P008 Hepatocellular carcinoma surveillance in patients with liver cirrhosis: are we following the guidelines?

Introduction The British Society of Gastroenterology (BSG) recommends, if HCC surveillance is offered, 6 monthly ultrasound- scan with serum AFP.1 We aim to evaluate our screening practice in liver cirrhosis patients and compare it with the BSG guidelines. Methodology Retrospectively, all patients with liver disease who admitted to gastroenterology ward between January 2020 and Jun 2020 at Royal Lancaster Infirmary were assessed. Stages of liver cirrhosis were taken into consideration with the presence of decompensated liver disease signs and the underlying cause of liver cirrhosis.2 Data collected from Electronic- Patients Record included any blood test, ultrasound, and endoscopy report. We analysed the data by using One-Way ANOVA on SPSS. Results Total number of hepatology admissions during the study period was 183 patients with 65% (n=119) known to have liver cirrhosis. 74% were male (n=137) of total admissions and only forty-six female patients. Among individuals with liver cirrhosis, twenty-seven patients had Child-Pugh (A) liver cirrhosis with Fifty and forty-two had Child-Pugh (B) and (C) respectively. Admission with decompensated Alcoholic liver Cirrhosis was higher in male patients 69% (n=47) compare to female patients of only 30% (n=21) (p= 0.001). None of the patients had autoimmune or metabolic liver disease as main cause of cirrhosis (p= 0.0001). Oesophageal varices were diagnosed in thirty-one patients (26%) predominantly males (n=22). HCC surveillance with Ultrasound occurred in 85% (n=102) whereas only 73 patients (61.3%) had AFP checked. The ANOVA results suggest the HCC surveillance differs significantly between different stages of liver cirrhosis (Child-Pugh A, B and C) (F3,359 = 6.11, p= 0.003). Male patients had more robust HCC surveillance (M=37.61, SD=23.46, n=13) in comparison to Female patients with liver cirrhosis (M=13.38, SD = 8.60, n = 13). This was statistically significant, t (24) = 2.06, (p= 0.0009). Conclusion More than two third of Hepatology admissions have liver cirrhosis, however, the study period was during the first COVID-19 wave, yet the adherence to the BSG in HCC surveillance guidelines was achieved in 85% and 61.3% with USS and AFP respectively. Significant improvement is required;hence, we recommend adding checklist and proforma to the patients' record as this may improve our practice.