SUMMARY BackgroundPatients with ulcerative colitis (UC) that is chronically active despite 5-aminosalicylates or immunomodulators, or who are dependent on corticosteroids to maintain remission, have limited treatment options. Granulocyte ⁄ monocyte adsorptive apheresis (GMAA) may have a role in this situation.

Background and study aim: Malignant change can occur in gastric ulcer but guideline recommendations for follow-endoscopy (FU-OGD) are conflicting. This study aims to determine rate of malignancy and need for follow-up for gastric ulcers. Patients and methods: Patients with a first diagnosis of gastric ulcer between January 2012 and September 2013 were studied by analyzing endoscopic assessments, dysplasia, and malignancy yield and the influence of risk factors on the likelihood of benign disease. Results: In a cohort of 432 patients with gastric ulcer (53 % male, mean age 65 years) dysplasia or neoplasia were found in 27 (19 adenocarcinomas, 2 cases of dysplasia, 5 lymphomas, 1 melanoma; malignancy yield 6 %). Twenty-five (93 %) cases were diagnosed on first biopsy. The cancer yield of FU-OGD after initially benign biopsy was 0.9 %. Binary logistic regression analysis revealed that endoscopically benign appearance (odds ratio 0.004 95 % CI 0 – 0.576; P = 0.029), benign histology on first biopsy (odds ratio 0 95 % CI 0 – 0.39; P = 0.011) and lower number of ulcers (odds ratio 0.22 (95 % CI 0.05 – 0.99); P = 0.049) were independent predictors of benign disease. All dysplastic and neoplastic cases would have been identified by a combination of initial biopsies plus repeat endoscopy with further biopsies for endoscopically suspicious appearances. Conclusions: In this large cohort 6 % of gastric ulcers were found to be malignant, highlighting the need for all gastric ulcers to be biopsied. The cancer yield of FU-OGD after benign biopsies was low. We have demonstrated that the combination of benign index histology and no endoscopic suspicion of malignancy can predict benign disease. We recommend that all gastric ulcers to be biopsied. Risk stratification could potentially reduce need for FU-OGD.

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ability of a capsule endoscope to visualise 6 anatomical landmarks (cardia, fundus, body, incisura, antrum and pylorus). Success of visualisation of an anatomical area was only accepted when >90% mucosal visualisation was achieved from a particular station. The pyloric canal angles were calculated to create a vector. We mapped the position of this vector on the patient's skin (pyloric canal vector surface point) to determine the optimal placement of the magnet that would allow traversing of the capsule endoscope through the pylorus. Results There were 65 female and 35 male patients. Mean age of patients was 53 years (s.d+/-18 years). Best mucosal visualisation of the stomach landmarks was achieved from 3 stations; fundal dependant, antral dependent and opposite the antral dependent points. Maximal visualisation of the whole of the stomach, required combining 2 stations as shown in Table 1.The box in the figure shows the placement of the magnet in the upper back towards the right loin would allow pyloric traversing of the capsule endoscope in 83% of cases. Increasing age (p = 0.03) and inability to view the pylorus (p = 0.04) were predictors of being outside the box. Conclusion CT modelling has provided important data regarding the optimal stations in the stomach to position a magnetic capsule endoscope to allow maximal luminal mucosal visualisation and traversing the pylorus. Although there is some extreme variation in the upper GI anatomy, the majority of cases will allow the use of a single standard method in performing MACE which may be very useful for screening purposes. Disclosure of Interest None Declared. -2014-307263.20 Introduction BO is the strongest precursor of oesophageal adenocarcinoma. Participation patterns and effectiveness of BO community screening using unsedated transnasal endoscopy (uTNE) is unknown. Feasibility of mobile van screening closer to home is also unknown. We aimed to assess the effectiveness of this technique compared to sedated endoscopy (SE). Methods A population cohort ≥50 years of age, with no history of endoscopic evaluation, was identified from a group of subjects who previously completed a validated symptom questionnaire. Patients were randomised (stratified by age, sex and reflux symptoms) and invited to undergo either uTNE in a mobile research van (muTNE), uTNE in outpatient endoscopy suite (huTNE) or SE. uTNE was performed using a portable oesophagoscope with a disposable sheath. Procedure performance characteristics and validated tolerability scales (0 = none and 10 = severe) were recorded. Results 459 subjects were contacted and 209 (46%) agreed to undergo study procedures (muTNE n = 76, huTNE n = 72, SE n = 61). Baseline characteristics were comparable among the three groups. OC-020 COMPARATIVE EFFECTIVENESS OF NOVEL TECHNIQUES FOR BARRETT'S OESOPHAGUS (BO) SCREENING IN THEParticipation rates were numerically higher in the unsedated arms (muTNE 47.5%, huTNE 45.7%) than in the SE arm (40.7%) (p = 0.27). Patients with acid reflux symptoms ≥1/ week were more likely ...

Granulocyte and monocyte adsorptive apheresis in the management of ulcerative colitis: authors' reply SIRS, We thank Dr. Yamamoto for his interest in our article, 1 and for his letter regarding the role of granulocyte ⁄ monocyte adsorptive apheresis in the management of ulcerative colitis. 2 Although we agree with his general points regarding the possible benefit of granulocyte ⁄ monocyte adsorptive apheresis in ulcerative colitis, in terms of remission rates and corticosteroid-sparing effects, most of these were observed in Japanese patients. The only sham-controlled study conducted in a Western population, to date, failed to demonstrate any clear benefit of therapy. 3 We therefore feel that it is a little premature to speculate on the cost-effectiveness of this therapy in ulcerative colitis. As we stated in our article, what is actually required are convincing high-quality data that granulocyte ⁄ monocyte adsorptive apheresis is effective in Western patients with ulcerative colitis. ACKNOWLEDGEMENTDeclaration of personal interests: P. John Hamlin has participated in an advisory board for Otsuka Pharmaceuticals. Declaration of funding interests: None.