Objective:To compare food and nutrient intakes of infants aged 6–12 months following a baby-led complementary feeding (BLCF) approach and a standard weaning (SW) approach.Design:Participants completed an online questionnaire consisting of sociodemographic questions, a 28 d FFQ and a 24 h dietary recall.Setting:UK.Participants:Infants (n 134) aged 6–12 months (n 88, BLCF; n 46, SW).Results:There was no difference between weaning methods for the food groups ‘fruits’, ‘vegetables’, ‘all fish’, ‘meat and fish’, ‘sugary’ or ‘starchy’ foods. The SW group was offered ‘fortified infant cereals’ (P < 0·001), ‘salty snacks’ at 6–8 months (P = 0·03), ‘dairy and dairy-based desserts’ at 9–12 months (P = 0·04) and ‘pre-prepared baby foods’ at all ages (P < 0·001) more often than the BLCF group. The SW group was offered ‘oily fish’ at all ages (P < 0·001) and 6–8 months (P = 0·01) and ‘processed meats’ at all ages (P < 0·001), 6–8 months (P = 0·003) and 9–12 months (P < 0·001) less often than the BLCF group. The BLCF group had significantly greater intakes of Na (P = 0·028) and fat from food (P = 0·035), and significantly lower intakes of Fe from milk (P = 0·012) and free sugar in the 6–8 months subgroup (P = 0·03) v. the SW group. Fe intake was below the Reference Nutrient Intake (RNI) for both groups and Na was above the RNI in the BLCF group.Conclusion:Compared with the SW group, the BLCF group was offered foods higher in Na and lower in Fe; however, the foods offered contained less free sugar.

Background: The safety of percutaneous endoscopic gastrostomy (PEG) insertion in amyotrophic lateral sclerosis (ALS) patients with significant respiratory compromise has been questioned. Objectives: To review the characteristics of an ALS clinic patient cohort undergoing PEG, and the introduction of a risk stratification tool with procedural adaptations for higher-risk individuals. Methods: Patients undergoing PEG insertion were analysed (n = 107). Cases stratified as higher-risk underwent insertion in a semi-recumbent position, minimising sedation, with the option of nasal non-invasive ventilation. Results: All underwent successful PEG. One-third had pre-procedure FVC ≤50% (mean, 64 ± 22%). Of those who underwent PEG insertion after introduction of risk stratification (n = 58), 39 (67%) met criteria for being higher risk, 16 (41%) of whom had FVC ≤50% (p = 0.005). High-risk patients received lower sedative doses vs. the low-risk group (midazolam 2.1 ± 1.1 vs.2.8 ± 0.95mg, p = 0.021; fentanyl 42 ± 16 vs. 60 ± 21μg, p = 0.015). Four deaths occurred within one month of insertion (attributable to the natural disease course). Conclusions: Risk stratification identified a greater number of patients with evidence of respiratory compromise than using the sole criterion of FVC ≤50%. A modified PEG procedure enabled safe insertion despite respiratory compromise, in those who might not have tolerated attempted insertion by alternative means such as radiologically-inserted gastrostomy.

This paper provides an overview of the nutritional management and care of people living with motor neurone disease (MND) in a specialist nutrition clinic. A specialist pathway of care has been developed to enable people living with MND to undergo a percutaneous endoscopic gastrostomy (PEG) procedure in a safe way; the pathway incorporates attendance at a dedicated nutrition clinic, a stratification tool to identify patients with a high periprocedural risk and a PEG insertion team with significant experience in the MND population. Since this pathway has been in place, gastrostomies have been successfully placed in patients with a forced vital capacity (FVC) of less than 50%; previously, this would not have been possible.

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Introduction Gastric cancer is the 4th leading cause of cancer death worldwide. Prognosis remains poor, largely due to late diagnosis. Early gastric neoplasia carries a far better prognosis with a 5 year survival of 85%. Traditionally, gastrectomy is the definitive locoregional treatment, but carries significant perioperative morbidity. For early gastric cancer without risk of nodal metastasis, endoscopic en bloc resection with endoscopic submucosal dissection (ESD) is a feasible alternative. We present a prospective cohort analysis of patients with early gastric neoplasia undergoing ESD at a single tertiary Centre in the United Kingdom Methods Patients were all referred through local cancer networks after staging to exclude metastatic disease. Patients underwent gastroscopy with biopsy for histology and contrast computed tomography (CT) for staging. High definition endoscopy & chromoendoscopy with indigo carmine were used to help delineate lesions. Pathology was confirmed by expert GI pathologists prior to resection. Surgery was discussed with all patients as an alternative to ESD. All gastric ESD were performed under propofol sedation by a single endosocopist with specialist training. Results Over 24 months, 19 patients underwent ESD. Mean age was 71 years (range 23-87). 68% were male. Two lesions (10%) were in the proximal stomach, 1 in mid body (5%) 16 in distal stomach (85%). Mean resection size was 28mm (15-58). Mean resection time was 71 mins from intubation. En-bloc resection was achieved in 15/19 (74%) patients. 16/19 patients (84%) had a clear deep resection margin. Resection histology was high grade dysplasia in 52%, carcinoma in situ 11%, LGD 5%, poorly differentiated adenocarcinoma 21%, neuroendocrine tumour in 5%. 13/16 with clear resection margins post ESD remain in follow up. Of these 11/13 (87%) remain free of disease at most recent biopsy (median follow up 6 months, range 0-38). Both recurrences were LGD at the resection site. One was treated with laser ablation and the other with repeat ESD. There were no perforations or bleeding seen in our cohort during ESD Conclusion In this small cohort of early gastric neoplasia, ESD appears to provide a safe and effective alternative to surgery with encouraging durability although our follow up time is short. Early recognition of lesions is essential to offer patients a minimally invasive curative intervention. With increasing use of high definition endoscopy more patients will become eligible for therapy. Long term durability remains to be seen. Disclosure of Interest None Declared. Introduction A human sporadic colorectal adenoma may influence the formation of another adenoma even after its removal, with up to 60% of such patients developing metachronous adenomas following adenoma excision. However data regarding the occurrence site of a metachronous colorectal adenoma relative to the index adenoma is scarce. Therefore, we investigated whether a metachronous colorectal adenoma was more likely to occur in the same, proximal or distal segment as the inde...

cirrhosis and decompensation at presentation as covariates) showed similar outcomes in both groups. Seventeen of the 23 patients continued MMF to end of follow-up and 6 discontinued MMF (lack of efficacy 4, successfully restarting of AZA 1 and cause unknown 1). Conclusions Patients switching to MMF because of AZA intolerance do not differ from those continuing AZA in regard to: (a) normalisation of serum ALT (b) necro-inflammatory and fibrosis scores on follow-up biopsy and (c) 5-and 10 year mortality. This supports use of MMF as a steroid sparing agent in AZA intolerant patients.