Endoscopic Tattoo FAQs

Endoscopic Tattoo FAQs

Great strides are made in the fight against colon cancer each and every day, but there is an often-overlooked step that can make an impact in the detection and treatment of this disease — endoscopic tattooing.

Endoscopic tattoos have proven to both decrease time spent in the operating room1 and greatly improve tumor localization2. In fact, endoscopic tattoos are recommended in the ESGE’s Guidelines for EMR and Polypectomy3 and society-recommended by the American College of Gastroenterology4, European Society of Gastrointestinal Endoscopy5, British Society of Gastroenterology6, and Society of American Gastrointestinal Endoscopic Surgeons7.

Despite this, the methods for endoscopic tattooing are still not part of the core surgical curriculum at most medical schools. A lack of standardized guidelines for the procedure make it even more of a challenge to get physicians on the same page about when and why to tattoo.

Not surprisingly, that leaves medical professionals with a lot of questions. Here are just a few of those frequently asked questions:

What are the benefits of endoscopic tattooing?

By tattooing lesions with dark, permanent endoscopic tattoos, localization in colon resection surgery or post-polypectomy for follow-up colonoscopy can be fast and easy. When a surgeon cannot locate a lesion during surgery, potential risks include8:

  • Longer surgical times while the surgeon attempts to locate the lesions
  • Additional colonoscopies to identify the site
  • The need for the surgeon to convert from a laparoscopic to an open procedure
  • The need for an intraoperative colonoscopy
  • Wrong site surgery, the potential for the surgeon to remove the wrong section of bowel

How many tattooing methods are there (and what are they)?

There are two widely used tattooing techniques that are considered by most physicians as the most reliable methods — saline bleb and direct.

Learn more about both methods here.

Does it matter which method is used?

Proper placement of the tattoo is an important part of ensuring it is visible during a follow-up colonoscopy and/or surgery, so using a reliable method (such as the two listed above) is important.

In “A Gastroenterologist’s Guide to Endoscopic Tattooing Methods” we’ve answered even more of these frequently asked questions and explained the most common methods for tattooing to help medical professionals get the most out of this latest tool in the fight against colon cancer. Get your copy here:

Get The Guide

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1- Arteaga-Gonzalez I, et. al., The use of preoperative endoscopic tattooing in laparoscopic colorectal cancer surgery for endoscopically advanced tumors: a prospective comparative clinical study. World J Surg. 2006. 30(4):605–611.
2 – Askin MP, Waye JD, Fiedler L, Harpaz N. Tattoo of colonic neoplasms in 113 patients with a new sterile carbon compound. Gastrointestinal Endoscopy. 2002;56(3):339-342. doi:10.1067/mge.2002.126905.
3 –  Ferlitsch M, Moss A, Hassan C, et al. Colorectal polypectomy and endoscopic mucosal resection (EMR): ESGE Clinical Guideline. 2017.
4 –  Rex D, Schoenfeld P, Cohen J, et al. Quality Indicators for Colonoscopy. Am J Gastroenterol. 2014: 1-19.
5 –  Ferlitsch M, Moss A, Hassan C, et al. Colorectal polypectomy and endoscopic mucosal resection (EMR): ESGE Clinical Guideline. 2017.
6 –  Rees C, Bevan R, Zimmerman-Fraedrich K, et al. Expert opinions and scientific evidence for colonoscopy key performance indicators. Gut BMJ. 2016.
7 –  SAGES. Guidelines for laparoscopic resection of curable colon and rectal cancer. 2012.
8 –  Acuna SA, et. al., Preoperative localization of colorectal cancer: a systematic review and meta-analysis. Surg. Endosc. 2017; 31:2366-2379.