IntroductionThe BSG guidelines1 recommend that every endoscopy unit in an acute hospital setting should provide a basic percutaneous endoscopic gastrostomy (PEG) service, which is a part of the nutritional support team. The service should provide a framework for patient selection, pre-assessment and post-procedural care as well as working closely with the community-based services. Our trust recently appointed an accredited therapeutic endoscopist and gastroenterology nurse practitioner to run this service.MethodsRetrospective analysis of all PEG insertions performed from Jan 2014 to Nov 2015 over a 23 month period. We looked at early-term (four weeks) and late term (eight weeks) mortality after PEG insertion.ResultsAll patients were referred via a revised pathway proforma and examined by the team before the procedure to assess suitability. Further help and advice is offered to the community team upon discharge. 71 patients were referred for PEG insertion during the period of study. 29 (41%) were male, with a mean age 68 (range 29–87 years), 42 (59%) were female, with a mean age 69 (range 18–93 years). Indications for referrals included: 37 (52%) stroke related dysphagia, 15 (21%) head and neck cancers, 6 (8.5%) Huntington’s disease, 4 (5.6%) traumatic head injury, 3 (4.2%) learning disability, 2 (2.8%) cerebral palsy, 2 (2.8%) multiple sclerosis, 1 (1.4%) supranuclear palsy, 1 (1.4%) mitochondrial myopathy, 1 (1.4%) syringomyelia, 1 (1.4%) parkinsonism, 1 (1.4%) Korsakoff’s psychosis, and 1 (1.4%) myoclonic epilepsy with ragged-red fibres (MERRF) syrdrome. Patients with a formal diagnosis of dementia were not selected to undergo PEG insertion during this period. No short-term complications were reported post-insertion.Early-term mortality was 12.7% and late-term rose to 22.5%. Previous departmental audit in 2014 revealed early-term mortality of 20% and late-term mortality of 28%.ConclusionMeta-analysis has reported a 19% 30 day mortality following PEG insertion. 3We have shown that in our centre, both early and late-term mortality has improved due to careful patient selection and a dedicated PEG service. Adherence to the BSG guidelines on PEG service has had a direct impact on improving mortality and clinical outcome.References1 Westaby D, Young A, O’Toole P, Smith G, Sanders DS. The provision of a percutaneously placed enteral tube feeding service. Gut. 2010;59:1592–1605. doi:10.1136/gut.2009.2049822 Johnston S, Tham T, Mason M. Death after PEG: results of the national confidential enquiry into patient outcome and death. Gastrointestinal Endoscopy 2008;68:223–7.3 Mitchell SL, Tetroe JM. Survival after percutaneous endoscopic gastrostomy placement in older persons. J Gerontol A Biol Sci Med Sci 2000;55:M735–9.Disclosure of InterestNone Declared

Urinary tract infections (UTI) are a common presentation in a medical assessment unit, and we wanted to check compliance with hospital guidelines for antibiotic prescribing in patients presenting to hospital with urinary tract infection. The guidelines are based on local organisms and sensitivities. A retrospective audit of 40 patient records with positive urine cultures from July to August 2013 showed that 20% of patients with culture confirmed UTI were not given antibiotics at all. Of those prescribed antibiotics, 25% were non-compliant with local policy, and nearly one in two patients received more than one antibiotic. Furthermore, stop dates were not stated on 77% of the drug charts and duration of treatment ranged from one to 11 days.Interventions were then introduced in the form of group teaching sessions, proactive checks by Trust pharmacists and widely distributed posters, and the same data sets collected for April to March 2014 to assess for efficacy of the interventions. On re-auditing, 35% patients were not prescribed any antibiotics. However, compliance with local policy was 100%, including 100% drug charts having a stop/review date stated. The overall duration of treatment now ranged from one to seven days, and fewer than one in four patients had more than one antibiotic.Our results showed that improvement was needed in antibiotic stewardship, in particular with regards to compliance with the local guidelines and documentation of prescription. We have demonstrated that it is possible to improve compliance through teaching, by displaying information prominently, and vigilance by the clinical team. The outcome of this is a decreased number and duration of antibiotics prescribed, which has benefits for the patients, the hospital, and the community as a whole. Further work would include interventions to improve the number of patients who are missing antibiotic prescriptions altogether.

Gender reassignment surgery is a form of treatment for gender dysphoria. It can be male-to-female or female-to-male. We present a patient who underwent male to female reassignment and had a vaginal reconstruction. She presented almost a year later with acute kidney injury and bilateral ureteric obstruction, subsequently ending up with nephrectomy for a non-functioning kidney.

Results An average of 2460±366 colonoscopies were performed in every 6-month period by 42±4 endoscopists. Collective ADR and PDR were 12% and 19%, respectively, at the beginning of the study period. Figure 1 shows a continuous improving trend in collective performance was recorded since the provision of individual feedback started. Departmental ADR improved from the initial 12% to 22% (Slope .10 ±.01; R 2 .84, p<0.0001), and PDR from 19% to 30% (Slope .10±.01; R 2 .78, p<0.0001) in the last 6-month period. Interestingly, the ADR/PDR ratio (overall 0.68±0.05, mean±SD) also increased over time from a baseline of 0.63 to a final figure of 0.73 (Slope .001±.0003; R 2 .52, p<0.01). Other KPIs showed similar improving trends. The number of non-neoplastic polyps detected did not increase during the study period. Conclusions Our data show that regular written feedback to endoscopists about their individual and departmental KPIs, along with expected benchmarks, improves adenoma detection and overall endoscopy performance. The parallel improvement of ADR/PDR ratio suggests that the above result is not due to increased removal of no-risk polyps, which is a potential unintended consequence of PDR monitoring. Concomitant monitoring of ADR and PDR may be important to prevent 'gaming' behaviour and ensure that a genuine quality improvement is achieved.

IntroductionStraight-to-test (STT) endoscopy as a 2 week-wait (2 WW) referral pathway for patients with dysphagia has been operable since 1996 in Barnsley Hospital NHS Foundation Trust. It offers a “one stop assessment” as patients has an “on table” consultation and examination and additional investigations can be requested. It allows direct general practitioner referrals with an aim to reduce delays in cancer management. However, it may reduce endoscopy capacity as patients require a longer time slot (1.5 vs 1.0 slot). We reviewed the clinical outcome of this service.MethodsPatients were identified through an electronic database "Endosoft" with retrospective analysis of all STT upper gastrointestinal (UGI) endoscopies performed from November 2014-October 2015. Primary end-point was total diagnostic yield with secondary end-point of clinical outcome.Results1192 patients were referred as 2 WW. 398 (33%) of these were STT referrals for dysphagia. 385 proceeded to UGI endoscopy. Ratio of male (M) to female (F) was equal. Mean age in M and F was 63 years (range 26–95 in M and 25–95 in F). Total diagnostic yield is shown in Table 1. Multiple diagnoses co-existed in the same patient.Abstract PTH-140 Table 1Total diagnostic yield of STT serviceDiagnosisPercentage of total cohortOesophageal cancer6Hiatus hernia20Oesophagitis/Oesophageal ulcer24Oesophageal stricture/Schatski ring3Gastritis/Duodenitis26Normal19Others6Oesophageal cancer was detected in 6% (18 M, 5 F). Histopathology confirmed adenocarcinoma in 70%, squamous cell carcinoma in 17%, carcinoma in situ in 9% and small cell carcinoma in 4%.All were referred for Multi-Disciplinary Team discussion and had staging Computed Tomography (CT). 4 patients were referred for surgery. 1 patient received radical radiotherapy. 4 received palliative chemo/radiotherapy. The rest were managed with best supportive care.Of the non-cancer patients, 12% (42/362) were discharged from endoscopy. From endoscopy, 9 patients had investigations arranged (2 barium swallows, 4 abdominal ultrasound scans, 3 CT abdomens) and 3 patients were referred to Ears, Nose and Throat.ConclusionThe STT pathway for dysphagia in our institution helps in maintaining overall prescribed target time for patients for oesophago-gastric cancer. The diagnostic yield for oesophageal cancer was 6%, which is similar to known rates in patients presenting with dysphagia.1 Other benefits are discharge of patients from endoscopy and expedition of management as investigations and referrals can be made from endoscopy.Reference1 Rosenstock AS, Kushnir VM, Patel A, et al. Su1509 Diagnostic yield in the evaluation of Dysphagia. Gastrointestinal Endoscopy. 2011;73:AB287Disclosure of InterestNone Declared