From the Guidelines
Three complications of injecting tattoo ink for lesion localization in colon are submucosal fibrosis, difficulty in subsequent endoscopic procedures, and potential interference with histopathological examination. These complications can arise due to the injection of tattoo ink, which can cause an inflammatory response, leading to submucosal fibrosis, as noted in a study published in Gut 1. Some key points to consider when injecting tattoo ink for lesion localization in colon include:
- Submucosal fibrosis can occur as a result of tattoo ink injection, which can compromise subsequent endoscopic resection, as reported in a case series 1.
- Difficulty in subsequent endoscopic procedures may arise when excessive or imprecisely placed tattoo ink obscures the mucosal surface, making it challenging to identify subtle lesions or anatomical landmarks during follow-up colonoscopies.
- Potential interference with histopathological examination can occur due to pigment deposition in tissue samples, potentially obscuring cellular details and complicating the pathologist's ability to accurately assess margins or detect microscopic disease, as suggested by the US Multi-Society Task Force on Colorectal Cancer 1. It is essential to follow guidelines and recommendations for tattoo ink injection, such as placing the tattoo at least 3 cm away from the lesion, to minimize the risk of complications, as recommended by the US Multi-Society Task Force on Colorectal Cancer 1.
From the Research
Complications of Injecting Tattoo Ink for Lesion Localization in Colon
- Complications associated with tattooing in colon include:
- Tissue injury, such as necrosis, edema, and neutrophilic infiltration in the submucosa and muscularis propria 2
- Inflammation of vessels, but without fibrinoid necrosis 2
- Ischemic ulceration, necrosis, and eosinophilic infiltration in the submucosa, as well as fibrinoid necrosis of vessel walls when using methylene blue as a tattoo agent 2
- The overall complication rate of colon tattooing has been reported to be around 7 percent 3 and 0.6% 4 in different studies
- It is essential to minimize the amount of ink injected and ensure that the injection site is completely resected at surgery to avoid potential complications 2