3 (4.1±0.6 Vs 1.3±0.7, P=0.008). CD patients used their PCA for longer (85.7±16.3 Vs 47.7±4.2 hours, P=0.017) and used a greater total amount of morphine (148.6±33.8 Vs 37.0±7.8 mg, P<0.001). Post-operative CRP was higher in patients with CD on day 1 (P=0.011), day 2 (P=0.001), day 3 (P=0.001) and day 4 (P=0.007), but no leak or intra-abdominal abscess occurred in either group.CONCLUSIONS:CD patients experience increased post-operative pain, require more post-operative analgesia and have an enhanced post-operative inflammatory response. Further studies to elucidate the mechanism of this hyperalgesia and strategies to obviate it are required.

Aims To determine the incidence of COVID-19 transmission following outpatient gastrointestinal (GI) endoscopy duringrising community incidence of COVID-19. Methods This prospective study was conducted in a single tertiary referral centre in Dublin. Consecutive patients whoattended the endoscopy unit for a procedure at time points in June, September, and October 2020 were included. Patientsreceived a COVID-19 triage phone call 48 hours before their procedure. COVID-19 testing was not performed beforeoutpatient endoscopy. Inpatients and any outpatient that failed telephone triage were excluded. Standard surgical masks,FFPs and PPE were used by endoscopy staff for all procedures. Patients were contacted 14 days after the procedure toenquire if they had developed symptoms suggestive of COVID-19. Results 522 patients who had GI endoscopy were enrolled, and 506(96.9 %) were contacted for follow up. 163, 157, and186 patients were included in June, September, and October respectively. The mean age was 55.6(range 16-92). Nationallythere were 558, 7430, and 25476 new cases of COVID-19 in June, September, and October respectively. In the two weeks post endoscopy, 7/506(1.3 %) patients required testing for symptoms suggestive of COVID-19. Allpatients had negative results. No member of our endoscopy personnel contracted COVID-19 during the study period. Conclusions This study highlights that the risk of COVID-19 transmission related to GI endoscopy is negligible despitedramatic escalation in community infection.

Aims Barrett’s oesophagus is associated with 24 fold increase in risk of Oesophageal cancer. Seattle biopsy protocol is gold standard in Barrett’s surveillance. Adherence to Seattle protocol increases dysplasia detection rate (DDR). In addition, the inclusion of chromoendoscopy with Narrow band imaging (NBI) and Acetic Acid spray (AA) is also associated with improved dysplasia detection rate. Our aim was to review how our assessment of Barrett’s oesophagus with regards to the use of chromoendoscopy, adherence to Seattle Protocol and documentation of Prague classification has evolved over time at our institute and if dysplasia detection rate improved concomitantly.

Purpose Secondary loss of response (LOR) to infliximab (IFX) commonly occurs. One cause is the development of anti-drug antibodies (ADAs). Evidence regarding the optimal management of ADAs is lacking. We aim to identify the best practice of management of ADAs to IFX to avoid discontinuation of therapy and to determine specific ADA cut-off values to determine pre-specified clinical outcomes. Methods This is a 3-year study of patients receiving IFX who developed ADAs > 8μg/ml. We reviewed the management strategies and subsequent outcomes in patients who developed ADAs. Results A total of 132 patients are included. Baseline characteristics include 54% male patients and mean age of 39.4 years. Fifty-two percent ( n = 69) of patients discontinued IFX following the development of ADAs, 33.3% ( n = 44) sited as secondary to LOR. Both an increase in IFX and adjustments to combination therapy were associated with lower rates of discontinuation of IFX vs no intervention ( p value < 0.001, p value < 0.001). An increase in IFX resulted in a significant difference in ADAs/IFX trough levels pre- and post-intervention ( p value < 0.001, p value = 0.032). ROC curve analysis yielded significant cut-off values for ADAs and treatment failure (ADA >16μg/ml, AUC 0.642, p value 0.003), steroid use (ADA >19 μg/ml, AUC 0.61, p value 0.048) development of infusion reactions (ADA> 37 μg/ml, AUC 0.68, p value 0.045) and switch to another biologic (ADA >45 μg/ml, AUC 0.739, p value <0.001). Conclusion Both escalation of IFX and combination therapy resulted in lower rates of LOR. ROC curve analysis identified significant cut-off values for ADA trough levels and important clinical outcomes.

Introduction:Vedolizumab (VDZ) is a monoclonal antibody designed to inhibit alpha 4 beta 7 integrin and result in gut-selective anti-inflammatory activity. Real-world data are important in providing information to clinicians on the effectiveness and safety of this agent. Methods:A retrospective, multi-centre study was conducted across 9 Irish academic centres. Adult (>= 18 years) patients receiving VDZ for active IBD (ulcerative colitis [UC] or Crohn's disease [CD]) with at least 6 months follow-up were included in the study cohort. Primary study endpoints were defined as 3-month clinical response and 6-month corticosteroid-free remission. Secondary endpoints included 3-month corticosteroid-free clinical remission, 6-month clinical response, change from baseline in CRP, albumin and faecal calprotectin, and adverse events. Results:One hundred and twenty-nine patients were included in total (64 UC, 65 CD). In the UC cohort, baseline median PMCS was 7 [0 - 9] and 78.1% had prior anti-tumour necrosis factor alpha (anti-TNF alpha) exposure. Three-month and 6-month endpoints were achieved in 40% and 31%, respectively. Milder disease, CRP, albumin and prior anti-TNFa were associated with endpoints. One minor adverse event was documented. In the CD cohort, baseline HBI was 12 [0 - 29] and 94% previously received anti-TNFa therapy. Three-month and 6-month primary endpoints were achieved in 52% and 48%, respectively. Six-month remission was positively associated with Montreal B1 disease and negatively associated with perianal disease and baseline faecal calprotectin. Adverse events occurred in 11% of cases. Conclusion:These real-world data support the effectiveness and safety of vedolizumab in the treatment of IBD and give valuable insight into predictors of treatment outcomes. This study reviews the safety and efficacy of treatment with vedolizumab for patients with inflammatory bowel disease across 9 Irish hospitals. It generates valuable and timely real-world data on treatment outcomes to add to the existing evidence base. Our population represents a refractory cohort with most patients previously exposed to at least one anti-TNFa agent and expressing an inflammatory phenotype. Results are reassuringly similar to larger international studies with additional insights into potential predictors of treatment response. This study further supports the safety and efficacy of vedolizumab in the treatment of inflammatory bowel disease.Key Summary Vedolizumab has growing real world data on its safety and efficacy in the treatment of IBD. Data on predictors of response are lacking. Studies such as VARSITY require new real-world data to help identify the place VDZ will occupy in the treatment algorithm for IBD This study provides national Irish data on the safety and efficacy of VDZ in the treatment of IBD. It gives insight into various predictors of response for both UC and CD. It strengthens the available body of evidence on the use of VDZ and helps us determine its position on the treatment algorithm.

Abstract Background IBD is an umbrella term used to describe Crohn’s disease and ulcerative colitis, both characterised as lifelong relapsing remitting diseases (O’Connor et al., 2013). Hope et al (2012) reported a significant increase in the incidence of childhood IBD in Ireland over a relatively short period of time. The aim of this research study was to assess the self-management and healthcare utilisation skills of adolescents and young adults (AYA) (aged 16–21 years) with (IBD). Methods Service users aged from 16 to 21 attending the IBD service were asked to complete the Transition Readiness Assessment Questionnaire (TRAQ). Divided into five domains, 20 questions related to: managing medications, appointment keeping, tracking health issues, talking with providers and managing daily activities. Results 31 completed questionnaires were returned via stamped addressed envelope provided. Seventeen patients were diagnosed in a paediatric hospital and 14 were diagnosed in adult hospital services. Seventy-five per cent of respondents manage their own medications, 50% take responsibility for appointment keeping and 51% keep track of their health issues. Eighty-nine per cent talk to health care providers independently and 81% manage daily activities independently. Further analysis showed that females had significantly higher health tracking scores compared with males p = 0.04. Overall, 65% of all female users provided positive feedback regarding this domain. In male group this score reached only 40%. The biggest discrepancy was noted in relation to query concerning the list of questions before doctor`s visit. Almost 70% of females replied positively to this question, while only 28% of male patients provided positive answer. There was no significant difference in scores from those diagnosed in paediatric setting vs. those diagnosed in adult hospital services. Conclusion Some aspects of the appointment keeping as well as health tracking issues (especially in male group) were identified as domains that need further improvement. Ongoing education will be provided to patients attending the service with training focused on increasing awareness of the users in the most lacking domains.

Summary Barrett’s esophagus (BE) is the main pathological precursor of esophageal adenocarcinoma (EAC). Progression to high-grade dysplasia (HGD) or EAC from nondysplastic BE (NDBE), low-grade dysplasia (LGD) and indefinite for dysplasia (IND) varies widely between population-based studies and specialized centers for many reasons, principally the rigor of the biopsy protocol and the accuracy of pathologic definition. In the Republic of Ireland, a multicenter prospective registry and bioresource (RIBBON) was established in 2011 involving six academic medical centers, and this paper represents the first report from this network. A detailed clinical, endoscopic and pathologic database registered 3,557 patients. BE was defined strictly by both endoscopic evidence of Barrett’s epithelium and the presence of specialized intestinal metaplasia (SIM). A prospective web-based database was used to gather information with initial and follow-up data abstracted by a data manager at each site. A total of 2,244 patients, 1,925 with no dysplasia, were included with complete follow-up. The median age at diagnosis was 60.5 with a 2.1:1 male to female ratio and a median follow-up time of 2.7 years (IQR 1.19–4.04), and 6609.25 person years. In this time period, 125 (5.57%) progressed to HGD/EAC, with 74 (3.3%) after 1 year of follow-up and 38 (1.69%) developed EAC, with 20 (0.89%) beyond 1 year. The overall incidence of HGD/EAC was 1.89% per year; 1.16% if the first year is excluded. The risk of progression to EAC alone overall was 0.57% per year, 0.31% excluding the first year, and 0.21% in the 1,925 patients who had SIM alone at diagnosis. Low-grade dysplasia (LGD) progressed to HGD/EAC in 31% of patients, a progression rate of 12.96% per year, 6.71% with the first year excluded. In a national collaboration of academic centers in Ireland, the progression rate for NDBE was similar to recent population studies. Almost one in two who progressed was evident within 1 year. Crucially, LGD diagnosed and confirmed by specialist gastrointestinal pathologists represents truly high-risk disease, highlighting the importance of expertise in diagnosis and management, and providing indirect support for ablative therapies in this context.

Aims Bleeding upper GI ulcers is a common indication for endoscopy. Its management is focused on resuscitation, pharmacological therapy and endoscopic management. ESGE does not recommend the use of adrenaline injection as monotherapy for bleeding ulcers due to the risk of rebleeding. We aimed to review departmental experience of stable non-variceal upper GI, assessing the indication and number of endoscopic interventions for bleeding upper GI ulcers.

Abstract Barrett’s Esophagus is the main pathological precursor to esophageal adenocarcinoma (EAC), dysplasia is known to be one of the principal predictors of progression to malignancy. The RIBBON Registry was established with six academic medical centers in the Republic of Ireland to identify and manage high risk Barrett’s Esophagus (BE) patients. From our database of over 4,000 patients our aim was to establish characteristics of those patients who progressed to dysplasia and furthermore to malignancy. Methods Data was gathered prospectively from December 2007—December 2019. Ethical approval was sought for the database at the time of establishment. Detailed endoscopic, pathological and clinical data was collected via a web-based data capture system at time of initial diagnosis and at each subsequent encounter. A data manager was appointed at each site and a national lead coordinating the project. The Vienna Grading system was used to grade histology. Patients were included if they had an initial or subsequent diagnosis of Specialized intestinal metaplasia (SIM), Indefinite for dysplasia (IND) or Low-Grade Dysplasia (LGD). Results 860 patients were included with a total of 3792 patient years, a male to female ratio of 2.9:1 and a median age at diagnosis of 63. 50 patients had an initial diagnosis of SIM with subsequent episodes of dysplasia while 510 patients had IND or LGD at diagnosis. 158 (18.37%) progressed to High grade dysplasia (HGD) and EAC. The overall incidence of EAC was 1.7% per year, HGD 2.4% per year and a combined rate of 4.2% per year. Median time to progression in SIM was 4.7 years, 1.1 years for IND and 9 months for LGD. Conclusion The overall progression of the group was much higher compared to looking at those who had SIM alone without dysplasia from the same registry (0.9% per year). Time to progression was significantly faster in the groups with initial dysplasia be that IND or LGD. In our centers those patients were followed up with repeat endoscopy as per international guidelines, the above results highlight the importance of this practice given the potential for malignancy.