P82 Developing a variceal banding service: a quality improvement project

<h3></h3> Variceal haemorrhage is associated with morbidity and mortality in decompensated cirrhosis. Oesophago-gastro-duodenoscopy (OGD) is performed to screen for oesophageal varices and for band ligation treatment. Banding is recommended for those with high-risk bleeding stigmata or where beta-blockers are contraindicated. The British Society of Gastroenterology recommends follow-up endoscopy after four weeks and repeat banding until variceal eradication. Despite a high liver disease burden, our busy district general hospital in London lacked a formal variceal banding service in 2022, highlighting the need for improvement. In 2023, dedicated variceal banding lists were introduced to ensure endoscopists performing variceal surveillance had the requisite banding expertise. Additionally, in 2024, we introduced a hepatology specialist nurse to actively monitor patients undergoing variceal banding. We audited endoscopy lists and electronic patient records to assess the following outcomes: number of repeat endoscopies within 4 weeks, morbidity defined as admission with variceal haemorrhage, and mortality after the index procedure. Outcomes were compared after implementing the interventions in 2023 and 2024. In 2022, 13 patients underwent OGD for surveillance and variceal haemorrhage. This increased to 48 in 2023 and 31 in 2024 to date. The outcome data comparison following our interventions are shown in table 1. The median time to repeat endoscopy decreased from 38 days in 2023 to 30 days in 2024 (p&lt;0.05). Most common aetiology of liver disease was alcohol-related 72.2% and non-attendance at appointments was highest in this group 6 out of 8 no shows (75%). Unfortunately, some patients did not receive a follow up appointment for their repeat endoscopy in 2023 this was 25% and in 2024 this reduced to 14%. The introduction of dedicated banding lists increased the number of OGDs from 2022 to 2023, and the addition of a hepatology specialist nurse reduced the median time to repeat endoscopy and missed appointments. These interventions positively impacted morbidity from variceal bleeding. However, further efforts are needed to engage patients with alcohol-related liver disease to improve attendance and outcomes.