Safety of preoperation endoscopic tattoo with india ink for identification of colonic lesions

Abstract

Preoperative mucosal tattooing with india ink is recommended as a safe and necessary procedure.

Preoperative Localization of Colorectal Tumors with Endoscopic Tattooing for Laparoscopic Surgery

“…These methods include barium enema, computed tomography colonography, placement of mucosal clips, and intra-operative colonoscopy [4]. The barium enema historically has been the modality used to localize lesions for surgery but is increasingly unreliable [5]. While it is a good method for localizing exophytic and stenosing lesions, it is less effective for localizing early or flat tumors [6].…”

“…While it is a good method for localizing exophytic and stenosing lesions, it is less effective for localizing early or flat tumors [6]. Preoperative location of a lesion by measuring centimeters of instrument introduced into the rectum is a poor method due to variability in length of colon and looping of the scope within the colon [5]. Localization with computed tomography colonography is useful for detecting not only the primary tumor but also synchronous colon lesions, provides additional information about regional and distant metastatic disease, the depth of wall invasion, and the precise location of the lesion in the colon prior to surgery [6].…”

“…Different dyes such as methylene blue, indigo carmine, and indocyanine green all successfully stain the bowel wall but usually disappear within days as they are rapidly absorbed making for inappropriate techniques for localization [5]. These agents are less useful compared with India ink with respect to safety, efficacy, and ease of use.…”

“…It is effective and safe. It is a permanent marker demonstrated to persist for at least 10 years in patients [5]. Its permanence may be due to the lack of local lymphatics to remove these inert particles [8].…”

Complications of Colonoscopy

“…Although three studies with a total of 264 patients who underwent colonoscopic tattooing reported no fever, abdominal pain, or any major complications [64][65][66], a systematic review of 447 patients with colonoscopic tattooing described 5 cases of complications with only one was an overt clinical complication (22.3 per 10,000 tattooing) [67].…”