When it comes to endoscopic tattoos, most gastroenterologists know of them and utilize them in certain clinical situations, but the full value of endoscopic tattoos is not yet realized in routine clinical practice.
Seasoned clinician Professor Cesare Hassan is no stranger to endoscopic tattoos and is taking steps toward educating other medical professionals about this powerful tool.
According to the 2017 Guidelines for EMR and Polypectomy from the European Society of Gastrointestinal Endoscopy (ESGE), lesions that may need to be located at future surgical procedures should be tattooed.1 Additionally, the following lesions should also be tattooed:
Proven or suspected malignant
Polypectomy of lesions with potential cancer or piecemeal removal
Endoscopic mucosal resection (EMR)
Endoscopic submucosal dissection (ESD)
Professor Hassan, one of the authors behind the ESGE Guidelines, understands the importance of this step and completes each of his procedures by injecting endoscopic tattoos where needed.
“So what we use is Spot® Ex. It is the first tattoo to have clinical indication for endoscopic surveillance because it is a permanent and not transitory tattoo,” said Hassan in a recent ESGE webinar (included below).
During the procedure, Professor Hassan follows the ESGE-recommended bleb method that places a saline bleb in the submucosa prior to injecting the ink. A proper distance between the lesion and the tattoo is also needed. The ESGE Guidelines encourage three centimeters of space between the two, and tattooing the colon wall opposite of the lesion ensures that the ink will not spread into or under the lesion. “The tattoo spreads very quickly...do it the opposite way in order not to have the tattoo on the scar.”
According to the ESGE Guidelines, Spot Ex’s “sterile and biocompatible pre-packaged suspension containing highly purified and very fine carbon particles has enhanced the accessibility, ease of use, and safety” of the endoscopic tattooing procedure, helping clinicians take the next step in the fight against colon cancer one tattoo at a time.
For more information about endoscopic tattooing methods and Spot Ex, download “A Gastroenterologist’s Guide to Endoscopic Tattooing Methods” below:
And see gastroenterological expert Dr. Cesare Hassan in action here in his ESGE webinar recording:
1 - Ferlitsch M, Moss A, Hassan C, etal. Colorectal polypectomy and endoscopic mucosal reseaction (EMR): ESGE Clinical Guideline. 2017.