Protocol management for patients presenting with lower GI haemorrhage saves costs and maintains outcomes.

BACKGROUND: Lower gastrointestinal (LGI) bleeding is a common medical problem associated with significant morbidity and mortality. Although most patients stop bleeding spontaneously without intervention and most do not re-bleed, a small number have massive haemorrhage that requires intervention to prevent shock and coagulopathy. Many choices are available in managing such patients. The clinician faces decisions regarding the timing and nature of investigations and treatment options. The aim of this study is to analyse the impact of a protocol to improve clinical practice in this area. METHODS: The protocol was based on a review of investigative patterns, and transfusion at the outset of the project. Length of stay, number of inpatient and outpatient colonoscopies, radiolabelled red blood cell (RBC) scans, blood transfusions, re-admissions, operations and deaths were compared for patients admitted prior to and following implementation of the protocol. RESULTS: The number of transfusions and RBC scans both significantly lessened after implementation of the protocol. There were no demonstrable adverse outcomes by way of mortality, length of stay and number of patients requiring operation, colonoscopies and re-admissions. CONCLUSIONS: The implementation of a protocol to manage patients with LGI bleeding is matched by a significant reduction in use of hospital resources for these patients over the same time frame. Low morbidity and mortality outcome was maintained following introduction of the protocol.

Complete pathologic response after preoperative rectal cancer chemoradiotherapy.

BACKGROUND: Following preoperative treatment of rectal cancer with chemoradiotherapy (CRT), a complete pathological response (CPR) can be seen in the surgical specimen. The aim of this study was to assess the outcome of these patients as compared with those who did not have a complete response. METHODS: A retrospective study of the outcome of patients managed with preoperative CRT for their rectal cancer was conducted. RESULTS: Between November 1998 and July 2004, there were 530 new presentations of rectal cancer at The Queen Elizabeth and Royal Adelaide hospitals. Forty of these patients (7.5%) were treated with long-course preoperative CRT. After resection, a CPR was seen in seven patients (17.5%). These patients were all disease free at January 2006 after a median follow-up of 6.0 years (range 1.42-7.02 years). One patient had died from non-tumour-/surgery-related causes. Tumour recurrence, but not mortality, in this group was superior to the comparison group of patients without a CPR. CONCLUSIONS: None of our patients who had a CPR after preoperative CRT have recurred or died from their disease.