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161 patients have been offered assessment and patient
uptake is high with only 23 (14%) declining assessment. 52
(32%) patients were offered group therapy and the rest
received individual therapy or declined ongoing support.
Patients have been keen to access the service and feedback
from those who have accessed it has been positive.
Conclusions There is high demand for an IBD psychology
service with high patient uptake. This has led to pressure on
the service and development of a long waiting list.
Within the IBD team there is improved understanding of
what psychology can offer but the wide variation in referrals
between individuals would suggest that further education as
to the role of psychological input is required. This is sup-
ported by the observation that the greatest numbers of refer-
rals come from sources where psychologist has most
interaction.
As referrals increase the service will have to adapt to man-
age them as a 5 month waiting list is inappropriate for certain
referrals.
Provision of this service has allowed the team to move
closer to meeting IBD standards (IBDUK, 2019).
P358 INTRODUCTION OF THE NEW POLYPECTOMY
GUIDELINES –WHAT’S THE COST?
Jonathan Fawkes*, Charleston Mendoza, Melanie Corpus, Roser Vega, Edward Seward.
Uclh, London, UK
10.1136/gutjnl-2020-bsgcampus.432
Introduction New guidelines have been issued for dictating
surveillance post-polypectomy and post colorectal cancer,
which estimate a reduction of the surveillance workload to
20% of current levels. These represent a challenge to patients,
clinicians and organisationally to deliver a review of the sur-
veillance workload. We recorded the time, cost and success of
this process.
Methods The first 1000 cases on the UCLH surveillance path-
way were reviewed. The new guidelines were applied to each
case and a new recommendation for surveillance made by a
team of three band 7 and 8 nurse endoscopists, with oversight
by the endoscopy clinical lead. The first 20 cases were inter-
preted together to assist learning and have been omitted from
this analysis. A letter was sent to every patient explaining the
decision, if a patient complained the case was investigated by
the clinical lead, a decision made and fed back to both the
patient and nurse endoscopist. Costs were assigned as per
internal accounting agreements.
Results 512 patients were discharged from the pathway (51%).
106 (21%) of these were >75 years, 231 were discharged
from 5 year surveillance. 58 patients (6%) were young enough
to require 5 year surveillance as they were >10 years below
screening age. 110 patients had surveillance upheld based
solely on family history (11%) in the absence of a Lynch
diagnosis. 45 patients were assessed on average per 4 hour
session at a cost of £120/session, total cost of assessing sur-
veillance list £2667. There were a total of 16 objections from
patients (3%), of which 1 was upheld (multiple hyperplastic
polyps). Diagnostic colonoscopy tariff is set at £433, repre-
senting a net saving of £219K and 102 surveillance lists over
the next 5 years.
Conclusions The new guidelines represent an enormous oppor-
tunity for hard pressed endoscopy units to free up surveillance
time and both save money as well as improving the timeliness.
Assessment of the surveillance list can be efficaciously per-
formed by nurse endoscopists, appeals of surveillance decisions
are relatively low. 11% of patients had surveillance arranged
purely on family history not always apparent from the elec-
tronic patient record –it may be that better documentation
can reduce this figure in the future. Our discharge rate was
lower than suggested, better documentation of reasons for
ongoing surveillance may improve this figure in the future.
P359 TOWARDS A GREENER ENDOSCOPY: ESTIMATING THE
AMOUNT OF SINGLE USE PLASTIC BOTTLES IN
ENDOSCOPY
Kohilan Gananandan*, Karishma Sethi, Andrew Dawes, Simon Phillpotts, Eleanor Wood,
Iain Ewing, Laura Marelli, Jun Liong Chin. Homerton University Hospital Trust, London, UK
10.1136/gutjnl-2020-bsgcampus.433
Introduction A significant amount of plastic is being used in
endoscopy. We believed that plastic polypropylene water bot-
tles for the transport of sterile water generates significant
amount of plastic/cost and strategies need to be employed to
reduce its use. In this study, we aimed to assess the amount
of plastic generated by 1L single-use polypropylene water bot-
tles in a year for a number of endoscopic procedures.
Methods Data was obtained from the Endoscopy Database
(Unisoft) regarding the number/type of procedures performed
throughout 2019. We prospectively assessed the volume of
sterile water used for a dedicated endoscopy list: oesophago-
gastroscopy (OGD), sigmoidoscopy and colonoscopy. For each
type of procedure, the volume of sterile water/plastic was esti-
mated for a minimum of 20 procedures. The weight of plastic
was measured using a Salter-Arc Electronic scale after leaving
the bottle to dry for 48 hrs.
Results In our endoscopy unit, we estimated that we used 336
ml of sterile water per gastroscopy (7.05L for 21 OGDs); 241
ml per sigmoidoscopy (5.3L for 24 sigmoidoscopies); and 782
ml per colonoscopy (17.2L for 22 colonoscopies). For 2019,
we performed 4436 OGDs, 2251 sigmoidoscopies and 3135
colonoscopies, which equates to a total estimated volume of
sterile water of 4,485L (1490.5L for OGD; 542.49L for sig-
moidoscopy; 2451.57L for colonoscopy). The dry weight of a
single-use 1L plastic water bottle was 65 g while the cost of
1L of sterile water was 80p. Hence, the amount of plastic
generated from water bottles in a year was approximated to
Abstract P357 Figure 1 Numbers of referrals and descriptions
Abstracts
A226 Gut 2021;70(Suppl 1):A1–A262
on November 14, 2021 by guest. Protected by copyright.http://gut.bmj.com/Gut: first published as 10.1136/gutjnl-2020-bsgcampus.432 on 21 January 2021. Downloaded from