Successful endoscopic submucosal dissection of colon cancer with severe fibrosis after tattooing

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Endoscopic tattooing is often used to facilitate the identification of colorectal lesions before endoscopic treatments. However, tattooing under the lesion can result in technical difficulties because of the dark endoscopic field and submucosal fibrosis. A 65-year-old man with a non-granular-type laterally spreading tumor was referred to our hospital after tattooing with India ink for surgery. However, endoscopic submucosal dissection (ESD) was selected for the resection of this lesion because the findings of magnifying endoscopy suggested an intramucosal cancer. Dissection around a dense section was difficult because of the dark endoscopic field and non-lifting as a result of severe fibrosis. We performed ESD using the following strategy: (1) injection with a smaller amount of indigo carmine and (2) cut and dissection from the side of the thinly tattooed area. The lesion was curatively resected en bloc without any complications. This finding suggests that endoscopic tattooing before endoscopic treatment should be performed one or two folds away from the lesion.

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Endoscopic submocosal dissection


Laterally spreading tumor


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Correspondence to Hideyuki Chiba.

Ethics declarations

Conflict of interest:

Hideyuki Chiba, Jun Tachikawa, Daisuke Kurihara, Keiichi Ashikari, Akihiro Takahashi, Hiroki Kuwabara, Michiko Nakaoka, Taiki Morohashi, Toru Goto, Ken Ohata, Atsushi Nakajima declare that they have no conflict of interest.

Human/animal rights:

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2008(5).

Informed consent:

Informed consent was obtained from all patients for being included in the study.

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Chiba, H., Tachikawa, J., Kurihara, D. et al. Successful endoscopic submucosal dissection of colon cancer with severe fibrosis after tattooing. Clin J Gastroenterol 10, 426–430 (2017).

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  • Endoscopic tattoo
  • Fibrosis
  • India ink
  • Endoscopic submucosal dissection
  • Complication
  • Colorectal cancer
  • Laterally spreading tumor