days following PEG and RIG insertion in NHS Lothian, a healthboard covering a population of approximately 1 million people. Endoscopy records from Unisoft and radiology request records from NHS Lothian Trakcare were used to identify patients who underwent one of these procedures in 2018. Electronic notes and endoscopy reports were reviewed. Results In total there were 139 RIG insertions and 29 PEG insertions carried out in patients who had never had this procedure performed before. 81% of the RIG insertions were carried out for cancer, of which 88% were in patients undergoing active treatment of their cancer with curative intent. PEG insertion was most commonly performed following a stroke (24%). The 30-day mortality rate was lower for RIG insertion (6% vs 14% for PEG), as was mortality at 90 days (11% vs 21%). The most common cause of death within 30 days in the RIG group was related to the underlying malignancy (n=5) whereas in the PEG group it was aspiration pneumonia (n=3). The morbidity rate at 30 days was 48% in the RIG group compared to 37% in the PEG group. Overall 15% of patients developed an infection at their gastrostomy site within 30 days of insertion. Conclusions Contrary to previous studies, this audit found a lower risk of mortality at 30 and 90 days following RIG insertion than with PEG insertion. This may be related to patient selection, with those undergoing PEG being frailer with more co-morbidities. However, the morbidity rate was higher in the RIG group. The number of RIG insertions was significantly higher than has been recorded in other studies covering a 12-month time period. We conclude that having experienced radiologists performing a large number of procedures each year reduces the risks of the complications. It is important for all invasive procedures that the medical practitioner carrying them out has sufficient expertise to perform them safely.

IntroductionCapsule endoscopy (CE) is increasingly being used to visualise the small intestine in patients with known or suspected Crohn’s disease. The aim of this study was to review the use of CE for this purpose over a two year period in a medium sized DGH following the creation of a new CE service.MethodsElectronic records of all patients undergoing CE between 1st April 2013 and 31st March 2015 were reviewed. Patients who underwent the procedure to investigate for possible small bowel Crohn’s disease (based on clinical, biochemical and/or endoscopic suspicion) or to assess previously diagnosed Crohn’s disease we identified. Record was also made of contemporaneous faecal calprotectin results and ileal appearances at colonoscopy.ResultsTwenty-four patients underwent CE to investigate possible small bowel Crohn’s disease. Of these, 11 (46%) had CE findings supportive of Crohn’s disease. 5 of these 11 patients had contemporaneous faecal calprotectin measurement of which 4 (80%) were positive. Eight of these 11 patients had contemporaneous ileal intubation of which 7 (88%) showed evidence of ileitis. Of the 13 patients with normal CE findings, 8 had faecal calprotectin measurement of which only 1 (12%) was positive. Eleven of the 13 patients had contemporaneous ileal intubation of which 4 (36%) showed mild ileitis.Ten patients underwent CE to assess known small bowel Crohn’s disease. CE was normal in 4 cases and showed evidence of active small bowel Crohn’s in 6 cases. Of the 4 patients with normal CE findings, 2 had faecal calprotectin measurement of which both were normal and 3 had ileal intubation which showed no evidence of inflammation in all cases. Of the 6 patients with CE findings suggestive of active small bowel Crohn’s, 5 had faecal calprotectin measurement of which 4 (80%) were normal and all 6 had ileal intubation which showed ileitis in 4 (67%).ConclusionIn patients with suspected small bowel Crohn’s disease CE findings supported this diagnosis in nearly half of patients and CE findings correlated well with faecal calprotectin measurement and ileal appearances at colonoscopy. However, in patients undergoing CE to assess known small bowel Crohn’s, CE showed active disease in 57% of patients with normal faecal calprotectin measurement although there was better correlation between CE findings and ileal appearances at colonoscopy. This suggests that CE is an informative test in both the investigation and ongoing management of small bowel Crohn’s disease, and may be a more sensitive test of small bowel Crohn’s disease than faecal calprotectin.Disclosure of InterestNone Declared

IntroductionCapsule endoscopy (CE) is increasingly being used to investigate iron deficiency anaemia (IDA) when bi-directional endoscopy does not find a cause although current guidelines do not recommend routine small intestinal investigation unless symptoms or recurrent/refractory IDA.1 The aim of this study was to review the use of CE in the investigation of IDA over a two year period in a medium sized DGH following the creation of a new CE service.MethodsElectronic records of all patients undergoing CE between 1st April 2013 and 31st March 2015 were reviewed. Indication for CE was recorded along with the result of the investigation. Clinic letters were reviewed to assess the impact of CE on patient management.ResultsOver the study period 97 CE procedures were performed. Fifty (52%) procedures were performed to investigate IDA, 34 (35%) for investigation of possible or known Crohn’s disease; 4 (4%) for polyposis and 9 (9%) for other indications.Of the 50 CE procedures for IDA, 18 (36%) showed abnormalities in the small bowel; these included polyps (28%), vascular lesions (33%) and ulcers (28%). No malignancy was found over the 2 year period although one large (3 cm) polyp exhibited high grade dysplasia. Thirteen procedures (26%) showed gastroduodenal pathology but no small bowel abnormality. There was no difference between the mean ages of patients with normal compared to abnormal small bowel CE findings (56.9 years old vs 57.6 years old).In 8 of the 18 cases (44%) where small bowel abnormalities were found there was a subsequent change in patient management; this included surgery to remove polyps, endoscopic treatment of vascular lesions and medication changes. Thirty-eight patients (76%) were discharged from clinical follow up following CE with advice to continue long-term iron supplementation; this included 8 patients with abnormalities seen at CE.ConclusionOver a third of patients undergoing CE to investigate IDA were found to have small bowel pathology. However less than half of these findings resulted in significant management changes. In total CE findings altered clinical management in only 16% of patients although it did allow 76% of patients to be discharged from further clinical follow-up. Clincal factors such as age did not appear to predict the presence of small bowel pathology. As a result, the role and timing of CE in the investigation of IDA remains uncertain.Reference1 Guidelines for the management of iron deficiency anaemia. Goddard, et al. on behalf of the British Society of Gastroenterology 2011.Disclosure of InterestNone Declared

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IntroductionFaecal calprotectin (FC) is a marker of intestinal inflammation, used to investigate gastrointestinal symptoms for inflammatory bowel disease (IBD). The normal range and significance of mild elevations in FC remains under debate. This study aimed to determine endoscopic findings and conditions associated with levels of 50–200.MethodsData was collected retrospectively. Details of patients with FC of 50–200 received by St Richard’s Hospital pathology department over an 11 month period were obtained. Results were reviewed with clinical information from clinic letters and investigations that were available 9 months after the FC collection period.Results189 patients had a FC of 50–200, with 109 having clinical information available. The remaining 80 not seen in secondary care were excluded.Of the 109 patients included, mean FC was 102.7, 73 were female and mean age 47.3 years. The most prevalent symptoms were abdominal pain (46.8%) and diarrhoea (64.2%). 82 (75.2%) patients underwent endoscopy, (54 colonoscopies, 32 flexi-sigmoidoscopies), with 10 procedures done before. 47 (57.3%) patients had normal endoscopies, with 34 (63%) colonoscopies being normal. Abnormalities included inflammation, ulcers, diverticulosis and polyps with low grade dysplasia. 51 patients had mucosal biopsies at recent endoscopy, with 12 showing inflammation. From these 12 patients; mean FC was 135.9, though 3 had FC < 100, 4 were diagnosed with IBD (mean FC = 167.5), 2 followed up for possible IBD, 1 had collagenous colitis, 3 had non-specific colitis and 2 had infective colitis. All patients with IBD or possible IBD had FC ≥ 100, with mean FC of 158.3. Patients with no inflammation on biopsy had mean FC of 100.3.Clinic letters showed 37 (33.9%) patients had a diagnosis of irritable bowel syndrome (IBS), with mean FC of 97. 21 (19.3%) patients with normal investigations lacked a formal diagnosis, being mostly discharged or not followed up. Many patients avoided endoscopy as alternative diagnoses were made. Other diagnoses included chronic pancreatitis (5.5%), gastroenteritis (5.5%), coeliac disease (2.8%), diverticulosis (5.5%) or symptoms improved (3.7%).ConclusionFC levels of 50–200 have a low association with subsequent diagnosis of IBD (3.6%). Many patients were diagnosed with IBS or had normal investigations indicating a functional condition. In this range of FC, patients with inflammation on biopsy had a higher FC than those with negative biopsies (p < 0.05). Inflammation caused by IBD had a higher FC than other causes of inflammation. Negative predictive values of FC 50–99 were higher than FC 100–200 with regards to excluding IBD (100% v 91.8%) and mucosal inflammation if undergoing endoscopy (95% v 81.6%). Many patients with FC 50–200 were not referred to secondary care. This study suggests a low rate of missed IBD is likely as a result.Disclosure of InterestNone Declared