PTH-027 Impact of changes in guidance on variceal prophylaxis on rate of variceal haemorrhage in gloucestershire

Introduction Oesophageal varices develop as a consequence of portal hypertension in patients with cirrhosis and account for around 10% of admissions with acute GI bleeding in the UK with a significant in-hospital mortality rate of 15%.1 In 2015–2016 the BSG and NICE published new guidance recommending endoscopic variceal band ligation for primary prevention of bleeding.2 3 A subsequent change in local policy sees patients with grade 2 or 3 varices identified during elective upper GI (UGI) endoscopy offered endoscopic variceal band ligation routinely. We aimed was to assess the impact of this policy change on the rate of variceal haemorrhages. Methods Electronic endoscopy records at Gloucestershire Hospitals NHS Foundation Trust were interrogated to identify procedures performed for variceal surveillance (VS) or UGI bleeding and where the diagnosis was variceal bleeding over two periods: Jan-May 2015 and Oct 2017 to Mar 2018. Results Of the 92 VS procedures performed in the first period, 53 had varices, of which 9 (17%) underwent prophylactic banding. Of the 246 VS procedures performed in the second period, 166 had varices, of which 52 (31.3%) underwent prophylactic banding. The proportionate number of variceal bleeds in the first and second period was 8.8% (n=10) and 6% (n=17) respectively. Conclusions The increase in prophylactic banding since the policy change appears to have reduced the proportionate number of variceal bleeds by 2.6%. This is seen alongside a significantly increased number of patients attending for VS, for unclear reasons. This could simply reflect the increasing burden of chronic liver disease.4 However, given the short interval period it could reflect an improvement in identifying patients suitable for variceal screening. References Jairath V, et al. Acute variceal haemorrhage in the United Kingdom: patient characteristics, management and outcomes in a nationwide audit. Dig Liver Dis 2014;46:419–26. Tripathi D, et al. UK guidelines on the management of variceal haemorrhage in cirrhotic patients. Gut 2015;0:1–25. Cirrhosis in over 16s: assessment and management. NICE [NG50]. Pimpin L, et al. Burden of liver disease in Europe: Epidemiology and analysis of risk factors to identify prevention policies. J Hepatol 2018;69(3):718–35.