This cohort from across the UK is older than other multicentre AIH cohorts. One-fifth had decompensation or MELD >15. Diagnosis was delayed in 19%, diagnostic testing was incomplete in one-third and rosettes and emperipolesis were infrequently reported.

Background and AimAcute gastrointestinal bleeding carries poor outcomes unless prompt endoscopic hemostasis is achieved. Mortality in these patients remains significant. Hemospray is a novel intervention that creates a mechanical barrier over bleeding sites. We report the largest dataset of patient outcomes after treatment with Hemospray from an international multicenter registry.Patients and MethodsProspective data (Jan 2016–May 2018) from 12 centers across Europe were collected. Immediate hemostasis was defined as endoscopic cessation of bleeding within 5 min after application of Hemospray. Rebleeding was defined as subsequent drop in hemoglobin, hematemesis, persistent melena with hemodynamic compromise post‐therapy.ResultsThree hundred and fourteen cases were recruited worldwide (231 males, 83 females). Median pretreatment Blatchford score was 11 (IQR: 8–14) and median complete Rockall score (RS) was 7 (IQR: 6–8) for all patients. Peptic ulcer disease (PUD) was the most common pathology (167/314 = 53%) and Forrest Ib the most common bleed type in PUD (100/167 = 60%). 281 patients (89.5%) achieved immediate hemostasis after successful endoscopic therapy with Hemospray. Rebleeding occurred in 29 (10.3%) of the 281 patients who achieved immediate hemostasis. Seven‐day and 30‐day all‐cause mortality were 11.5% (36/314) and 20.1% (63/314), respectively (lower than the predicted rates as per the RS). Similar hemostasis rates were noted in the Hemospray monotherapy (92.4%), combination therapy (88.7%) and rescue therapy (85.5%) groups.ConclusionsThese data show high rates of immediate hemostasis overall and in all subgroups. Rebleeding and mortality rates were in keeping/lower than predicted rates.

Background With few data regarding treatment and outcome of patients with AIH outside of large centres we present such a study of patients with AIH in 28 UK hospitals of varying size and facilities. Methods Patients with AIH were identified in 14 University and 14 District General hospitals; incident cases during 2007–2015 and prevalent cases, presenting 2000–2015. Treatment and outcomes were analysed. Results In 1267 patients with AIH, followed up for 3.8 (0–15) years, 5‐ and 10‐year death/transplant rates were 7.1 ± 0.8% and 10.1 ± 1.3% (all‐cause) and 4.0 ± 0.6% and 5.9 ± 1% (liver related) respectively. Baseline parameters independently associated with death/transplantation for all causes were: older age, vascular/respiratory co‐morbidity, cirrhosis, decompensation, platelet count, attending transplant centre and for liver related: the last four of these and peak bilirubin. All‐cause and liver‐related death/transplantation was independently associated with: non‐treatment with corticosteroids, non‐treatment with a steroid‐sparing agent (SSA), non‐treatment of asymptomatic or non‐cirrhotic patients and initial dose of Prednisolone >35 mg/0.5 mg/kg/day (all‐cause only), but not with type of steroid (Prednisolone vs. Budesonide) or steroid duration beyond 12 months. Subsequent all‐cause and liver‐death/transplant rates showed independent associations with smaller percentage fall in serum ALT after 1 and 3 months, but not with failure to normalise levels over 12 months. Conclusions We observed higher death/transplant rates in patients with AIH who were untreated with steroids (including asymptomatic or non‐cirrhotic subgroups), those receiving higher Prednisolone doses and those who did not receive an SSA. Similar death/transplant rates were seen in those receiving Prednisolone or Budesonide, those continuing steroids after 12 months and patients attaining normal ALT within 12 months versus not.

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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

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randomised clinical trials assessed the treatment-independent trends for overall colon cleansing quality versus overall colon lesion detection. Methods Three multi-centre phase 3 clinical trials compared the cleansing efficacy and safety of the 1L PEG NER1006 (PLENVU ® ) versus standard bowel preparations in patients aged 18-85 years. Treatment-blinded assessment of colon cleansing quality was performed by both site colonoscopists (SC; who also detected all lesions per local practice) and by central readers (CR). Two validated cleansing scales were used: the Harefield Cleansing Scale (HCS) and the Boston Bowel Preparation Scale (BBPS; only by CR). Patients with documented HCS cleansing grades D-A, overall BBPS scores 0-9, and overall colon lesion counts were included in this analysis. Logistic regression trends were fitted to polyp-(PDR) and adenoma (ADR) detection rates, using cleansing quality as a covariate. Results Out of 1,985 randomised patients, 1,749 patients were included (table 1). With site colonoscopists' HCS grades, the logistic regression for relative lesion detection demonstrated an odds ratio of 1.17, i.e. for each incremental increase in the HCS colon cleansing grade from D to A there was a 1.17 times increase in both PDR (P=0.009) and ADR (P=0.019). With central readers, the corresponding increase was 1.24 times for PDR (P=0.005) and 1.26 times for ADR (P=0.006). With central readers, each incremental increase in the successful BBPS scores 6-9 resulted in a 1.08 times increase in PDR (P<0.001) and 1.10 times increase in ADR (P<0.001) versus failing BBPS scores 0-5. Conclusions Adopting a better bowel preparation remains a good way to improve quality in colonoscopy. With both HCS and BBPS, an increased overall colon cleansing quality was associated with greater overall colon PDR and ADR across the full range from cleansing failures and up to high-quality cleansing.