Should all endoscopically excised rectal polyps be tattooed? A plea for localization

Abstract

Most malignant rectal polyps are neither diagnosed nor tattooed at initial colonoscopy. Moreover, the distance of the polyp from the anal verge is rarely measured, and gross characteristics are not well described. Tattooing of all endoscopically excised rectal polypectomy sites would avoid confounding of subsequent identification and management.

Endoscopic tattoo: the importance and need for standardised guidelines and protocol

“…However, a retrospective review done by Keller et al. 23 demonstrated potential benefit to tattooing rectal tumours. About 5–8% of presumed benign polyps removed at colonoscopy showed invasive carcinoma.…”

“…Tattoos helped accurately localise sites that may have been difficult to identify via endoscopy or rectal exam; tattoo also helped plan distal resection margins for polyps that had high-grade dysplasia. 23 Given there is significant negative implications in failing to localise a rectal polyp such as inappropriate use of neoadjuvant therapy, removal of excessive lengths or wrong segment of bowel, or creation of unnecessary or permanent ostomies, being able to localise resected polyps is pertinent. That being said, this is the only published source supporting rectal polyp tattooing.…”

“…About 5-8% of presumed benign polyps removed at colonoscopy showed invasive carcinoma. 23 By not tattooing, there is no other method of identifying the location of the removed polyp. 23 It was also found that endoscopists had difficulty predicting malignant potential of polyps.…”

Discrepancy between gastroenterologists’ and general surgeons’ perspectives on repeat endoscopy in colorectal cancer

“…11,14 Nevertheless, the rate of tattooing remains quite low -between 0% and 23%. 15,16 Furthermore, while tattoo localization is often recommended for colonic lesions suspicious for malignancy, 17 the use of tattooing in different clinical scen arios remains unclear.…”

“…Most of the respondents in our study said they would tattoo right-sided (85.5%) and left-sided malignancies (89.9%), whereas only 20.3% said they would tattoo rectal lesions. Keller and colleagues 15 demonstrated an even lower rectal tattoo rate of 4.1% in 49 patients with rectal polyps that were later diagnosed as neoplastic. This discrepancy in tattooing of rectal lesions may best be explained by the clinical scenarios addressed: whereas Keller and colleagues assessed only tattooing of polyps, our study assessed the likelihood of tattooing rectal lesions suspicious for malignancy.…”