![]() However, because it contains several other substances that are immunologically active, injection of India ink has resulted in complications such as sterile abscess formation, focal peritonitis, and inflammatory pseudotumor, and has precipitated inflammatory bowel disease, although very rarely. G&H How do the dyes compare in terms of safety, efficacy, and ease of use?ĭR Carbon black in the form of India ink is a very effective tattoo. ![]() Other substances injected into the submucosa primarily for the purposes of facilitating EMR and ESD, such as indigo carmine, methylene blue, and indocyanine green, do not leave a permanent tattoo in the colon. A new formulation called Spot Ex is 50% darker than the original formulation it is sold in 5-mL vials and is immediately ready for endoscopic injection. Carbon black is available in India ink, but pure carbon black is commercially available and approved by the US Food and Drug Administration in a formulation called Spot (GI Supply). G&H What types of ink or dye are available?ĭR Carbon black is the only permanent tattoo appropriate for use in the colorectum. For the cecum and for some ascending colon lesions, a photograph of the lesion with the appendiceal orifice or the ileocecal valve in view serves as an excellent record to guide surgical resection or subsequent endoscopic follow-up. Similarly, some lesions in the proximal ascending colon do not need to be tattooed if the cecum is still visible. Tattooing is appropriate for such lesions in all colon locations, except it is not required in the cecum because the cecum itself is a completely reliable landmark for both endoscopic and surgical follow-up. G&H Which lesions should be considered for marking?ĭR Tattooing should be considered for obvious colorectal cancers and for lesions with suspected cancer, for pedunculated adenomas with endoscopic features of cancer or with sufficient size to have a substantial risk of cancer (≥2 cm in size is a reasonable guide), and for large flat or sessile lesions removed by piecemeal endoscopic mucosal resection (EMR) or by endoscopic submucosal dissection (ESD). However, tattooing is widely considered the best method of marking the colon. Alternatives to tattooing include taking an abdominal radiograph with the endoscope tip at the site of the lesion (for surgical location) or placing metal clips near a lesion followed by taking an abdominal radiograph. ![]() G&H What are the reasons for endoscopically tattooing the colon?ĭR Colon tattoos are used to mark lesions for subsequent surgical resection or for later endoscopic resection, or to mark an endoscopic resection site for easy endoscopic follow-up of the resection site. ![]()
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