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. A study was conducted in Western Australia to determine whether remotely-sensed spectral data can be used to detect and map areas in cereal crops where growth has been affected by waterlogging, Spectral discrimination was established between waterlogged and non-waterlogged crop using either 13-band airborne MSS data or Landsat-TM data. Near infrared and thermal channels were found to be important in providing the observed discrimination. Classification procedures incorporating measures of confidence of class membership were applied, and produced classification maps which agreed closely with ground information, It is concluded that timely Landsal-TM data, together with ground calibration information, can be used for mapping and monitoring waterlogged cereal crops.

The optical properties of phenazine, 5,10-dihydrophenazine, 1: 1 phenazhydrin, and 3: 1 phenazhydrin have been investigated, and ir, uv, and diffuse reflectance spectra are reported. The ir data indicate that the structures of the phenazhydrins resemble those of the parent compounds. The uv spectrum of 5,10-dihydrophenazine has a Λmaxat 350 nm, which is not in agreement with a previously reported value of 325 nm. Absorption spectra of the reduced phenazine were also obtained via diffuse reflectance and a subtraction technique. Absorption in the visible region which is not present in the solution spectra is observed in the diffuse reflectance spectra of the phenazhydrins. The optical spectra of the four related compounds are collectively presented and discussed.

IntroductionBleeding is a well recognised complication of endoscopic resection (ER), particularly in endoscopic submucosal dissection (ESD). Electrocautery can be used to control bleeding but does increase the risk of perforation. A novel extracellular scaffold matrix (Purastat) has recently been approved for gastrointestinal haemostasis. This self-assembling peptide forms a transparent gel that can be applied via a catheter through the scope over the bleeding area.We conducted a feasibility study in a high bleeding risk cohort to assess its applicability, safety and efficacy. We also aimed to ascertain the mean volume of Purastat required to cover the resection base prophylactically.MethodThis was a prospective observational cohort study of patients undergoing complex ER in a tertiary referral centre from December 2015–2016. Purastat was used for prophylaxis over the resection base in high bleeding risk procedures or for primary haemostasis in active bleeding.Data was collected on patient and lesion characteristics including surface area, technical feasibility of gel application, haemostasis and delayed bleeding rate.ResultsPurastat was used in 74 patients (average age 69 years, male to female ratio of 2:1). All lesions were >2 cm and 33.8% (25/74) had cardiac co-morbidities with anticoagulant or antiplatelet usage reflecting a high bleeding risk. 60 (81.1%) had ESD and 14 (18.9%) had endoscopic mucosal resection. Table 1 shows the distribution of lesions according to location and size.Abstract PTH-019 Table 1LocationNumber of lesions (%)Mean lesion size (cm)Oesophagus 39 (52.7%) 3.22 Rectum 11 (14.9%) 6.36 Gastric 9 (12.2%) 4.50 Colon (excluding rectum) 8 (10.8%) 2.76 Duodenum 7 (9.4%) 2.64 Abstract PTH-019 Table 2Purastat®useHaemostasis achieved with Purastat®onlyHaemostasis achieved with Purastat®+ heat/clipsDelayed BleedingProphylaxis alone (n=26) N/A N/A 2 (gastric) Primary haemostasis (n=48) 35 13 1 (oesophageal) Purastat on its own was effective in stopping bleeding in 35/48 (72.9%) cases (see Table 2). It was successfully applied in all patients with no interference in visibility or catheter blockageThe mean surface area of the resection base was 16.2cm2requiring a mean Purastat®volume of 2.7mls, or 0.2mls/cm2.On follow up in 1 month, delayed bleeding was noted in 3/74 (4%) patients. All were managed with endoscopic intervention and no transfusion was required.ConclusionPurastat was effective in controlling bleeding in almost ¾ of the cases where it was used for primary haemostasis. It is safe, easy to use and does not hamper ongoing ER. Only a small amount is needed to effectively cover the resection base for prophylaxis. Our data has demonstrated its potential as a novel haemostatic agent that can minimise bleeding during ER.Disclosure of InterestS. Subramaniam: None Declared, K Kandiah: None Declared, S Thayalasekaran: None Declared, G Longcroft-Wheaton: None Declared, P Bhandari Conflict with: Receives educational grants from Fujifilm, Olympus and Pentax

IntroductionNeoplasia in Barrett’s can be subtle and difficult to identify. Blue light imaging (BLI) by Fujifilm is a novel advanced endoscopic technology that provides high intensity contrast imaging for superior visualisation of mucosal surface and vessel patterns. This can improve the identification of Barrett’s neoplasia. To date there is no formal classification system that enables the characterisation of neoplastic and non-neoplastic Barrett’s for BLI. The aim of our study was to develop and validate a classification to identify Barrett’s neoplasia using BLI.Method3 expert endoscopists formed a working group to identify criteria characterising neoplastic and non-neoplastic Barrett’s on BLI using a modified Delphi method. A simple classification system utilising pit, vessel pattern and colour was developed using a database of 40 images. 6 experienced endoscopists then assessed a library containing 45 images of neoplastic and non-neoplastic Barrett’s using the proposed criteria. Sensitivity, specificity, positive (PPV) and negative predictive values (NPV) were calculated to assess its performance. The same parameters were then evaluated for each component criteria.ResultsThe BLINC criteria are as follows:Non NeoplasticNeoplasticPit patternCircular, tubular or branching with normal density Irregular, crowded with increased density Vessel PatternRegular, pericryptal, non dilated vessels with normal density Irregular, non cryptal, dilated vessels with increased density ColourPale Focal darkness The table below shows the overall sensitivity, specificity, PPV and NPV of the classification in the identification of Barrett’s neoplasia. Sensitivity (95% CI)96.7 (92.4–98.9)% Specificity (95% CI)96.7 (91.2–99.1)% PPV (95% CI)97.3 (93.3–99.0)% NPV (95% CI)95.9 (90.7–98.2)% When each category in the classification was analysed separately the predictive values of pit and vessel pattern in neoplasia characterisation were high compared to colour. Sensitivity (95% CI)Specificity (95% CI)PPV (95% CI)NPV (95% CI)Pit Pattern96.0 (91.5–98.5)% 98.3 (94.1–99.8)% 98.6 (94.8–99.7)% 95.2 (89.9–97.7)% Vessel Pattern94.7 (89.8–97.7)% 93.3 (87.3–97.1)% 94.7 (90.1–97.2)% 95.2 (89.9–97.7)% Colour86.7 (80.2–91.7)% 78.3 (69.9–85.3)% 83.3 (78.0–87.6)% 82.5 (75.6–87.7)% ConclusionWe have developed the first internally validated simple classification system for the diagnosis of Barrett’s neoplasia using BLI. The classification criteria demonstrated high sensitivity and specifity. We aim to use the proposed classification in future studies for real time optical diagnosis of Barrett’s neoplasia.Disclosure of InterestS. Subramaniam: None Declared, K. Kandiah: None Declared, F. Chedgy: None Declared, R. Bhattacharyya: None Declared, P. Basford: None Declared, G. Longcroft-Wheaton: None Declared, P. Bhandari Conflict with: Receives educational grants from Fujifilm, Olympus, Pentax

IntroductionThe PillCam Colon Capsule is a minimally invasive colonic imaging modality that is emerging as a safe and effective tool to visualise the colon. To date the majority of studies have focused on its use in research settings where it has been evaluated for colonic polyp and cancer detection.MethodThe aim of this study is to report on the current clinical use of colon capsule in a large teaching hospital in the South ofEngland. This was a single centre retrospective review of all the PillCam colon capsules performed from April 2015 toNovember 2016.ResultsA total of 37 patients (27 females, 10 males), median age 43.5 (maximum age 82 years and minimum age 20 years) were evaluated. 22/37 (59.5%) had a previous attempt at colonoscopy. Reasons for colon capsule over colonoscopy were: 12/37 pain. 12/37 need for small bowel investigations, 4/37 anxiety, 2/37 patient choice, 2/37 reaction to IV contrast for CT, 1/37 learning difficulties, 1/37 Ehlers-Danlos, 1/37 tachycardia at flexible sigmoidoscopy and 1/37 agorophobia.The colon capsule was completed in 23/37 (62%) of patients. In 4/14 cases the capsule did not exit the stomach, so a clinic appointment is scheduled to discuss positioning of the capsule with gastroscopy. In 10/14 patients the colon capsule was incomplete; 3 reached the left colon and 7 reached the rectum. In 2/14 incomplete colon capsules a flexible sigmoidoscopy completed investigations. 3/14 incomplete colon capsule patients were discharged as a functional disorder was diagnosed. 2/14 patients are awaiting colonoscopy under GA and 1/14 a flexible sigmoidoscopy for polyp removal. 1/14 had a colonoscopy and polypectomy under sedation. 1 patient subsequently died, but this was unrelated to the colon capsule. 87% of the cases avoided subsequent colonoscopy. There were no complications observed in the series.16/23 (69.6%) completed colon capsules identified pathology. 7 had features of inflammatory bowel disease. 6 identified polyps; 2 proceeded to endoscopic resection and the remaining 4 diminutive polyps are scheduled a clinic appointment to discuss the relative merits of endoscopic resection. The remaining 3 colon capsules identified threadworms; diverticular disease and angioectasia respectively.ConclusionColon capsule is safe and colonoscopy was avoided in 87% of patients. It is associated with a high pick up rate for pathology. The failure rate is high but usually in the left colon where a flexible sigmoidoscopy can complete examination easily. We believe that it is an effective approach for investigation of patients where tolerance to colonoscopy is likely to be poor, or where additional small bowel investigation is required, particularly in the evaluation of IBD or obscure bleeding where radiological imaging may be less effective or contraindicated.Disclosure of InterestNone Declared

Please see PTH-054A

Please see PTH-054B

IntroductionHemospray (Cook Medical) is a haemostatic powder licensed for the management of non-variceal upper gastrointestinal bleeding (UGIB). Our aim was to describe the effectiveness of hemospray monotherapy vs adjunctive and salvage therapy, haemostasis and re-bleed rates.MethodA retrospective use of hemospray use in UGIB at 2 teaching hospitals in the north and south of England was evaluated from June 2014-June 2016. Data was extracted from the endoscopy reporting system.ResultsA total of 44 patients (19 females and 25 males), median age 77.5 years (max 94 years and min age 25 years) with UGIB were treated with hemospray across the 2 centres over the 2 year period. Bleeding was secondary to peptic ulcer disease in 29/44 (65.9%), varices in 3 (6.8%), post biopsy bleeds in 3 (6.8%), unidentified lesion in 3 (6.8%), post sphincterotomy bleed in 2 (4.5%), mallory weiss tear in 2 (4.5%), portal hypertensive gastropathy in 1 (2.3%) and diffuse large b-cell lymphoma in 1 (2.3%). Forrest classification was calculated where information was available (34/44).Forrest Ia-9 cases. Forrest Ib-15 cases. Forrest IIa-8 cases. Forrest IIb-2 cases.Hemospray was utilised as a monotherapy in 10/44 (22.7%) of patients. It was used as adjunctive treatment in 25/44 cases (56.8%) and as salvage treatment in 9/44 (20.5%) of cases where previous treatment had failed.Haemostasis was achieved in 41/44 patients (93.2%). 1/3 patients without haemostasis had hemospray monotherapy and 2/3 patients had hemospray as salvage treatment. 2/3 patients without hemostasis who received hemospray salvage therapy went for interventional radiology. 1/3 patient without hemostasis with hemospray monotherapy application due to profuse bleeding was unstable from admission and palliated after the gastroscopy.7/44 (15.9%) patients had a re-bleed. 4/10 (40%) had been treated with hemospray as monotherapy, 2/25 (8%) as adjunctive treatment and 1/9 (11.1%) as salvage therapy. Of the 7 re-bleeds, 3 were Forrest IIa classification, 3 wereForrest Ib classification and the 7th Forrest IIb classification. Haemostasis was achieved in 5/7 (71.4%) of the rebleeds.2/7 re-bleeds did not achieve hemostasis and went for surgery. 4/7 re-bleeds achieved hemostasis with a combination of adrenaline, diathermy and clips. 1/7 re-bleeds did not receive treatment as there were no stigmata of recent haemorrhage. No adverse events occurred.ConclusionHemospray as monotherapy appears to be associated with high rates of re-bleeding. It appears to be more effective as an adjunctive treatment or salvage therapy. Further larger studies are needed to establish where it can most effectively be used, but this data does not support its use as a primary monotherapy.Disclosure of InterestNone Declared

A 30-year-old woman presented to the acute medical take with nausea and vomiting of 48 hours' duration. Clinical examination showed no evidence of bowel obstruction. X-rays showed no abnormalities and blood tests were unremarkable. A gastroenterology opinion was sought. A closer probing of the history revealed that the vomiting consisted of regurgitation of completely undigested food contents shortly after eating. As an infant she had been diagnosed with a ‘narrow’ oesophagus, but had been told by paediatricians that she would ‘grow out of it’. She was of short stature, and on closer questioning revealed that she had always found eating difficult and had a poor appetite. The possibility of partial oesophageal atresia was raised.A gastroscopy was performed which revealed almost complete obstruction of the oesophagus at 35 cm. On barium swallow a thin string-like 4 cm passage into the stomach was evident, enough to allow the passage of fluids (Figures 1–3). A computed tomography scan was performed to further delineate the anatomy and to exclude a mass lesion associated with the stricture. Owing to the severity of the stenosis, it was felt that dilatation would only provide temporary relief and could be potentially dangerous, with a high risk of perforation. A surgical review was requested and it was decided that a Merendino jejunal transposition may be required to allow effective swallowing. The patient was consented for this elective procedure, and she was fed on a liquid diet of build-up products for 3 weeks. Surgery went ahead as planned. However, during the operation it was decided that the changes were not as severe as previously felt and that a simple myotomy would provide adequate relief, with the option to proceed to more aggressive surgery at a later date if needed. It was probable that a degree of the narrowing seen on imaging was caused by inflammation from eating solid foods, and that this had improved on the liquid diet. The postoperative period was complicated by an anastomotic leak. However, the patient recovered quickly from this and was discharged home shortly afterwards. In the 3 months post surgery she continued to improve, and she is now able to eat a normal diet without difficulty.

A 16-year-old male was admitted following a loss of vision. Baseline observations demonstrated SpO2 80% on air, tachycardia of 180 beats per minute (bpm) and hypotension of 90/50 mmHg. He reported bilateral visual disturbance while sitting in bed together with breathlessness, chest discomfort and dizziness but had not had palpitation or syncope. He had been prescribed propranolol for recurrent migraines of increasing frequency with similar visual disturbances, nausea and vomiting but with no perceived benefit. He was otherwise well, a non-smoker who drank minimally and denied recreational drug use.On examination, the jugular venous pressure was elevated but there were no other cardiorespiratory findings of note. Arterial blood gas analysis revealed profound hypoxia and a compensated metabolic acidosis. A 12-lead electrocardiogram demonstrated a supraventricular tachycardia with broad QRS (Figure 1). Carotid sinus massage and intravenous adenosine had no effect. Electrolyte levels were abnormal (potassium 2.7 mmol/litre, magnesium 0.45 mmol/litre, corrected calcium 1.60 mmol/litre) and a central venous line was inserted to allow electrolyte replacement. During this procedure, he spontaneously reverted to sinus rhythm at a rate of 70 bpm.A repeat electrocardiogram showed sinus rhythm with normal axis but T wave inversion in the inferior leads and evidence of pre-excitation with a short PR interval and classical delta waves (Figure 2). As a result, Wolff–Parkinson–White syndrome was diagnosed. The chest radiograph showed an abnormal, globular cardiac silhouette (Figure 3).Following return to sinus rhythm, the blood pressure and acid–base status normalized. Routine transthoracic echocardiography demonstrated Ebstein's anomaly with an associated atrial septal defect and small membranous ventricular septal defect.

An 80-year-old man presented to the acute medical take in September 2007 with a mechanical fall at home. For the preceding 2 weeks he had developed progressive bilateral heel tenderness following a course of afloxacin prescribed by his GP for a chest infection. This spread to his calves, with the ankles giving way on weight-bearing. He had seen his GP after a week of symptoms, who had noted this as a possible rare side effect of the medication but continued the drug. He had started falling as a result of pain in the tendons, and had no history of trauma before developing these symptoms.On examination both Achilles tendons were tender with associated bruising. The ankles were hot to touch with flexion confined to 20° because of the pain. It was not possible for the patient to weight bear because of the pain. Simmonds test showed that there was no continuity of the Achilles tendon. Blood tests revealed a C-reactive protein level of 269 mg/litre. The impression was that there was bilateral Achilles tendonitis secondary to the quinolone. Simple analgesia was given and the patient was advised to immobilize because of the significant risk of rupture of the tendons.An orthopaedic opinion and magnetic resonance imaging was sought to confirm the diagnosis. This revealed bilateral rupture of Achilles tendons (Figures 1aand b), and repair was needed. A kersler suture repair and vicryl plication was performed.

A 69-year-old woman was admitted in September 2005 dehydrated and unwell. She had a 6-month history of constipation, poor appetite and weight loss, and was hypoalbuminaemic (21 g/litre). She had initially been referred for colonoscopy in March to exclude colonic malignancy. Multiple pedunculated polyps up to the splenic flexure were seen, with histology felt to be consistent with hyperplastic polyps and mild inflammation. Her symptoms persisted, and by August she had lost 3 stone in weight. She started to experience loose stools, and repeat colonoscopy was planned. However, the bowel preparation made her feel unwell. She couldn't walk, and so presented to the acute medical take.The patient looked pale and dehydrated. Her chest was clear, with a diffusely tender abdomen. Bowel sounds were present, and there were no palpable masses. Bloods showed a corrected calcium of 1.58 mmol/litre. Fluid resuscitation and calcium replacement was started. A malignant process was queried. Liver function tests showed a low albumin of 21 g/litre but were otherwise unremarkable. A computed tomography scan of the abdomen and chest were normal. A gastroscopy showed mild oesophagitis with Candidain the mid and lower oesophagus, gastritis in the antrum of the stomach with heavy Helicobacter pylorigrowth, and a normal duodenum. Biopsies showed no evidence of coeliac disease or giardia.The patient's albumin fell to 8 g/litre. A 24-hour urine protein collection was 0.46 g, excluding nephrotic syndrome. Nasogastric feeding was commenced.Gut hormones showed a modestly elevated chromogranin A (164 pmol/litre) and gastrin (307 pmol/ litre) but were not diagnostic of a neuroendocrine tumour. Amyloid was queried and the original colonic biopsies re-examined. This was not found, but cap polyposis was suggested.The patient failed to improve and died 15 days after admission. Post mortem found the distal large bowel to contain multiple dark sessile polyps, looking like slugs, on exaggerated mucosal folds (Figure 1). The histological findings comprised elongated, tortorous and distended crypts, with evidence of inflammation and a 'cap' of granulation tissue, confirming cap polyposis. In addition the patient had a right haemothorax. This was caused by a dissection in the pulmonary artery, with evidence of atheroma identified. The right ventricle was hypertrophic, with the lungs showing multiple haemorrhagic infarcts. These changes suggested pulmonary hypertension. Whether this was related to the cap polyposis was unclear. A reasonable explanation is that the patient had showered off pulmonary emboli from a deep vein thrombosis (DVT) for some time, secondary to immobility associated with her poor state of health. This was supported by a right calf DVT identified at post mortem. The dissection of the pulmonary artery was probably secondary to the low protein state and pulmonary artery hypertension.