OTU-12 Validation of Edinburgh dysphagia score in a national evaluation of upper GI cancer 2ww pathway

Abstract

OTU-12 Figure 1 Cancer Dysphagia Score Abstracts Gut 2021;70(Suppl 4):A1–A220 A1 on Jauary 1, 2022 by gest. P rocted by coright. http/gut.bm jcom / G t: frst pulished as 10.113utjnl-2021-B S G .2 on 7 N ovem er 221. D ow nladed fom Results 1496 patients were studied: median age 62 (IQR 5173), 58% female. Median EDS score was 4 (IQR 2.5-6); with 67% having an EDS 3.5. 64% were triaged to 2WW endoscopy; 18% to urgent (but not 2WW) endoscopy; 2.8% to urgent CT scan; 5.5% to routine OGD; and 4.4% to barium swallow. After excluding patients who declined investigation, results were available for 96%. 91 UGI cancers were diagnosed (prevalence 7.1%); with 3 (3%) UGI cancers diagnosed in patients with EDS<3.5 (one with EDS 3, two with EDS 1.5). EDS 3.5 had sensitivity of 96.7% and negative predictive value of 99% for UGI cancer. The factors associated with UGI cancer and hence selected to develop CDS included: age odds ratio 1.05 (95% CI 1.03-1.06); male 3.95 (2.36-6.58); progressive dysphagia 2.30 (1.39-3.79); unintentional weight loss 3.28 (2.02-5.31); acid reflux symptoms 0.47 (0.25-0.88) and dysphagia localised to the neck (0.26 (0.12-0.57). Dysphagia duration less than 6 months was not statistically significant (1.02 (0.452.22). AUROC was 0.83 for CDS as compared to 0.81 for EDS. Cancer dysphagia score and its receiver operating curve in comparison to Edinburgh dysphagia score is presented in figure 1. Conclusion A national prospective cohort confirms that EDS has high sensitivity and negative predictive value for UGI cancer, however, a modified cancer dysphagia score offers higher diagnostic accuracy. Our results suggest that CDS should be incorporated in the UGI cancer 2WW pathway for risk stratification of patients with dysphagia and further studies in primary care are needed. OTU-13 EUS CHOLEDOCHODUODENOSTOMY IN MALIGNANT DISTAL BILIARY OBSTRUCTION: MULTI-CENTRE COLLABORATION FROM THE UK AND IRELAND Wei On*, Bharat Paranandi, Andrew M Smith, Alistair Young, James Pine, Suresh V Venkatachalapathy, Martin W James, Guruprasad P Aithal, Ioannis Varbobitis, Danny Cheriyan, Ciaran McDonald, John S Leeds, Manu Nayar, Kofi Oppong, Joe Geraghty, John Devlin, Wafaa Ahmed, Ryan Scott, Terence Wong, Matthew T Huggett. Leeds Teaching Hospitals NHS Trust, Leeds, UK; Nottingham Digestive Diseases Centre (NDDC) and NIHR Nottingham Biomedical Research Centre (BRC), Nottingham University and Nottingham University Hospitals NHS Trust, Queen’s Medical Centre, Nottingham, UK; Beaumont Hospital and RCSI, Dublin, Ireland; The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle, UK; Manchester University NHS Foundation Trust, Manchester, UK; King’s College Hospital NHS Foundation Trust, London, UK; Belfast Health and Social Care Trust, Belfast, Ireland; Guys’ and St Thomas’ NHS Foundation Trust, London, UK 10.1136/gutjnl-2021-BSG.3 Introduction Endoscopic ultrasound guided choledochoduodenostomy (EUS-CDD) with electrocautery enhanced lumen apposing metal stents (EC-LAMS) has emerged as a viable option in the management of patients with malignant distal biliary obstruction (MDBO). We conducted a multi-centre collaboration from the UK and Ireland with an aim to analyse the pooled efficacy, safety and long term outcomes of EUS-CDD for treatment of MDBO. Methods Consecutive patients with MDBO who underwent EUS-CDD with EC-LAMS at 8 tertiary hepatopancreatobiliary institutions between September 2016 and September 2020 were retrospectively analysed. Recorded variables included patient demographics, procedural characteristics and follow-up data. Results 112 patients (59 male) were identified. The mean age was 72 years old (range 46 94 years old). Pancreatic adenocarcinoma was the commonest underlying malignancy in 63.4% (n=71). The indications for EUS-CDD were: an inaccessible papilla (n=49), tumour infiltration of papilla (n=29) and unsuccessful biliary cannulation/stricture impassable with guidewire (n=34). Technical success was achieved in 91.1% (n=102) of patients. Additional stenting with plastic pigtails through the EC-LAMS was performed in 26 patients at the discretion of the endoscopist to augment biliary drainage. Data for clinical success (reduction of serum bilirubin to £50% of original value at day 7) was available for 90 patients and was achieved in 94.4% of these (n=84). The adverse event rate was 16.9% (n=19) and further details are summarised in the table. The biliary re-intervention rate was 8.1% (n=8) in 99 patients with successful EUS-CDD (3 lost to follow-up), over a median follow-up of 70 days (range 3 761 days). Eight patients underwent attempted surgical resection of their primary tumour and in those who did, resection and formation of hepaticojejunostomy was successful. Conclusion We present the first collaborative data from the UK and Ireland demonstrating EUS-CDD in MDBO to be efficacious with a reasonable safety profile. OTU-14 COLONOSCOPY POLYP DETECTION IS LOWER AT WEEKENDS: A NATIONAL ENDOSCOPY DATABASE ANALYSIS Liya Lu, Jamie Catlow, Raphael Broughton, Peter Rogers, Linda Sharp, Matt Rutter*. Population Health Sciences Institute, Newcastle University, on behalf of the NED-APRIQOT Team; North Tees NHS Foundation Trust; JAG, RCP London; Weblogik