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IntroductionEosinophilic oesophagitis (EoE) is an inflammatory condition characterised by symptoms of oesophageal dysfunction (typically dysphagia and food bolus obstruction) and at least 15 eosinophils/hpf on oesophageal biopsy. Although there are endoscopic features associated with EoE, 10%–25% of endoscopies in patients with this condition will be normal [1]. Currently, it is unclear if oesophageal biopsies should be taken in every patient presenting with dysphagia and a normal oesophagus. A more patient focussed strategy can be more cost effective.Our aim was to determine clinical risk factors predictive for EoE, that may then guide the endoscopist for when to take oesophageal biopsies.Method127 patients presenting with dysphagia or FBO and a new diagnosis of EoE (eosinophils>15/hpf) were compared to 127 patients presenting with dysphagia or FBO but no evidence of EoE on biopsies.A multivariate logistic regression analysis was carried out to predict who might have EoE prior to taking biopsies, based on history where available and endoscopic findings. Receiver operator characteristic (ROC) curves were generated and the area under the curve (AUC) was calculated to test the accuracy of the model.ResultsFrom the EoE group, 95 (75%) were male and 32 (25%) were female, with an average age of 39 years. From the control group 59 (46%) were male and 68 (54%) were female with an average age of 60 years. The mean number of biopsies taken between the 2 groups was non-significant.In the EoE cohort, the most common abnormal endoscopic findings were strictures (40%) followed by trachealization (15%) and furrows (15%). 19% had a normal endoscopy.A multivariate logistic regression analysis identified age (p<0.001) and sex (p<0.001) as the strongest predictors of EoE. The AUC for younger age and male sex was 0.86 (95% CI 0.81–0.90). Using the Youden index, the optimal cut-off for age was 46 years giving a sensitivity of 86% and specificity of 69%.ConclusionIn patients presenting with dysphagia or FBO and a normal endoscopy, utilising a simple bedside tool comprising of age (<46 years) and male sex can reliably predict the presence of EoE.Reducing the number of potentially low yield histological examinations for EoE has significant implications for time and cost.Reference. Dellon ES. Diagnostics of eosinophilic esophagitis: clinical, endoscopic, and histologic pitfalls. Dig Dis2014;32(1-2):48–53.Disclosure of InterestNone Declared

IntroductionManagement of eosinophilic oesophagitis (EoE) includes proton pump inhibitors (PPIs), topical steroids, or dietary intervention. In adults dietary management commonly consists of either the six-food elimination diet (SFED) or allergy-test directed food exclusion. To date patient characteristics and outcomes from various interventions have not been reported in a UK population.MethodA retrospective evaluation of adults (≥16 years) with oesophageal eosinophilia (≥15 eos/hpf) over a two-year period was undertaken. Patients were identified from histology reports and clinical records. Treatment episodes were analysed in those who had both pre- and post-intervention biopsies. Patients who underwent dietary interventions were advised by a specialist dietitian.ResultsOur search identified 100 subjects 18–84 years of age (median 35) with a predominance of males (76%; 76/100) and Caucasians (94%; 67/71). Atopic conditions were reported in 75% (65/87) and allergy testing with skin prick or specific IgE tests was positive to food allergens for 71% (44/62) and aeroallergens 72% (38/53). PPIs were given first-line for 75% (38/51) and overall 22% fully responded to a PPI (5/23). Fifty-one patients had both biopsies covering 73 treatment episodes (table 1). Signficant reductions in eosinophil counts were seen for SFED and allergy-test directed diets. There were no significant differences in efficacy between treatment groups.Abstract OC-041 Table 1Median peak eosinophil countInterventionResponders (%)*PrePostp value**PPI8/23 (35)44300.230Steroids5/12 (42)53150.117SFED13/23 (65)47100.006Test-directed5/10 (50)62230.036Other empiric diet1/6 (17)55580.437Elemental diet2/2 (100)331n/a*<15 eso/hpf or ≥50% reduction in peak count. **Wilcoxen signed rank testThrough food reintroduction and biopsies 14 patients identified dietary triggers: 57% milk (n=8), 29% gluten containing cereals (n=4), 14% egg (n=2), 7% soya, nuts, shellfish or fruit (each n=1). For those who completed the process (n=10), 50% had only one trigger, 30% two, and 20% three or more.ConclusionBaseline characteristics were comparable to other described cohorts with a high proportion of males, Caucasians and a high rate of atopy. Dietary intervention particularly with the SFED appears to be effective in our population, with a non-significant trend to higher response rates compared to other interventions. Since the most common triggers were dairy and cereals, empirical exclusion of these two food groups may be an effective approach.Disclosure of InterestNone Declared

IntroductionEndoscopic Therapy for T1a oesophageal adenocarcinoma (OAC), and some T1b with favourable pathological features (sm1, no LVI, G1 or G2 differentiation), is now the recommended standard of care by BSG. Many endotherapy centres have large geographic catchment areas, so accurate staging for these early cancers is crucial to avoid unnecessary visits for patients. Our aim was to assess the utility of staging techniques to define whether endotherapy is possible.MethodAll referrals for endoscopic therapy to tertiary centre (St Thomas’ Hospital), who subsequently underwent EMR and had confirmed T1 OAC, were assessed. All patients were referred with baseline CT CAP. PET scans were scheduled to assess accuracy of nodal disease following confirmation of OAC. EUS was undertaken prior to EMR when intramucosal cancer or greater was diagnosed on biopsy locally.ResultsForty seven patients had confirmed T1 OAC on EMR, undertaken by 3 expert endoscopists at STH between April 2012 – November 2016. Age range 46–86 years old, 38/47 male. Barrett’s oesophagus was present in all, median length C2M4.Original histology was upstaged by EMR in 24 (51%) patients from dysplasia only, including 7/47 with LGD.CT staging of T stage was inaccurate in 57%, under-staging in 19 patients (40%) and over-staging in 8 (17%). CT over staged nodal disease >N0 in 9% vs. PET, all were T1a. Only 1/39 PET scans showed possible nodal disease but no involvement was found after primary surgery.20 patients had EUS and 7/20 had nodal disease but in 6 of these PET was negative for nodes. No Tx/T1 disease on baseline CT was upstaged by EUS.Pathological staging and treatmentDetailed pathological staging is shown in table 1. 25 subjects had T1a, of which 23 had no LVI. 22 subjects had T1b, of which 15 had no LVI or T1b sm1 (or any LVI)n=23n=15n=9Baseline Histology (>dysplasia)13 (57%)11 (73%)7 (78%)CT (>T1)5/18 (28%)2/14 (14%)1/9 (10%)CT (node accuracy vs. PET)10/1312/128/8PET (node negative)17/1813/138/8EUS (T and N)6/94/63/5ConclusionIn this retrospective study we have shown that baseline histology and CT are inaccurate for staging T1 disease, compared to EMR histology. Endoscopically treatable T1 disease was over staged by CT in 22%. Decisions on referral to Endotherapy centre for potential EMR should not be based on CT and histology alone. PET may prove a useful adjunct to confirm node negative disease but more follow up data is required.Disclosure of InterestNone Declared