A majority of patients tolerate endoscopic procedures well when benzodiazepine/opiate sedation is used. Accurately identifying the minority who tolerate these procedures less well remains difficult.

Introduction Flexible sigmoidoscopy (FS) has been shown to offer substantial reduction in the incidences of and mortality from distal colorectal cancer and is soon to become the new screening method. Although quality markers for colonoscopy have been widely adopted in the UK, similar practice for FS is variable. In order for this procedure to be used as an effective screening tool it will need standardisation in term of quality assurance. Methods It was a retrospective study which was carried out using an endoscopy database to identify patients who had FS performed during 2009e2011 in three district general hospitals serving a population of 600 000. The patient's age, sex, extent of examination, grade of endoscopist, use of medications, procedure tolerance, bowel visualisation and missed left sided lesions were investigated. A complete examination was defined as a procedure when the scope was passed to the splenic flexure or beyond. Mucosal visualisation and patient tolerance were graded as good, fair and poor. Results A total of 2823 procedures were recorded, of which 87.5% were carried out as an out-patient. In 56.7% of cases the scope was passed to the splenic flexure or beyond, while examination was limited to descending colon in 20.2%, sigmoid colon in 18.7% and rectum in 4.6%. Poor bowel preparation accounted for procedure failure in 3.7%, pain for 1.5% and anatomical complexities and pathology encounter in 1%, while in 94.1%, there were no limitations. 94.8% of procedures were performed without sedation. Good mucosal visualisation was achieved in 76.1% and the procedure was well tolerated in 80.7%. 2% of the patients used entonox and 3.3% received midazolam (range 1e5 mg median dose 3 mg). Pathologies were detected in 58.8% of the cases while procedure was reported normal in the remaining 41.2 %. No patient had a subsequent diagnosis of a left sided lesion. Conclusion This study identified wide variability in FS practice in local hospitals and highlighted the lack of quality standards particularly in terms of examination extent, use of medication, bowel preparation and mucosal visualisation. It showed that FS is widely practiced and a useful diagnostic tool but to make it more effective screening tool for colorectal cancer, a standardisation process is needed.Competing interests None declared.

Introduction A UK wide audit of acute upper gastrointestinal bleeding in 2007 showed overall mortality was 10% -varices were identifi ed in 8% of these patients 1 . The SIGN guidelines (2008) adopted by the BSG, recommend that balloon tamponade should be considered as a temporary salvage treatment for variceal haemorrhage which has not been controlled by endoscopic and drug therapy 2 . Unlike previous Gastroenterology StR/SpR curricula, competence in placing and managing Sengstaken-Blakemore (SB) tubes is included in the 2010 curriculum and should be assessed by DOPS. Methods This survey aimed to determine trainee confi dence in the insertion and management of SB tubes and to suggest how training should be delivered. In addition we asked the opinions of consultant gastroenterologists. An online survey was emailed to all trainees and consultants in the Severn and South West Peninsula deaneries. Results The survey was sent to 34 trainees with a 71% response rate. 47% were ST3 or 4 with the remaining 53% ST5, 6 or SpRs. 75% of trainees have been involved in managing patients with SB tubes averaging 3 patients in the last 5 years. 96% felt SB tubes are a useful management option and 50% have seen one deployed by a senior colleague. Only 38% felt confi dent to insert a SB tube independently and 25% are confi dent to give management instructions to nursing or junior medical staff. 100% of trainees felt there should be formal training. The survey was sent to 65 consultants with a 40% response rate. 77% had used SB tubes in an average of 3 patients in the last 5 years. 96% felt trainees should be competent in inserting SB tubes and have formal training. 88% did not know if SB tubes are a component of the 2010 curriculum with only 12% saying yes. With regards to training, 46% of trainees preferred a session integrated into a regional training day, followed by 29% who wanted a study day including a model/simulation session. 35% of consultants felt either of these methods would be suitable. 17% of trainees wanted an e-learning module followed by model/simulation session. Conclusion This survey demonstrates that the insertion and management of SB tubes is a weak area in gastroenterology training. This must be addressed, particularly as it is included in the 2010 StR curriculum requiring demonstration of competence. Trainees and consultants agree there should be formal training in this skill ideally as a model/simulation session or at a regional training day. Competing interests None.

IntroductionObesity is a risk factor for the development of colorectal cancer (CRC).1 Colonoscopy in obese patients has been suggested to be more technically difficult,2 3 but variation in indication and age of patients, and operator technical ability may be confounding factors. The Bowel Cancer Screening Programme (BCSP) has a single indication for colonoscopy in a narrow age band (60–70 years) and the colonoscopists are of a proven standard, therefore studying data from this group of patients may avoid confounding factors and give a truer assessment of technical difficulty.MethodsWe compared measures of technical difficulty (quality of preparation; caecal intubation rate and time; sedation/analgesia dose; and patient tolerance) and findings (polyp and cancer detection) in the Taunton Faecal Occult Blood positive (FOB+ve) BCSP colonoscopy patients in 2008/9 (N=359, males 209, females 150) in relation to their BMI.ResultsBMI was known in 348, and was 15.7–58.3 (median 28.0). One hundred and eleven patients (31.8%) had BMI >30. Bowel preparation scores were not affected by BMI (Fisher's Exact Test, p=0.62), nor were sedation and analgesia requirements (all comparisons obese vs non-obese, Fisher's Exact Test or regression analysis). Comfort scores were similar (minimal or no discomfort 63% vs 68%, p=0.33). Overall caecal intubation rates were 96.3%, vs 97.4% (p=0.73). Caecal intubation time was not effected by BMI (r=0.022, p=0.68). Polyps were found in 210 (58.4%) patients and cancer in 43 (11.9%) in total. BMI did not affect the number of polyps found (p=0.33). There was no significant difference in the number of cancers identified in patients with a BMI>30 (14 of 97) compared to the others (29 of 208) (p=1.0).ConclusionObesity does not impair the technical performance of colonoscopy in this population. There is a high rate of obesity in the FOB +ve BCSP population, but the effect of obesity on findings cannot be assessed by this study, since the proportion of obese patients in the overall population from which this group is drawn was not available. Nether-the-less this study suggests that obesity should not be a factor in deciding whether colonoscopy is an appropriate investigation to exclude CRC.