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IntroductionThere are no universally accepted guidelines regarding surveillance of IBD patients after ileal pouch-anal anastomosis (IPAA). The BSG suggest ‘considering’ pouchoscopy and biopsy but accepts ‘there is no clear evidence that surveillance is beneficial and thus it cannot be strongly recommended’.We assessed how frequently pouch surveillance is carried out at our centres. We also evaluated the approaches used for pouchoscopy and the use of endoscopic biopsies.MethodThe records of 177 patients who underwent IPAA for IBD at three London IBD referral centres (Guy’s and St Thomas’, University College London and St Mark’s Hospitals) were reviewed. Patients with Crohn’s or less than 1 year post-surgical follow-up, were excluded. Data regarding the endoscopic follow-up of the remaining 126 patients was collected retrospectively. Fisher’s exact (categorical) and signed rank sum (continuous) tests were used.Results15/126 (12%) had never undergone pouchoscopy for any indication. Of the 111 who had, the median interval between pouch surgery and first pouchoscopy was 1.3 years (0.2–6.4). Median number of pouchoscopies was 3 (0–11), carried out at a median frequency of every 2.4 years (0.9–8.1). Two rectal cuff cancers were found.[Figure]59/126 (47%) had never undergone pouchoscopy with surveillance as the sole indication and no significant differences were found between sub-groups. Median pouch duration 7.1y surveillance, 8.4y none (p=0.193). Gastro, Surgery and joint-care surveillance rates: 7/16 (44%), 28/46 (61%) and 32/64 (50%), respectively (p=0.382). Pouchitis history surveillance rates: present 29/51 (57%), absent 36/73 (49%)(p=0.501).Rates of examination and biopsy by pouch region shown in fig 1.ConclusionWe demonstrated wide variation in endoscopic surveillance of UC-IPAA patients, even amongst experienced clinicians. Some patients underwent several pouchoscopies for surveillance, whereas others had none. In additional, the decision whether to perform surveillance pouchoscopy did not seem to be related to risk factors such as pouch duration. Moreover, endoscopic pouch assessments could be considered incomplete in a proportion of patients with no description of the prepouch ileum or rectal cuff/anal transition zone.Disclosure of InterestNone Declared

IntroductionThe use of Home Parenteral Nutrition (HPN) in patients (pts) with advanced cancer who cannot meet their nutritional requirements by oral or enteral routes, remains controversial with significant variation worldwide. Cancer cachexia is an irreversible process. Timely commencement of HPN is crucial to prevent malnutrition-related morbidity and mortality in these patients. To review data from literature and identify the potential benefit of HPN in pts with advanced cancer. Our aim was to review data from literature and identify the potential benefit of HPN in pts with advanced cancer.MethodArticles on HPN in advanced cancer from 2002 to 2016 were scrutined in PubMED. Primary end point was survival, secondary end points were quality of life (QoL) and nutritional/performance (Karnofsky score, KPS) status.ResultsOf 175 studies, 18 met the quality inclusion criteria (11 retrospective, 7 prospective and 2 randomised). Overall survival was primary endpoint in 15 papers. Study characteristics are reported in table 1. Due to data heterogeneity and the small number of randomised studies a meta-analysis was not performed. Studies were mainly conducted in Western countries (30% in Italy, 15% in USA, 10% in Canada and Germany), including overall 3066 patients. Mean age was 57,2±6,4 years. Most common cancer site were GI tract, ovary, breast, head and neck. Main indication for HPN was bowel obstruction or cachexia. Mean duration of HPN was 3,8±1,4 months. Median overall survival was 4,6±2,4 months (1,5 month in a selected cohort with peritoneal carcinomatosis, 8 months in a study including only advanced ovarian cancer). At baseline, mean weight was Kg 57,6±5,1, mean BMI 20,7±0,8 and mean KPS 55±5. After 1–5 months of HPN, mean weight and mean BMI increased to 61,9±5.3 and 21,2±0,5 respectively. KPS increased in 2 studies, stable in 2 studies. QoL was analysed through validated scales in 5 studies and resulted significantly increased after HPN. On average, HPN related complications were reported in 13%±6% of the pts.ConclusionIndications for HPN and overall survival (3,8±1,4 months) in advanced cancer was in accordance with prognostic parameters specified in European and American guidelines. Variation in clinical practice is evident in different countries. The cost effectiveness and impact of HPN on nutritional/performance status and QoL in these patients has not been adequately assessed and further prospective studies are required. A cultural change and education of healthcare professionals is required to ensure early access to HPN for appropriate patients.Disclosure of InterestNone Declared[Figure]