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published guidance on 'Improving Outcomes in Upper Gastro-intestinal cancer' in January 2001. 1 One of the important recommendations was 'Fast Track Endoscopy' service within 2 weeks for patients with suspicion of cancer ('the 2 weeks rule'). Our aim was to compare the detection of curative Upper GI cancers (Oesophagus and stomach) and survival in patients referred for Oesophago gastro duodenoscopy (OGD) via USC versus non-USC (routine) route in a District general hospital. Methods We performed a retrospective audit on all patients referred for OGD between October 2006 and April 2007 in Wrexham maelor hospital (Cross-border Upper GI Cancer center for North Wales and West Cheshire). Data on mode of referral (USC or non-USC), endoscopic and histological diagnosis, curative or palliative intervention (if cancer detected) was collected. Patients with upper GI cancers were followed to check for survival at 18 and 36 months.

NASH and 7% Hepatitis C. Median MELD score was 15.5 (IQR 13.5-21). All patients were prescribed lactulose. Of the 30 patients, 5 died within 6 months of commencing Rifaximin. One patient was discontinued, due to non-compliance. 24 patients were included in the final analysis. We compared the outcomes for the 6 months prior to, and the 6 months after commencing Rifaximin treatment. Median hospital admissions were reduced from 2 admissions (IQR 1-3, Range 1-5) to 1 admission (IQR 0-2, Range 0-4, Wilcoxon p < 0.05). Median number of bed days was reduced from 27.5 (IQR 16.0-35.3, Range 2-129) to 2.5 (IQR 0-23.5, Range 0-55, Wilcoxon p < 0.05). No patient developed Clostridium difficile-associated diarrhoea in the 6 months after commencing Rifaximin. Conclusion In our hospital, the basic cost of a hospital bed day is £300. A 6 month course of Rifaximin costs £1688. This study demonstrates that Rifaximin treatment in patients with HE, due to chronic liver disease, produced a marked reduction in hospital admissions and hospital bed day occupancy in a District General Hospital, with major cost savings and improved clinical outcomes. Disclosure of Interest None Declared.

Introduction It is well known that CO2 insuffl ation reduces pain during and after colonoscopy. However air insuffl ation is more popular probably due to limited randomised studies. 1 This study compares the effects of air and CO2 insuffl ation on pain during and after colonoscopy. Methods The study was conducted over a 3-month period and 126 patients were randomly assigned into CO2 or air insuffl ation groups. Discomfort scores during and after colonoscopy was recorded using the modifi ed gloucester discomfort score and factors infl uencing outcome such as sex, endoscopist grade, previous surgery and sedation were also considered. Results Of 126 in the study, air was used in 36 and CO2 in 90. The caecal intubation rate in CO2 was 95% versus 91% in the air group. Patients in the CO2 group had lower pain scores during the procedure compared to air. During the procedure, 51.6% CO2 versus 36.11% (Air) had no discomfort at all (score 1). Patients who had a score of 2, 3 were 46% Air versus 40% CO2. There was a higher pain score (4, 5) noted at 7% versus 2.7% (Air) noted mainly in females (83.3%). Postprocedure discomfort scores were almost equal noted to be 1.19 Air versus 1.06 at 1 h and 1.08 versus 1.00 CO2 at 2 h. A number of factors were taken into consideration to see whether this infl uenced discomfort scores. (1) Sex: 57 males and 69 females were in the study. Females had higher pain scores 31.34% versus 15.52% (males). However this was not statistically signifi cant using the Mann-Whitney test.(2) Sedation: Average sedation used, midazolam (M) 1.93 versus 0.67 mg CO2, Pethidine 9 versus 14 mg CO2, fentanyl 34 versus 17 mg CO2. Average top up sedation used was 0.02 versus 0.05 mg CO2 of M, Pethidine 0.69 versus 0.5 mg CO2 and fentanyl 2.5 mg top up for CO2 group versus no top up. (3) Previous surgery: Data for only 74 patients was available. Those patients who have had no previous surgery (n=50) appear to have lower discomfort levels, however data points for pelvic surgery were too few to come to a conclusion. (4) Endoscopist: Discomfort scores were higher in trainees (n=34) using CO2 than consultants (n=56). Using MannWhitney test this was statistically signifi cant with a CI of 95.1%. There was no difference in scores in air group. In the consultant group, using CO2 lowered patient discomfort compared to air (p=0.06) that was statistically signifi cant.

PWE-154 The prevalence of GI malignancy ranged from 0.0% in younger females with mild anaemia, to over 25% in older males with more severe anaemia. By the pre-defined criteria, the model identified subpopulations of 84 (11% of the total) at extreme low risk, and 117 (16%) at extreme high risk. ConclusionThe results confirm previous work identifying age, sex and haemoglobin concentration as variables predictive of underlying malignancy in IDA. Furthermore, the findings suggest that over a quarter of subjects with IDA can be predicted to be of extremely low or high risk on the basis of these simple and objective clinical criteria. This may be of clinical relevance for patient counselling, prioritisation of investigations and allocation of resources. Work is ongoing to validate risk prediction in a prospective study, and to refine the model by inclusion of additional variables. Disclosure of Interest None Declared. REFEREncE ROYAL MARSDEN HOSPITAL, LONDON, UKIntroduction As new cancer treatments have been introduced, there have been enormous improvements in outcomes for treated patients. They are living longer and the number of survivors of cancer therapy is growing by 3% per year in the UK. 17 000 UK patients are treated annually with pelvic radiotherapy. 80% of patients who receive pelvic radiotherapy are left with chronic alteration in GI function and 50% state that this affects daily activity. There are few data on the nature of the symptoms these patients develop. This study aims to describe the symptoms troubling patients referred to a specialist Pelvic Radiation Disease clinic. Methods A prospective service evaluation of patients treated with pelvic radiotherapy referred to our clinic was performed. Patient characteristics were recorded. Each new patient completed a modified Gastrointestinal Symptom Rating Scale and Bristol Stool Chart which described their symptoms and severity. Results Data on the first 110 patients collected included 47 women (43%), median age, 59 (range: 37-79 years) and 63 men (57%) median age, 72 years (range: 20-83 years) treated for prostate (47%), gynaecological (27%) or anorectal cancers (17%), lymphoma (5%) and other tumours (4%). The median length of time since starting radiotherapy to presenting in clinic was 3 years 1 month; range: 0.5-36 years. Pelvic symptoms causing frequent or severe impact on patients daily lives were urgency (68%), diarrhoea (defined as Bristol stool chart type 6 or 7) (62%), tenesmus (55%), fatigue (51%), rectal flatulence (51%), abdominal pain (45%), faecal leakage (43%), sexual concerns (35%), problems with urination (34%), bloating (34%), borborygmi (30%), woken at night to defaecate (28%), rectal bleeding (24%), belching (20%), heartburn (15%), steatorrhoea (13%), nausea and vomiting (10%).Women presented with a median of 12 symptoms (range: 2-17) out of a maximum of 17 recorded symptoms and men with a