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ObjectiveWe report on the increasing incidence and outcomes from intentional foreign body ingestion (iFoBI) presenting to our hospital over a 5-year period. The aim was to assess the impact on services and to identify ways to safely mitigate against this clinical challenge.Design/methodWe performed a retrospective observational study of all patients presenting to a university hospital between January 2015 and April 2020 with iFoBI with a focus on objects swallowed, timing of endoscopy and clinical outcomes.Results239 episodes of iFoBI in 51 individuals were recorded with a significant increase in incidence throughout the study period (Welch (5, 17.3)=15.1, pConclusionIn all except those patients with oesophageal impaction of the object on radiograph, there is no need to perform endoscopic extraction out of hours. A subset of cases can avoid endoscopy with an X-ray immediately prior to the procedure as a significant proportion have passed already. We discuss more holistic approaches to deal with recurrent attendances.

BackgroundFluoroscopy during endoscopic retrograde cholangiopancreatography (ERCP) exposes staff and patients to potentially harmful ionizing radiation. We performed a UK survey to explore trainee and trainer attitudes to radiation protection and cholangiogram interpretation in ERCP.MethodsAn electronic 10-point survey was prospectively distributed to endoscopy unit leads, training programme directors between October and November 2019. Only UK-based ERCP trainees and trainers with hands-on procedural exposure were eligible for the survey.ResultsThe survey was completed by 107 respondents (58 trainees and 49 trainers), with an estimated overall response rate of 46%. Overall, 49% of respondents were up to date with their radiation protection course, 38% were aware of European Basic safety standards directive (BSSD), 38% wore radiation protection goggles, and 40% were aware of the average radiation screening dose per ERCP procedure. Compared with trainers, trainees were less likely to routinely wear thyroid protection shields (76% vs 92%; p=0.028), have awareness of the BSSD (20% vs 49%; p=0.037) or know their average procedural radiation dosages (21% vs 63%; pConclusionThis survey highlights a relative complacency in safety attitudes to radiation protection during ERCP. These data provide impetus to improve training and quality assurance in radiation protection, which should be regarded as a mandatory safety aspect prior to commencing hands-on ERCP training.

Objective Recent data have suggested that non-selective β-blockers (NSBB) are associated with increased mortality in patients with cirrhosis and refractory ascites. However, other evidence implies that NSBB may be beneficial in this setting by reducing bacterial translocation. Our aim was to determine whether NSBB use was a risk factor for mortality in patients with end-stage chronic liver disease and ascites awaiting liver transplantation. Design This was a single-centre retrospective study of 322 patients with ascites listed January 2007 to July 2011. Results NSBB patients (n=159) and non-NSBB patients (n=163) were comparable with regards to listing model for end-stage liver disease score (p=0.168), frequency of hepatocellular carcinoma (p=0.193) and refractory ascites (35.2% vs. 37.4%, p=0.681). 82 patients died, 221 patients were transplanted and 19 patients were removed from the list during a median follow-up duration of 72 days; the median time to death was 150 and 54 days in the NSBB and non-NSBB groups, respectively. In a multivariate competing risk Cox model, patients on NSBB had reduced mortality compared with propensity risk score-matched non-NSBB patients (HR 0.55; 95% CI 0.32 to 0.95, p=0.032). Similarly, in the subgroup of patients with refractory ascites (n=117), NSBB remained independently associated with less waitlist death (adjusted HR 0.35; 95% CI 0.14 to 0.86, p=0.022). Conclusions NSBB in patients with ascites and refractory ascites listed for liver transplantation are not detrimental, and instead are associated with reduced waitlist death. Our findings argue that NSBB are safe and may confer benefit in patients with ascites complicating end-stage liver disease.

Introduction Hepatocellular carcinoma (HCC) is the most common primary liver tumour, and represents the third leading cause of cancer death worldwide. 1,2 The most important risk factor is liver cirrhosis, mainly due to chronic infections such as hepatitis B or C .2 Increasing HCC cases are seen in nonalcoholic fatty liver disease (NAFLD). Methods The aim of the study was to compare demographics, treatments and survival among hepatitis C virus (HCV/HCC) and NAFLD (NAFLD/HCC) cohort of patients. Data were collected from medical electronic case notes, imaging reports and HCC multidisciplinary meetings. Results Among 292 patients, 212 patients (73%) had underlying HCV/HCC and 80 patients (27%) had NAFLD/HCC. The median age at diagnosis was significantly higher in NAFLD/HCC (p The median alpha fetoprotein level in HCV/HCC patients were 32.0 compared to 12.0 in NAFLD/HCC (p = 0.085). Patients with HCV/HCC were significantly more likely to be transplanted during the study period than NAFLD/HCC (30% vs. 15%, p = 0.010). Both transarterial chemoembolization (TACE) and percutaneous ethanol injection (PEI) were significantly more likely to be used as a single treatment in NAFLD patients, compared to HCV patients (p = 0.042, p = 0.021). Sorafenib was used as the only treatment in 6% of HCV/HCC and 3% of NAFLD/HCC cohorts (p = 0.364). Post transplant survival appeared to be worse in HCV-HCC patients compared to NAFLD/HCC, although it did not reach statistical significance (p = 0.081). Overall five year survival rates were similar between the two groups regardless of any treatment therapies (p = 0.424). Conclusion Despite the NAFLD/HCC being older and with higher metabolic risk factors, a significant proportion could undergo active therapy. Furthermore, patients with NAFLD/HCC selected for transplantation seemed to have better long term outcomes, possibly due to stricter selection for transplantation as well as variations in tumour biology between the two groups. References 1 Mittal S, El-Serag HB. Epidemiology of hepatocellular carcinoma: consider the population. J Clin Gastroenterol 2013;47 Suppl:S2–6 2 Lu T , et al . P revention of hepatocellular carcinoma in chronic viral hepatitis B and C infection . World J Gastroenterol 2013;19(47):8887–8894 Disclosure of Interest None Declared.