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Paediatric inflammatory bowel disease (IBD) is increasing globally, particularly among adolescents and young adults. 1 3 Complex cases, especially those approaching adult transition, benefit from multidisciplinary input, yet the impact of structured cross-speciality histopathology review remains underexplored. This service evaluation assessed the outputs and clinical impact of a novel ‘Cross-Trust’ Histopathology MDT, designed to refine diagnosis, guide therapy, and support transition in complex paediatric IBD patients at a UK tertiary referral centre.A retrospective review was conducted of eight biannual MDT meetings held between January 2021 and March 2024. Participants included paediatric gastroenterologists, adult IBD physicians, and specialist gastrointestinal histopathologists. Patients were referred for discussion due to diagnostic uncertainty, therapeutic complexity, or imminent transition. Extracted data included demographics, pre- and post-MDT diagnosis, therapeutic recommendations, surgical considerations, transition-related outcomes, and documentation in electronic health records. Primary outcomes were diagnostic reclassification, therapeutic modification, and transition-related decisions.Twenty-seven patients were reviewed (mean age 17.2 years, range 14–21; 59% male). The predominant reason for referral was diagnostic clarification. Following MDT review, 11 patients (41%) had their diagnosis revised: seven patients initially labelled as IBDU favouring UC were reclassified as UC, one as CD, and three were found not to have IBD (disuse colitis, eosinophilic colitis, amebiasis). Sixteen patients (59%) retained their initial diagnosis. Diagnostic refinement was driven by detailed histopathological assessment, including crypt architecture, basal plasmacytosis, granulomas, and eosinophilic infiltration. Therapeutic recommendations were modified in three patients (11%), with two commencing or escalating biologics (infliximab, vedolizumab) and one receiving a non-biologic adjustment. No surgical referrals were made. Transition planning was altered in one patient, with immunology referral delaying transfer. Only three MDT outputs (11%) were recorded in the electronic health record.In conclusion, the Cross-Trust Histopathology MDT improved diagnostic accuracy in 41% of complex cases, influenced therapy in selected patients, and prevented inappropriate immunosuppression in three non-IBD cases. Although documentation was limited, this model demonstrates the value of structured, cross-speciality review in optimising paediatric IBD management. Wider adoption, alongside improved recording processes, could enhance care consistency and outcomes across centres.References Benchimol EI, Fortinsky KJ, Gozdyra P, et al. Epidemiology of pediatric inflammatory bowel disease: a systematic review of international trends. Inflamm Bowel Dis. 2011;17:423–439.Thurgate LE, Lemberg DA, Day AS, Leach ST. An overview of inflammatory bowel disease unclassified in children. Inflamm Intest Dis. 2019;4:97–103.Sýkora J, Sýkora J, Pomahačová R, Kreslová M, et al. Current global trends in the incidence of pediatric-onset inflammatory bowel disease. World J Gastroenterol. 2018;24:2741–2763.