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Background With few data regarding treatment and outcome of patients with AIH outside of large centres we present such a study of patients with AIH in 28 UK hospitals of varying size and facilities. Methods Patients with AIH were identified in 14 University and 14 District General hospitals; incident cases during 2007–2015 and prevalent cases, presenting 2000–2015. Treatment and outcomes were analysed. Results In 1267 patients with AIH, followed up for 3.8 (0–15) years, 5‐ and 10‐year death/transplant rates were 7.1 ± 0.8% and 10.1 ± 1.3% (all‐cause) and 4.0 ± 0.6% and 5.9 ± 1% (liver related) respectively. Baseline parameters independently associated with death/transplantation for all causes were: older age, vascular/respiratory co‐morbidity, cirrhosis, decompensation, platelet count, attending transplant centre and for liver related: the last four of these and peak bilirubin. All‐cause and liver‐related death/transplantation was independently associated with: non‐treatment with corticosteroids, non‐treatment with a steroid‐sparing agent (SSA), non‐treatment of asymptomatic or non‐cirrhotic patients and initial dose of Prednisolone >35 mg/0.5 mg/kg/day (all‐cause only), but not with type of steroid (Prednisolone vs. Budesonide) or steroid duration beyond 12 months. Subsequent all‐cause and liver‐death/transplant rates showed independent associations with smaller percentage fall in serum ALT after 1 and 3 months, but not with failure to normalise levels over 12 months. Conclusions We observed higher death/transplant rates in patients with AIH who were untreated with steroids (including asymptomatic or non‐cirrhotic subgroups), those receiving higher Prednisolone doses and those who did not receive an SSA. Similar death/transplant rates were seen in those receiving Prednisolone or Budesonide, those continuing steroids after 12 months and patients attaining normal ALT within 12 months versus not.

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

healthcare assistants (HCA) to perform LSMs. The aim of this review was to assess the impact of this change on the quality of LSM as measured by success rate and failed scans. Methods A transient elastography service delivered by trained specialist liver nurses was set up in our hospital in May 2010. In July 2013, 3 HCAs were trained to carry out LSM using a Fibroscan®. The HCAs were initially trained by the manufacturers of the Fibroscan ® unit (Echosens Europe) and then underwent a period of formally observed training with formative and summative work place based assessments. After competency was ascertained, the HCAs were independently allowed to carry out LSMs. A retrospective review of all LSM reports from January 2013 to December 2013 was carried out and success rate of the tests were recorded. Any repeat requests due to failure were also recorded. Results A total of 876 LSM were performed during the review period. 542 LSMs were performed by trained nurses and 334 by trained HCAs. There was no statistically significant difference in the mean success rate between nurses (96% SD 11.9%) and HCAs (96.4% SD 11.7%) (p = 0.699, 2 sample T Test) nor the proportion of LSMs with 100% success rates between the two groups (78.4 vs. 82.3% p = 0.151, Fisher's exact test). Furthermore, there were no statistical differences in any central measure of the observed interquartile ranges of the reported LSM between the 2 groups (p = 0.255). No LSM was repeated when performed by HCA for reasons of failure. Conclusion LSM using a Fibroscan ® can be accurately performed by appropriately trained HCAs. The introduction of this change in practice has allowed a reduction in waiting time for LSM to within 2 weeks without affecting the quality of the service and allowed a more efficient use of resources. A high quality transient elastography service can be delivered by HCAs.

Background:Numerous associated injuries (bony and/or soft tissue lesions) occur commonly in conjunction with fractures of the femoral shaft in young patients after high-energy injuries. Knee ligamentous injuries, historically called as the internal derangements of the knee or IDK, are mostly not visible in plain radiographs taken in the emergency and these injuries are likely to be overlooked by clinicians because first attention always goes to open wounds and radiologically visible injuries of the limb whenever a patient is received in a trauma unit.Materials and Methods:A total of 93 cases of lower limb long bone fractures were retrospectively analyzed from materials of a prospective study conducted on consecutive patients having high-velocity injuries to lower limb long bones with a view to confirm or rule out concomitant ipsilateral IDK in cases of femoral and tibial shaft fractures, that already employed a policy of focused clinical examination followed by arthroscopy of the ipsilateral knee, immediately after operative fracture fixation under the same anesthesia. The goal was to determine the incidence of concomitant internal derangement of the ipsilateral knee and to understand any value of adding arthroscopy to detect concomitant IDK in lower limb long bone fractures besides careful intraoperative examination to propose a recommendation thereof.Results:Concomitant knee injury was found in 14 femoral fractures and 1 tibial fracture. Fifteen out of 93 (16%) such cases had concomitant knee ligamentous or meniscal injures. A total of 13 anterior cruciate and 4 posterior cruciate tears, 11 collateral ligament tears, and 10 meniscal injuries were confirmed in these 15 knees. Femoral shaft fractures were associated with a high incidence of serious ligamentous, meniscal, and chondral injury. Twelve out of 41 femoral fractures had chondral injuries (contusion), especially of the patello-femoral articulation, identifiable during arthroscopy.Conclusion:One should have high index of suspicion about internal knee injuries and capsule-ligamentous injuries while dealing with femoral shaft fractures in particular. Arthroscopy of knee may safely enhance the diagnosis of simultaneous IDK. We propose that when MR imaging is not possible and when contraindication for arthroscopy does not exist, a careful clinical examination followed by arthroscopy of the knee may be considered a useful adjunct in femoral shaft fractures as it can readily confirm IDK by its ability to objectively look, probe, and distinguish fragile tissue from a normal one. Further study in larger number of subjects is needed to validate our findings.