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(5.4%) of TNE biopsies did not permit a definite diagnosis, but when standard biopsies were later taken, also failed to confirm diagnosis. Conclusion TNE is equal to SOGD in image quality, endoscope handling and length of procedure. It is superior to SOGD in the ability to perform a panendoscopy and in terms of comfort and patient acceptance. Importantly it induced significantly less stress to the heart, thus should be considered as the endoscopic diagnostic method of choice in patients with significant cardio-respiratory problems. Introduction British Society of Gastroenterology guidelines on the management of gastric polyps 1 recommend increased intensity of evaluation compared with traditional practice, including biopsy of ALL polyps, biopsy of intervening gastric mucosa (hyperplastic/ adenomatous polyps) and 1 year follow-up of dysplasia; a considerable increase in endoscopic and histological workload. The purpose is to reduce risk, and increase early detection of gastric carcinoma. It would therefore be expected that in clinical practice there would be an association between gastric polyp detection and subsequent carcinoma, and that application of the guidelines would improve patient outcomes. The purpose of this study was to evaluate whether this association exists in a DGH setting where traditional polyp assessment and surveillance was followed. Methods Our database was searched for gastroscopies where polyps were found over 5 years. These records were cross-referenced against the local cancer database for those 5 years plus 1 year of follow-up. Any cases where polyps were found along with subsequent cancers were audited. Results Details of 15 489 gastroscopies in 11 938 patients over 5 years (2006e2010) were analysed. 670 patients (756 gastroscopies) were found to have gastric polyps (5.6%din line with larger studies).2 In 2006e2011, 1328 upper GI cancers were recorded on the local register. Cross reference of these revealed 57 patients with polyps at gastroscopy who had a co-existent record on the local cancer register. Cases were excluded where cancer was diagnosed at the index endoscopy [45 patients with polypoid tumours or coexistent polyps where the guidelines would not have influenced outcome]. Seven of the remainder had non-gastric neoplasia. Of the remaining 5, 3 had a small neuroendocrine tumour on follow-up endoscopy, with no specific treatment. The other two were an 80 year old with a dysplastic polyp, followed up at 3 and 6 months when carcinoma was identified (the patient was not fit for radical treatment); and a patient with a large suspicious polypdinflammatory on initial biopsies with dysplasia identified following intensive follow-up (leading to resection). Neither would have benefited from application of the guidance. Conclusion This retrospective analysis reveals no patients where an initial suspicion of simple fundic polyps was followed by a subsequent diagnosis of significant neoplasia, or where follow-up of hyperplastic polyps would prevent progression. On the basis of these results...

Introduction The optimal approach to managing terminal ileal (TI) Crohn’s disease remains to be defined. It is unclear at what stage surgery or biological therapy should be offered and current clinical and biochemical parameters offer poor prediction of disease course. Small bowel MRI scanning (SBMRI) has been correlated with endoscopic and histological disease severity in Crohn’s disease and may offer better global assessment of the extent and severity of disease. We aimed to determine which MRI features might predict the need for surgery or biological therapy. Methods 48 sequential patients with Crohn’s disease who underwent SBMRI in a 20 month period to Feb 2011 were identified from a radiological database. 8 patients were excluded due to predominant colonic disease. All remaining 40 patients had confirmed isolated TI disease. Standard management with escalation of therapy via immunomodulors, biological agents and surgery based on clinical follow up was applied. Patients were followed for a minimum of 2 years after the initial MRI. MRI scanning was performed using oral fluid load, IV buscopan, T1/2 axial, coronal and dynamic post contrast sequences. The images were reviewed by a radiologist blinded to outcome of cases and key abnormal features recorded (mesenteric abnormalities, wall thickness > 6 mm, disease extent > 15 cm or proximal dilatation > 25 mm). Patients were then divided into 2 groups, those requiring biological therapy or surgery (severe) and those managed with 5ASA or immunomodulators alone (non severe). Results The characteristic of the two groups is shown in the table. Means given unless stated. Abstract PTU-062 Table n Age CDAI at MRI CRP at MRI Years post diagnosis Previous surgery (%) Immunomodulator use (%) A Non severe 20 36 77 19 9.9 45 45 B Severe 20 42 120 30 9.8 45 75 6/20 patients in the non-severe group (A) had two or more adverse radiological features compared with 12/20 in the severe (B) group (p = 0.06). However, only 3/20 patients had lumen > 25 mm or extent > 15 cm in A compared with 15/20 in B (p < 0.001). Wall thickness and mesenteric involvement were not associated with a severe outcome. Disease extent and proximal luminal diameter were significantly associated with surgery (p = 0.02 and p = 0.0001). 85% of patients who eventually required surgery had either proximal lumen > 25 mm or disease extent > 15 cm. Conclusion Two or more adverse radiological MRI features are associated with with the need for surgery or biological therapy. Small bowel dilatation > 25 mm proximal to the disease segment and disease extent > 15 cm are particularly associated with the need for surgery. These MRI findings may be helpful in deciding appropriate longer term strategies for managing these patients. Disclosure of Interest None Declared