S0551 Variability in Endoscopic Tattoo Practices Among Colorectal Surgeons and Gastroenterologists: A Nationwide Survey

Abstract

INTRODUCTION: Effective tattooing is pivotal in localizing suspected malignant colorectal lesions for subsequent resection which has shown to reduce operating room time with significant cost savings. Despite its utility and widespread use, there are no established guidelines regarding optimal location or technique of tattooing. This has created wide variability in provider practices in the gastroenterology (GI) and colorectal surgery (CRS) communities. Thus, we sought to elucidate current practices among these providers. METHODS: A national online survey was e-mailed to directors of adult GI and CRS programs in the US, with additional distribution to their fellows and colleagues. RESULTS: Majority of providers, 93 of 108 (86.1%), practice tattooing to mark suspected colorectal cancer lesions for removal- GI (68 of 78, 87.2%) and CRS (25 of 30, 83.3%). Most GI providers tattoo proximal and distal to the lesion (57.7%) compared to most CRS who tattoo 2-3cm distal to the lesion (76.7%), this was statistically significant( P < 0.001, OR = 9.52, CI = 3.6–25.5). This remained unchanged when correcting for variables such as practice setting, age, gender and training. For tattoo injection technique, providers in both specialties inject while withdrawing the needle (80.8% of GI and 73.3% of CRS, P = 0.227), rather than while advancing it; usually 2 to 3 marks are placed at the tattoo site (72.2% of providers). Most providers do not tattoo cecal lesions—76.9% of GI and 73.3% of CRS—but tattoo practices for lesions in the rectum are more inconsistent with only 39.7% of GI tattooing these compared to 73.3% of CRS. CONCLUSION: Although there is paucity of data in tattooing techniques, published literature reports appropriate location for tattooing of suspected lesions to be 2-3cm distal to the lesion and technique to be injection of dye upon advancement of needle into the submucosal space. A minority of GI (25.6%) but a majority of CRS (76.7%) tattooed in the correct location, which was statistically significant. Both specialties had few providers using correct technique: 16.7% of GI and 6.7% of CRS. Our survey confirms the great variability in practices between GI and CRS, as well as within these respective groups. Tattooing practices are oftentimes institution dependent given the lack of national guidelines. There is a dire need for nationwide standardization of practices for improvement in efficacy and cost of patient care, especially for those receiving interfacility care.Table 1