Sir, Reply to MangatWe thank Dr Mangat 1 for his comments regarding our study. 2 We would like to point out that hypertension and diabetes were part of a list of exclusion criteria in our study, as was smoking. We therefore stand by our hypothesis that steroid-induced vascular fragility seems to be the likely cause of spontaneous subconjunctival haemorrhage in these subjects.

Aim Intra Gastric Balloons (IGB) have been used over the last three decades as a minimally invasive, non-surgical weight-loss option. The ElipseTM gastric balloon (EIGB) is a ‘procedure-less’ gastric balloon which can be placed in an average of 20 minutes without the need of endoscopy or sedation. The aim of our study is to investigate the first cohort of patients in uk who underwent IGB capsule and short term follow up. Method Single centre retrospective study of the first consecutive 202 patients that had the Eclipse IGB inserted between May 2018 and November 2020. Patients swallow the ElipseTM capsule and pre-inflation x-ray is taken to confirm correct positioning after which the gastric balloon is inflated with 550mls of sterile water and a post-inflation x-ray is taken. The balloon is designed to be in-situ for 4 months and then automatically deflates. Results Out of 202 patients 24 were lost to follow-up, 146 patients followed up to an average of 15 weeks, while 26 patients followed up to 4 weeks. Average weight loss at 4 weeks was 6% Total Weight Loss (%TWL) while at last follow up 9.63% TWL. Majority of patients experienced post procedural reflux, abdominal pain, bloating and vomiting. 6 patients had early removal of the balloon due to severe symptoms (4), pancreatitis (1) and hyperinflation (1). 1 had early expulsion at 2 months. Conclusions Eclipse IGB is safe and effective in selective patients, however long-term follow is needed to compare it with the other balloons in terms of significant and sustained weight loss.

Introduction Bleeps are a vestige of decades old technology common place in NHS Trusts. No formal guidelines exist to regulate the use of the bleep leading to user frustration on both ends of the system. Many junior doctors reported a high number of inappropriate and disruptive bleeps. This quality improvement project aimed to formulate a guide for the use of the bleep system. Methods Formal interviews were conducted among clinical and non-clinical staff as to the expectations in the use of the bleeping system. A list of bleeping etiquettes was created following formal interview and formed the basis of a Trust survey to formulate a Bleeping protocol. Results The following bleeping etiquettes were agreed upon; Conclusion A formalized protocol for bleeping can lead to a more effective and stress-free bleeping system.

Introduction The ElipseTM gastric balloon (EIGB) is an established outpatient, non-invasive, non-surgical device for weight-loss not requiring endoscopy nor sedation. This study reports the early safety and effectiveness from the largest and only reported UK cohort treated with the EIGB. Methods A retrospective study of 224 consecutive patients undergoing EIGB insertion between May 2018 and December 2020 was performed. EIGB placement involved swallowing of the ElipseTM capsule followed by a pre-inflation abdominal radiograph to confirm position. Inflation was performed with 550mls of sterile water followed by a post-inflation radiograph. Patients had weekly follow-up to assess symptoms, weight-loss, time and route of balloon expulsion. Results 224 patients underwent EIGB insertion during the study period; 39 patients were lost to follow-up. 185 patients (28 male and 157 female) were included in the final analysis with a mean age of 38.1 years. Mean study follow-up was 10 weeks, mean weight at insertion was 97.7 kg. Mean %Total Body Weight (TBW) loss was 6.5% at 4 weeks and 9% at last follow-up. 32 patients had 15.3 %TBW loss at 16 weeks follow-up. Frequently experienced symptoms during the first week were acid reflux, abdominal pain and bloating, nausea and vomiting. One patient had early expulsion at 8 weeks. Seven patients required early deflation due to severe symptoms (5), pancreatitis (1) and hyperinflation (1). Conclusion EIGB is a safe and effective method of weight loss. Longer follow-up studies in the UK population are required to assess overall patient outcomes and associated factors for weight loss.

Introduction Discharge summaries are a means of communication to the patient, the GP and for medical records. An initial audit showed surgical discharge summaries contained misleading information and sometimes omitted relevant information. Changes were implemented to improve the accuracy of surgical discharge summaries. Method The initial audit assessed the accuracy of discharge summaries over a two-week period and the re-audit was conducted after implementation of change over a similar time period. Data was extracted from electronic patient records (EPR). Change implementation included educating the surgical team on the need for accurate discharge summaries. The EPR team was notified of the intrinsic error in the PowerChart system which is widely used in various NHS Trust. Results Incidence of misdiagnosis or misleading diagnosis in discharge summaries reduced from 42% to zero, lack of relevant investigations decreased from 7% to 1%, No follow up status reduced from 23% to 10% (usually post appendicectomy patients which are not routinely followed up but this needs to be stated in the discharge summary for clarity), at both initial audit and re-audit all patients had relevant surgery or procedures done included in their discharge summaries while the rate at which relevant medications were not stated in the discharge summary decreased from 4% to zero. Conclusions Discharge summaries are vital for record keeping and are usually the only written information a patient receives regarding their hospital stay. It is important that errors in EPR systems be flagged up for review.