Is the "red flag" referral pathway effective in diagnosing colorectal carcinoma?

INTRODUCTION: In 2000-2004 there were, on average, 93 8 new cases of colorectal cancer (CRC) diagnosed per annum in Northern Ireland, accounting for 13.9% of all cancers. The two week "red flag" referral system aims to detect 90% of patients with CRC for prompt treatment. The aim of this study is to examine the impact of the "red flag" referral system on identification of patients with CRC, time to treatment and stage of disease. METHODS: A random sample of 200 patients referred via the "red flag" system was identified from the local cancer patient tracker database. Data pertaining to demographics, time to hospital appointment, appropriateness of referral and diagnosis were collected. For patients identified with CRC, the stage of disease and time to first definitive treatment were also documented. RESULTS: Of the 200 patients, 56% were female. The age range was 27-93 years. Eighty three percent were seen within 14 days of referral. Referrals adhered to the guidelines in 45% of cases. There were 4 pancreatic cancers, 1 endometrial cancer, 1 ovarian cancer and 1 myelodysplasia diagnosed. Three patients were diagnosed with CRC (1.5%). Of these, 1 was palliative and the remaining 2 commenced definitive management within 6 days of decision to treat. CONCLUSION: The "red flag" referral system does not appear to be effective in identifying patients with CRC but did identify patients with other types of cancer. Less than half of the referrals adhered to the guidelines. A review of this system should be undertaken.

The use of mechanical bowel preparation in elective colorectal surgery.

BACKGROUND: Mechanical bowel preparation (MBP) prior to elective colorectal surgery has been in use for many years. It is considered important in preventing post-operative infectious complications after colorectal surgery. The evidence to support these claims is lacking within the medical literature and yet this still remains standard practice in many hospitals. A literature search was undertaken to ascertain the evidence available regarding the use of MBP in elective colorectal surgery. METHODS: The search included the databases PubMed, Medline and Embase using the keywords "mechanical bowel preparation", "bowel cleansing" and "elective colorectal surgery", a search of recent issues of relevant journals including Diseases of the Colon and Rectum and British Journal of Surgery and backward chaining from articles obtained. RESULTS AND CONCLUSION: Most authors recommend that colorectal surgery is safe without pre-operative MBP but that there may some situations in which it may be beneficial (e.g. if there is a small tumour or the possible need for intra-operative colonoscopy). The implication for clinical practice in this situation is that there is not enough strength of evidence at present to recommend a change in practice. There is a need for further higher powered trials to try to answer this question definitively.