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Predictors and rates of prior endoscopic tattoo localization amongst individuals undergoing elective colorectal resections for benign and malignant lesions

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Abstract

Background

Appropriate tattooing of suspicious lesions during colonoscopy is critical for surgical planning. However, variability exists in tattoo placement, technique, and reporting. Our aim is to determine the rates and predictors of tattoo placement, tattoo location in relation to the lesion, and localization accuracy during lower endoscopy for individuals undergoing elective colorectal resections.

Methods

We performed a retrospective chart review on all patients undergoing elective colorectal resections for benign and malignant neoplasms between 2007 and 2017 at a high volume Canadian tertiary centre. Patient demographics, endoscopic, and tumour-related characteristics were collected. Multivariable logistic regression analysis was used to identify predictors of tattoo localization.

Results

Of the 1062 patients identified, laparoscopic resection occurred in 59% of patients. 57% of patients underwent tattooing for tumour localization at index endoscopy. Tattoos were placed distal (27%), both proximal and distal (4%), and just proximal (2%) to the lesion. However, in the majority of cases the tattoo location was not documented (67%). On multivariate analysis, patients who had lesions located in the transverse colon (OR: 1.93, 95% CI 1.04–3.59), had surgery performed after 2010 (2011–2014: OR: 1.88, 95% CI 1.31–2.68; 2015–2017: OR: 2.87, 95% CI 1.93–4.26), underwent laparoscopic resections (OR: 1.69, 95% CI 1.22–2.33), and had their index endoscopy performed in an urban setting (OR: 5.92, 95% CI 3.23–10.87), were at higher odds of having a tattoo placed at index endoscopy.

Conclusion

Endoscopic tattoo placement and location in relation to the lesion varies widely, with reports containing suboptimal documentation. Lesion location and laparoscopic procedures were significant predictors of tattoo placement. This study highlights the need for standardized tattooing practices and reporting amongst endoscopists. One of the focus of quality improvement efforts should be educational initiatives for rural endoscopists.

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Acknowledgements

The authors would like to thank Mr. Brenden Dufault for his contribution to the statistical analysis portion of the study and Ms. Ceceile Porter for her assistance with data collection.

Funding

The authors would like to acknowledge the financial support of the following granting agencies: The Manitoba Medical Services Foundation, The Canadian Society of Colon and Rectal Surgeons, and The Department of Surgery GFT Group Research Fund.

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Authors and Affiliations

  1. Section of General Surgery, Department of Surgery, University of Manitoba, Tache Avenue, Z3049-409, Winnipeg, MB, R2H 2A6, Canada

    Olivia Hershorn, Jason Park, Kathleen Clouston, Ashley Vergis & Ramzi M. Helewa

  2. Section of Gastroenterology, Department of Internal Medicine, University of Manitoba, Winnipeg, Canada

    Harminder Singh

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  1. Olivia Hershorn
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  2. Jason Park
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  3. Harminder Singh
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  4. Kathleen Clouston
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  5. Ashley Vergis
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  6. Ramzi M. Helewa
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Corresponding authors

Correspondence to Olivia Hershorn or Ramzi M. Helewa.

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Drs. Hershorn, Park, Singh, Clouston, Vergis, and Helewa have no conflicts of interest or financial ties to disclose.

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Hershorn, O., Park, J., Singh, H. et al. Predictors and rates of prior endoscopic tattoo localization amongst individuals undergoing elective colorectal resections for benign and malignant lesions. Surg Endosc 35, 5524–5530 (2021). https://doi.org/10.1007/s00464-020-08048-8

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  • DOI: https://doi.org/10.1007/s00464-020-08048-8

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