BSG abstracts thoroughly as infection with Hepatitis C Virus (HCV). The aim of this audit was to assess the number of service users chronically infected with HBV and their relevant co-infections, co-morbidities and access to treatment. Methods The Tower Hamlets Specialist Addiction Unit serves the London Borough of Tower Hamlets with a population of more than 200,000. Its Blood Borne Virus Team (BBVT) provides harm reduction healthcare in more than 10 drug and alcohol addiction facilities including outreach sites and neighbouring boroughs. Data on service users chronically infected with HBV was extracted from the service database. Results Of 2577 people currently registered with the BBVT 49 (1.9%) have chronic HBV infection with detectable HBs-Antigen. 88% are male, the average age is 40 years and the majority is of non-British origin with large groups of Baltic (18%) and Black/ African/Caribbean (20%) ethnicity. 16 patients (33%) are currently injecting drug users (IDU), 13 (27%) formerly IDU. Other reasons for referral are non-injecting drug and alcohol use. 14/49 patients (29%) have psychiatric comorbidities other than drug/ alcohol abuse. 22 patients (45%) knew about their infection when they entered the service. 12 patients (24%) have HBe-Antigen-positive and 37 (76%) HBe-Antigen-negative disease. 12/49 patients (24%) have detectable HCV-RNA and can be regarded as co-infected. 3/49 patients (6%) have detectable Hepatitis D Virus (HDV)-RNA. Two patients (4%) are infected with HBV, HCV and HDV. Two patients (4%) have active syphilis co-infection and HIV-co-infection, respectively. 10/49 patients (20%) have been diagnosed with cirrhosis. One patient has undergone resection for HBV-associated hepatocellular carcinoma and has been followed up for 9 years without recurrence. Two patients were infected after documented vaccination against HBV. 7/49 patients (14%) are currently undergoing treatment with a regimen that is effective against HBV. Three patients have cleared HBV, one through treatment and two spontaneously. Conclusion Even in a difficult setting where care can be interrupted by incarceration or psychiatric deterioration, successful health care for patients with chronic HBV infection is possible by using outreach facilities and appointment reminders. The community attending drug addiction services has overlapping risk factors and in East London, only a minority of patients chronically infected with HBV are currently injecting drug users. Vaccination against HBV has no 100% protection rate and service users should repeatedly undergo testing for blood borne viruses. Disclosure of Interest None Declared.

post ERCP pancreatitis, as observed in previous studies.2 Following adopting the technique of balloon sphincteroplasty there has been a statistically significant improvement in the success of stone extraction. A subsequent reduction in referrals to tertiary centres for failed ERCP has also been observed. Introduction Recent British Society of Gastroenterology (BSG) guidelines 1 recommend all post-menopausal women and all men with confirmed iron deficiency anaemia (IDA) should be considered for upper and lower gastrointestinal investigation. Increasing demands on limited resources mean a straight-to-test approach is commonly adopted in busy gastrointestinal units. In the elderly this may result in poor attendance and inappropriate endoscopic investigations in high-risk patients. Methods We looked at one year's experience of a nurse-led one-stop IDA service which offered an initial clinic visit to discuss the most appropriate mode of investigation in patients aged 75 years and older. Four options were considered: bi-directional endoscopy, OGD and CT colonography with faecal tagging, plain CT scan of abdomen/pelvis or treatment of anaemia without investigation. Data were collected retrospectively for the period of April 2010 to April 2011 for this group of patients. Results 244 patients were referred over the year. Ninety-six were 75 and over: 67 female, 30 male. Age range of 75e97. Fifty-nine patients had confirmed IDA based on the haemoglobin level, mean corpuscular volume (MCV) and ferritin. Twenty-seven patients were iron deficient without anaemia. Ten patients had normocytic anaemia. In the IDA group: 25/59 (42.3%) patients qualified for bidirectional endoscopy. 16/59 (27%) patients opted for alternative investigations and 18/59 (30.5%) either were not suitable, chose not to be investigated or did not attend their appointments. In the iron-deficient group: 6/27 (22%) underwent bi-directional endoscopy. 7/27 (26%) had alternative investigations and 14/27 (51.8%) were not investigated for reasons as outlined in the IDA group. In the normocytic anaemia group: 4/10 (40%) had IDA, 1/10 (10%) underwent bi-directional endoscopy. Only 32/96 (33%) patients initially referred to the IDA service underwent bi-directional endoscopy. Conclusion Only a third of elderly patients referred for investigation of IDA were appropriate for bi-directional endoscopy. A straight-totest approach in this group of patients is likely to result in inefficiencies in endoscopy slots and inappropriate investigations in a high-risk group. We recommend a one-stop initial clinic assessment in this group of patients.Competing interests None declared.

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