P284 Pre-operative and post-operative nutritional management in inflammatory bowel disease: a case for a dietetic pathway

Abstract

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.