Abstract Aims Endoscopic tattooing in suspected bowel cancer is encouraged in all lesions >2cm by the national bowel cancer screening guidelines. However, a known risk of the procedure is tumour cell seeding leading to upstaging of cancers. Our aim is to investigate the relationship between endoscopic tattoos and recurrence rates. Additionally, we aim to investigate if overall survival (OS) is affected by endoscopic tattoos. Methods Data was collected retrospectively using electronic medical records (EMR) on all patients with colorectal cancer who had a resection between January 2017 and May 2021 (n=614) in our local trust. Data was also collected on patient demographics, site of tumour, type of resection, whether an endoscopic tattoo was applied or not, length of follow-up, recurrences, outcomes of recurrences and all-cause mortality. Results 3 patients were excluded due to lack of information on EMR. In our cohort, the male:female ratio was 1.41:1. Patients ranged from 22-92 years old. 33.7% (n=206) of patients had an endoscopic tattoo and 66.3% (n=405) did not. At the time of data collection, 24.5% (n=150) of patients had a recurrence. Of these, 28.7%(n=43) had tattoos and 71.3% (n=107) did not. Conclusions Statistical analysis showed that OS remained similar in both groups (tattoo versus non-tattoo). However, we found that patients who had an endoscopic tattoo were less likely to have a recurrence (longer disease-free survival) than those who did not. Although this was not statistically significant, we can conclude from our study that endoscopic tattoos do not appear to upstage colorectal cancers.