When and How To Use Endoscopic Tattooing in the Colon: An International Delphi Agreement

Background & aims: There is a lack of clinical studies to establish indications and methodology for tattooing, therefore technique and practice of tattooing is very variable. We aimed to establish a consensus on the indications and appropriate techniques for colonic tattoo through a modified Delphi process. Methods: The baseline questionnaire was classified into 3 areas: where tattooing should not be used (1 domain, 6 questions), where tattooing should be used (4 domains, 20 questions), and how to perform tattooing (1 domain 20 questions). A total of 29 experts participated in the 3 rounds of the Delphi process. Results: A total of 15 statements were approved. The statements that achieved the highest agreement were as follows: tattooing should always be used after endoscopic resection of a lesion with suspicion of submucosal invasion (agreement score, 4.59; degree of consensus, 97%). For a colorectal lesion that is left in situ but considered suitable for endoscopic resection, tattooing may be used if the lesion is considered difficult to detect at a subsequent endoscopy (agreement score, 4.62; degree of consensus, 100%). A tattoo should never be injected directly into or underneath a lesion that might be removed endoscopically at a later point in time (agreement score, 4.79; degree of consensus, 97%). Details of the tattoo injection should be stated clearly in the endoscopy report (agreement score, 4.76; degree of consensus, 100%). Conclusions: This expert consensus has developed different statements about where tattooing should not be used, when it should be used, and how that should be done.

Citation

Medina-Prado, L., Hassan, C., Dekker, E., Bisschops, R., Alfieri, S., Bhandari, P., Bourke, M. J., Bravo, R., Bustamante-Balen, M., Dominitz, J., Ferlitsch, M., Fockens, P., van Leerdam, M., Lieberman, D., Herráiz, M., Kahi, C., Kaminski, M., Matsuda, T., Moss, A., Pellisé, M., … Jover, R. (2021). When and How To Use Endoscopic Tattooing in the Colon: An International Delphi Agreement. Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association, 19(5), 1038–1050. https://doi.org/10.1016/j.cgh.2021.01.024

DOI

10.1016/j.cgh.2021.01.024

URI

https://hdl.handle.net/20.500.14709/793