Summary Background There have been encouraging reports on transjugular intrahepatic portosystemic stent‐shunt (TIPSS) for Budd–Chiari syndrome (BCS). Long‐term data are lacking. Aim To assess long‐term outcomes and validate prognostic scores following TIPSS for BCS. Methods A single centre retrospective study. Patients underwent TIPSS using bare or polytertrafluoroethane (PTFE)‐covered stents. Results Sixty‐seven patients received successful TIPSS between 1996 and 2012 using covered (n = 40) or bare (n = 27) stents. Patients included had a Male: Female ratio of 21:46, and were characterised (mean ± s.d.) by age 39.9 ± 14.3 years, Model of end stage liver disease (MELD) 16.1 ± 7.0 and Child's score 8.8 ± 2.0. Seventy‐eight percent had haematological risk factors. Presenting symptoms were ascites (n = 61) and variceal bleeding (n = 6). Nine patients underwent hepatic vein dilatation or stenting prior to TIPSS. Mean follow‐up was 82 months (range 0.5–184 months). Fifteen percent had post‐TIPSS encephalopathy. Two have been transplanted. Primary patency rates (76% vs. 27%, P < 0.001) and shunt re‐interventions (22% vs. 100%, P < 0.001) significantly favoured covered stents. Secondary patency was 99%. Six‐, 12‐, 24‐, 60‐ and 120‐month survival was 97%, 92%, 87%, 80% and 72% respectively. Six patients had liver related deaths. Two patients developed hepatocellular carcinoma. The BCS TIPS PI independently predicted mortality in the whole cohort, but no prognostic score was a significant predictor of mortality after subgroup validation. Conclusions Long‐term outcomes following TIPSS for Budd–Chiari syndrome are very good. PTFE‐covered stents have significantly better primary patency. The value of prognostic scores is controversial. TIPSS should be considered as first line therapy in symptomatic patients in whom hepatic vein patency cannot be restored.

Our data support the stepwise approach to management of BCS, with very good outcomes from venoplasty combined with stenting when required. TIPSS should only be offered where HV interventions are not feasible or unsuccessful.

Introduction There is enormous variability in the referral rates for IBS from GPs and this relates to patient and physician factors. 1 IBS patients tend to wait longer for appointments and hence a standardised algorithm which includes faecal calprotectin (FC) might aid in the rapid assessment of IBS in secondary care. FC has been shown to consistently differentiate IBS from IBD because it has excellent negative predictive value in excluding organic pathology. 2 Methods To assess the effi cacy of diagnostic algorithm (using FC) for assessment of IBS in a pilot study using patients already referred to hospital GI clinics. Patients were included if the GP suspected IBS (age group 18-50),without alarm symptoms (weight loss, rectal bleeding etc) at time of referral. Initial assessment was in a nurse-led clinic using a standardised algorithm consisting of questionnaire and baseline investigations (FC, FBC, ESR, CRP, albumin, IgA and TTG). FC level < 100 mcg/g was considered normal. 3 4 week review was undertaken by a doctor and those with abnormal results were transferred to the GI clinic. 1-year assessment was undertaken on all study patients, reviewing fi nal diagnosis and hospital visits. Clinical diagnosis by nurse and doctor before results of FC and blood tests were compared. Co-primary end-points were the positive predictive value (PPV) of the algorithm in diagnosing IBS and the added benefi t of FC in excluding organic pathology.

IntroductionTreatments available to patients with neuroendocrine tumours(NETs) have been studied for their effect on tumour progression and carcinoid syndrome. However, there is minimal evidence on gastrointestinal (GI) symptom burden and its impact on quality of life (QoL). We aimed to determine whether patients with NETs receiving treatment experience GI symptoms, and to explore the impact that these symptoms have on QoL.MethodsA prospective cohort of 46 patients with histologically confirmed NET visiting endocrine and oncology clinics completed GSRS (gastrointestinal symptom rating scale) and EORTC QLQ-GINET21 QoL questionnaires prior to establishment of a gastroenterology NET service.ResultsThe majority of patients had a midgut(70%) or pancreatic(15%) primary with 96% having metastatic disease. Duration of diagnosis was 42 months (range 2–249), 91% having stable disease. The majority of patients reported GI symptoms including: abdominal cramps(80%), bloating(74%), excessive passing of wind(87%) and faecal urgency(87%). 50% had a stool frequency of more than 5 times a day and 71% of patients scored type 5 or higher on the Bristol Stool Chart. 54% of patients reported greasy/oily stool. 60% scored their QoL to be less than 7 out of 10. When asked how much bowel symptoms were affecting quality of life, 58% of patients scored more than 5 out of 10. 97% reported their illness to be distressing for those close to them.ConclusionThis study represents the first systematic analysis of specifically defined GI symptoms experienced by NET patients. Despite having stable disease, many patients frequently experience GI symptoms which have a negative impact on QoL.Disclosure of InterestNone Declared

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