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Objectives: To compare targeted neonatal echocardiography (TnECHO) and antero-posterior (AP) chest radiographs in the localization of the umbilical venous catheter (UVC) tip and to determine the accuracy of UVC tip localization by TnECHO when performed by a trained cohort of pediatric housestaff physicians. Study design: Prospective, observational study of consecutive neonates requiring UVC insertion, in a tertiary care center, in an 18-month period. Chest radiographs reporting optimal position of the UVC tip were compared with the TnECHO results of the pediatric cardiologist. The latter was also compared with the results of TnECHO performed by the pediatric housestaff physicians. Result: Thirty neonates with birth weight ranging between 270 and 4490 g and gestational age ranging between 24 and 44 weeks were enrolled. Nine patients (27%) required UVC tip repositioning as the cardiologist performed TnECHO revealed sub-optimal tip position despite optimal position on chest radiography. Among them, four had the UVC tip in the right atrium and five in the left atrium. Compared with the cardiologist, the housestaff physicians had reported TnECHO with a high-accuracy rate (area under the receiver operating characteristic curve=0.81). Conclusion: TnECHO is superior to chest radiography for identifying malpositioned catheters. TnECHO performed by pediatric housestaff physicians with basic training, demonstrated high-accuracy rates.

Objective To determine the nature, frequency and significance of errors related to the PN process in a tertiary paediatric unit. Methods In our children's centre, it is policy that ‘any unexpected event with an actual or potential detrimental effect on a patient is formally reported on an incident report (IR1) form’ by staff. We therefore reviewed all IR1 forms related to PN between January'06 and June'09. The errors were categorised according to where in the PN process they occurred. Harm scores (severity of the error in relation to patient safety) were based on the framework of the National Coordinating Council for Medication Error Reporting and Prevention (NCC MERP).1 Results Over 18 588 PN days, 46 errors were identified, giving an error frequency of 0.24%. Of these, 5 (11%) occurred during the prescription process (eg, incorrect PN volume calculation), 9 (20%) during the transcription process (eg, incorrect patient ID, surname, date of birth, rates or inadequate amount of lipid or vamin in bag), 11 (24%) during dispensing (eg, mislabelling of vamin or lipid bags, leaking bags), 7 (15%) during delivery of PN to the ward and 14 (30%) during the administration process (eg, administration at incorrect rates). No errors were reported during the preparation/compounding process. 43 (94%) errors did not result in patient harm, while 3 (6%) errors resulted in temporary harm (1 PN extravasation, 1 incorrect vamin infusion rate in a newborn resulting in hyperglycaemia and fluid overload, 1 incorrectly high potassium dosage in PN). Conclusion PN related errors resulting in harm appear to be rare. Most occur during dispensing and administration suggesting that more robust checking procedures may be required during these stages. The widespread reporting of non-harmful errors suggests that staff have an appropriately low threshold for completing IR1 forms and that these represent a valuable audit tool for improving patient safety.

Endoscopy teaching practice is variable, significantly affecting training provided. Endoscopy specific train the trainer courses are commonplace in adults, and in the UK are now mandatory. There is only one paediatric train the colonoscopy trainer course (PTCTC) in the UK and although informal feedback has been positive, its practical value has never been formally assessed. A small cohort of studies demonstrated a benefit with these courses but highlighted the need for further research, especially in paediatrics. We aim to assess the practical value of the PTCTC and how attendees perceive their teaching practice compared to non-attendees.A questionnaire based on the PTCTC learning objectives and aims was distributed to two groups of Consultant Paediatric Gastroenterologists who teach colonoscopy in the UK; those who had attended the course and those who had not attended the course (controls).41 completed responses were received. 25 attended a PTCTC, 3 attended an adult course and 13 had not attended any course. Overall responses indicated participants of the PTCTC rated their confidence and knowledge in teaching practices as higher than controls (4.27 vs 3.56 P = <.001). There was a statistically significant difference in all areas: set (4.21 vs 3.71 P = .011), dialogue (4.29 vs 3.55 P = <.001) and closure (4.37 vs 3.6 P = <.001) with those who attended the PTCTC giving higher ratings. There was evidence of increased understanding of key concepts such as using standardised language, conscious competence, dual task interference and performance enhancing feedback.Overall, this study demonstrates a higher perceived level of knowledge in fundamental teaching principles and confidence in colonoscopy teaching skills in those who attended a PTCTC. The study was limited by the sample size, but the results support the need for these courses and for ongoing research into their importance. Mehta T, Dowler K, McKaig BC, et al. Development and roll out of the JETS e-portfolio: a web based electronic portfolio for endoscopists. Frontline Gastroenterol 2010;2:35–42. Anderson JT. Assessments and skills improvement for endoscopists. Best Pract Res Clin Gastroenterol 2016;30:453–71.

Of these, 5 (11%) occurred during the prescription process (e.g. incorrect PN volume calculation), 9(20%) during the transcription process (e.g. incorrect patient ID, surname, date of birth, rates or inadequate amount of PN), 11 (24%) during dispensing (e.g. mislabelling of vamin or lipid bags, leaking bags), 7 (15%) during delivery of PN to the ward and 14 (30%) during the administration process (e.g. PN administered at incorrect rates).

IntroductionInadequate transition for chronic health conditions is associated with poor disease outcomes. The training of health care professionals in developmentally appropriate healthcare in the United Kingdom (UK) has not been measured. This national survey explores experience of Adolescent and Young Person (AYP) dedicated training and service delivery, from both adult and paediatric perspective.MethodsA 30-item ‘SurveyMonkey®’ questionnaire was developed by the British Society of Gastroenterology (BSG) AYP committee. This was emailed by the BSG and British Society of Paediatric Gastroenterology, Hepatology and Nutrition (BSPGHAN) to its member trainees and those within five years of Consultant appointment, between June-September 2020.ResultsOf 70 respondents, 71.4% were senior trainees or ≤ 5 years post CCT, with 54% being female. AYP training was not accessible to 58% in their current or most recent post. Of those that had prior AYP training, the majority (39%) had been to transition clinics. A fifth felt ‘at least confident’ that training offered adequate experience of AYP training. Nearly half of respondents wanted AYP specific training.Significant barriers to AYP training (figure 1) and delivery were reported including lack of resources (60%), issues with funding e.g. who pays for the service (52%) and a lack of local interest in service development (46%).Important patient related factors for successful transition were reported as ability to take medications unsupervised, patient understanding of disease and treatment.Health care related barriers to successful transition (1=lowest importance, 4=highest importance), were lack of time/space to set up joint clinic (3.12), lack of support services (3.04) and lack of funding (3.01).ConclusionsThis cross-society national survey has revealed AYP training is extremely limited and the majority of respondents perceive inadequate experience and confidence in this area, despite there being a demand for change. AYP service delivery is widely varied with lack of resources, funding and interest as key healthcare related barriers. A concerted expansion both at national curricula development level and in individual departments is urgently needed, to advance exposure and training in AYP Gastroenterology.Abstract PTU-82 Figure 1Barriers to AYP training: responses

Intravenous Ferric Derisomaltose (IV FDM) is increasingly used for the treatment of iron deficiency anaemia in paediatric gastroenterology patients. Our aim was to review the safety and effectiveness data of IV FDM in two paediatric tertiary gastroenterology centres (Hospitals A & B).A retrospective case notes review of all paediatric gastroenterology patients receiving IV FDM between 2018 and 2023 was undertaken, following approval by the Clinical Audit and Effectiveness team. Baseline demographics, indication for IV iron, previous oral iron treatment, monitoring pre and post infusion including haematological and biochemical parameters, adverse events and need for further IV iron infusions were recorded. All patients were administered a dose of 20mg/kg IV FDM with a maximum dose of 1 gram in Hospital A and 1.5 grams in Hospital B.A total of 65 patients who received 78 IV FDM infusions, were identified from Hospitals A and B, during this period. A majority, 49/65 (75.4%), had Inflammatory bowel disease, with a median age at iron infusion of 12.8 years (IQR: 9.6–15.2) and a median weight of 36.5 Kg (IQR: 24.1–58.5). A significant, rapid and well-maintained increase in median Haemoglobin (HB) levels was observed after IV FDM, paralleled by MCV trends (table 1). No alterations in phosphate levels were reported after the IV FDM infusion, with data available for 80% of the entire cohort. There were no alterations noted in liver and renal function tests. Overall, 53/65 (81%) patients recovered their anaemia after IV FDM with 9/53 (17%) re-dropping HB and requiring further iron supplementation. Regarding IV FDM safety, 3/65 (4.5%) patients had to discontinue the infusion, only one due to an allergic reaction with chest pain, decreased O2 saturations and cutaneous rash.Overall, our multicentre real-world data showed that IV FDM was safe, well tolerated and demonstrated good clinical effectiveness in paediatric gastroenterology with no significant biochemical changes induced post infusion.Abstract OC57 Table 1 FDM Infusion Median Hb (IQR) P value Median MCV (IQR) P value Pre FDM infusion 92 g/L(IQR 85–108) 72 fL(IQR 67–79) 1 month post-FDM 126 g/L(IQR 115–132) <0.001 80 fL(IQR 77–83) 0.038 3 months post-FDM 128.5 g/L(IQR 121–140) <0.001 82 fL(IQR 77–86) 0.005 6 months post-FDM 131 g/L(IQR 123–140) <0.001 83 fL(IQR 80–87) <0.001 12 months post-FDM 134 g/L(IQR 125–142) <0.001 84 fL(IQR 79–88) <0.001

Inflammatory cloacogenic polyp (ICP) is a rare lesion arising in the region of the anorectal transitional zone. It is considered to be a part of mucosal prolapse, which includes solitary rectal ulcer syndrome (SRUS), rectal prolapse, intussusceptions and rectocele. The etiopathogenesis is mucosal prolapse, which produces local trauma and ischemic injury followed by inflammation, repair and regenerative changes. The vast majority (85%) are located above the anal border and predominantly in the anterior lateral wall. The polyps vary in size from 3–4 cm in diameter and have a sessile appearance.1 The estimated annual incidence of ICPs is 1 to 3.6 per 1, 00,000 among all solitary rectal ulcers.2 It is rare in children. A review of clinical notes and investigations was undertaken along with review of literature.13-year boy, a Syrian refugee presented with history of pr bleeding for over 2 years which had increased over the past few weeks. There was no other significant medical history. He had a normal general and systemic examination on presentation. His weight and height were on the 25th centile. On presentation he had raised calprotectin(>4000)microgram/miligram. Haemoglobin of 128 g/dl on presentation, erythrocyte sedimentation rate-17 mm/hr. The MRI abdomen was normal.He underwent colonoscopy which revealed multilobulated polyp needing piecemeal resection (figure 1 and 2). Histopathology (figure 3) was suggestive of a polylobulated polyp in the rectum. There was smooth muscle passing up between the glands and the stroma appeared to be a mixture of smooth muscle and fibrotic tissue. Ulceration and inflammatory slough were noted on the surface. This was diagnostic of inflammatory cloacogenic polyp. Despite being on laxatives he required three piecemeal resections over a year. He continues to present with bleeding per rectum and is planned for endoscopic submucosal dissection (ESD).Awareness of this entity in children is important because of both the propensity for recurrence and persistence of the polyps. If the underlying etiology is not corrected, the long-term implications are of internal intussusception: procidentia, descending perineum syndrome, and ultimately, incontinence. Rectal bleeding is the most common presenting clinical symptom.Abstract OC94 Figure 1 and 2Endoscopic appearance of inflammatory cloacogenic polyp[Figure omitted. See PDF]Abstract OC94 Figure 3Histology appearance of inflammatory cloacogenic polyp[Figure omitted. See PDF] Calva-Rodríguez R, González-Palafox MA, Rivera-Domínguez ME, [Inflammatory cloacogenic polyp]. Rev Gastroenterol Mex. 2007 Oct-Dec;72(4):371–5. Ewertsen C, Svendsen CB, Svendsen LB, [Inflammatory cloacogenic polyp]. Ugeskr Laeger. 2008 Aug 25;170(35):2708.

BackgroundA paediatric global ratings scale for endoscopy(PGRS) is currently being piloted and this will provide a quality and safety framework for service improvement in Paediatric endoscopy units. An important aspect of this is patient involvement and an annual survey on the patient’s experience.AimA patient/parent feedback survey was used to evaluate the endoscopy experience for our patients and family, as part of an annual endoscopy audit plan.MethodA questionnaire that has previously been approved by our clinical governance team in 2013 was used. Questionnaires were distributed to patients and parents over a 3 week period (24/10/16–11/11/16).Results28 questionnaires were returned, including an even spread between age groups. The results are illustrated in Table 1.Abstract G190(P) Table 1Results of patient/parent questionnairePreparation before procedureYes (%)No (%)Not recorded (%)Was the procedure explained during consent?10000Did you feel you had opportunity to ask questions?10000Were you given information leaflets about the procedure?75187In those who had colonoscopies, were you explained the10000importance of bowel preparation?Were you informed of waiting time in advance?71254Did you have an opportunity to discuss options with the82117Anaesthetist?Overall preparation rated as 'excellent' or 'good'79147Experience post procedureDid the patient experience post-operative pain?296110Did the patient experience post-operative bleeding?48610Were the endoscopy findings discussed and explained?711117Were follow up arrangements given at discharge?71425Was advice given about complications after discharge?46747Overall experienceOverall patient comfort rated as 'excellent' or 'good'75 718Overall experience rated as 'excellent' or 'good'75 718ConclusionOverall, patients and families have had a good experience of endoscopy at our Unit, which is in line with previous studies. Areas for improvement include a need for specific endoscopy information and post procedure advice leaflets, and adolescent care.

BackgroundA paediatric global ratings scale for endoscopy(PGRS) is currently being piloted nationally, and this will provide a quality and safety framework for service improvement in Paediatric endoscopy units. An annual endoscopy audit plan is essential to help units identify that they are meeting the required measures and identifying areas of improvement.AimTo develop an annual endoscopy audit plan to facilitate quality improvement in the endoscopy service in a tertiary centre.Subjects and MethodsA retrospective audit of all procedures done by the Paediatric gastroenterology team during 1/10/16–15/ 10/16 was done. We used measures from the P-GRS to develop standards for the audit plan. Letters of correspondence, consent, operation notes, anaesthetic charts, nursing documentation and biopsy reports were reviewed. Patient feedback questionnaires were also included.Results46 patients(age range 8 months to 17 years) had endoscopies during the study period. 78%(36) of these had elective procedures. Out of the 22%(10) who had non-elective procedures, 18%(8) were urgent and 4%(2) were emergency procedures. 100% of procedures had a clearly documented indication, and had completed consent forms, all of which were 2-stage. The procedure completion rate was 100%, and bowel preparation was adequate in 98%. One patient developed post-operative oxygen requirement; otherwise there were no other post-procedure complications. There were no deaths within 30 days of the procedure. Patient feedback questionnaires showed 78% of respondents rated their overall endoscopy experience as ‘excellent’ or ‘good’. One patient had an endoscopic assessment for Upper GI bleeding during the audit period. This patient was risk assessed and had an endoscopic assessment appropriately.Summary and conclusionThe audit showed that our Unit is performing well against a number of the quality and safety measures in the P-GRS. Areas that require improvement include developing procedure-specific after care patient information leaflets, better documentation on patients‘ anaesthetic needs, and procuring an endoscopy reporting system(ERS). This also highlighted the need for close collaboration with other stakeholders such as anaesthetics and theatre admissions staff to share findings and implement change.