When and How To Use Endoscopic Tattooing in the Colon: An International Delphi Agreement.


Journal

Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association
ISSN: 1542-7714
Titre abrégé: Clin Gastroenterol Hepatol
Pays: United States
ID NLM: 101160775

Informations de publication

Date de publication:
05 2021
Historique:
received: 19 10 2020
revised: 27 12 2020
accepted: 18 01 2021
pubmed: 26 1 2021
medline: 19 8 2021
entrez: 25 1 2021
Statut: ppublish

Résumé

There is a lack of clinical studies to establish indications and methodology for tattooing, therefore technique and practice of tattooing is very variable. We aimed to establish a consensus on the indications and appropriate techniques for colonic tattoo through a modified Delphi process. The baseline questionnaire was classified into 3 areas: where tattooing should not be used (1 domain, 6 questions), where tattooing should be used (4 domains, 20 questions), and how to perform tattooing (1 domain 20 questions). A total of 29 experts participated in the 3 rounds of the Delphi process. A total of 15 statements were approved. The statements that achieved the highest agreement were as follows: tattooing should always be used after endoscopic resection of a lesion with suspicion of submucosal invasion (agreement score, 4.59; degree of consensus, 97%). For a colorectal lesion that is left in situ but considered suitable for endoscopic resection, tattooing may be used if the lesion is considered difficult to detect at a subsequent endoscopy (agreement score, 4.62; degree of consensus, 100%). A tattoo should never be injected directly into or underneath a lesion that might be removed endoscopically at a later point in time (agreement score, 4.79; degree of consensus, 97%). Details of the tattoo injection should be stated clearly in the endoscopy report (agreement score, 4.76; degree of consensus, 100%). This expert consensus has developed different statements about where tattooing should not be used, when it should be used, and how that should be done.

Sections du résumé

BACKGROUND & AIMS
There is a lack of clinical studies to establish indications and methodology for tattooing, therefore technique and practice of tattooing is very variable. We aimed to establish a consensus on the indications and appropriate techniques for colonic tattoo through a modified Delphi process.
METHODS
The baseline questionnaire was classified into 3 areas: where tattooing should not be used (1 domain, 6 questions), where tattooing should be used (4 domains, 20 questions), and how to perform tattooing (1 domain 20 questions). A total of 29 experts participated in the 3 rounds of the Delphi process.
RESULTS
A total of 15 statements were approved. The statements that achieved the highest agreement were as follows: tattooing should always be used after endoscopic resection of a lesion with suspicion of submucosal invasion (agreement score, 4.59; degree of consensus, 97%). For a colorectal lesion that is left in situ but considered suitable for endoscopic resection, tattooing may be used if the lesion is considered difficult to detect at a subsequent endoscopy (agreement score, 4.62; degree of consensus, 100%). A tattoo should never be injected directly into or underneath a lesion that might be removed endoscopically at a later point in time (agreement score, 4.79; degree of consensus, 97%). Details of the tattoo injection should be stated clearly in the endoscopy report (agreement score, 4.76; degree of consensus, 100%).
CONCLUSIONS
This expert consensus has developed different statements about where tattooing should not be used, when it should be used, and how that should be done.

Identifiants

pubmed: 33493699
pii: S1542-3565(21)00074-4
doi: 10.1016/j.cgh.2021.01.024
pii:
doi:

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

IM

Pagination

1038-1050

Informations de copyright

Copyright © 2021 AGA Institute. Published by Elsevier Inc. All rights reserved.

Auteurs

Lucía Medina-Prado (L)

Servicio de Medicina Digestiva, Hospital General Universitario de Alicante, Instituto de Investigación Biomédica Instituto de Investigación Sanitaria y Biomédica de Alicante, Alicante, Spain.

Cesare Hassan (C)

Digestive Endoscopy, Nuovo Regina Margherita Hospital, Rome, Italy.

Evelien Dekker (E)

Department of Gastroenterology and Hepatology, Amsterdam University Medical Centers, Location Academic Medical Center, Amsterdam, The Netherlands.

Raf Bisschops (R)

Department of Gastroenterology and Hepatology, University Hospitals Leuven, KU Leuven, Belgium.

Sergio Alfieri (S)

Surgery Department, Fondazione Policlinico A. Gemelli, Istituto di Ricovero e Cura a Carattere Scientifico, Università Cattolica del Sacro Cuore, Rome, Italy.

Pradeep Bhandari (P)

Department of Gastroenterology, Queen Alexandra Hospital. Portsmouth Hospital NHS Trust, Portsmouth, United Kingdom.

Michael J Bourke (MJ)

Department of Gastroenterology and Hepatology, Westmead Hospital, Sydney, Australia.

Raquel Bravo (R)

Department of Gastrointestinal Surgery, Institute of Digestive and Metabolic Diseases, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas, University of Barcelona, Centro Esther Koplowitz, Cellex Biomedical Research Center, Barcelona, Catalonia, Spain.

Marco Bustamante-Balen (M)

Gastrointestinal Endoscopy Unit, Gastrointestinal Endoscopy Research Group, Health Research Institute (Instituto de Investigación Sanitaria La Fe. NHS: National Health Service), Hospital Universitari i Politècnic La Fe, Valencia, Spain.

Jason Dominitz (J)

Gastroenterology Department, VA Puget Sound Health Care System, University of Washington, Seattle, Washington.

Monika Ferlitsch (M)

Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Wien, Austria.

Paul Fockens (P)

Department of Gastroenterology and Hepatology, Amsterdam University Medical Centers, Location Academic Medical Center, Amsterdam, The Netherlands.

Monique van Leerdam (M)

Department of Gastroenterology and Hepatology, Netherlands Cancer Institute, Amsterdam, The Netherlands.

David Lieberman (D)

Division of Gastroenterology and Hepatology, Oregon Health and Science University, Portland, Oregon.

Maite Herráiz (M)

Departamento de Digestivo, Clínica Universitaria de Navarra, Pamplona, Spain.

Charles Kahi (C)

Roudebush VA Medical Center, Indiana University School of Medicine, Indianapolis, Indiana.

Michal Kaminski (M)

Department of Gastroenterological Oncology, Maria Sklodowska-Curie Memorial Cancer Center, Institute of Oncology, Warsaw, Poland.

Takahisa Matsuda (T)

Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan.

Alan Moss (A)

Department of Endoscopic Services, Western Health, Melbourne Medical School Western Precinct, The University of Melbourne, St. Albans, Victoria, Australia.

Maria Pellisé (M)

Gastroenterology Department, Institute of Digestive and Metabolic Diseases, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas, University of Barcelona, Centro Esther Koplowitz, Cellex Biomedical Research Center, Barcelona, Catalonia Spain.

Heiko Pohl (H)

Department of Gastroenterology and Hepatology, VA Medical Center, White River Junction, Vermont; Dartmouth Geisel School of Medicine, Hanover, New Hampshire.

Colin Rees (C)

Department of Gastroenterology, South Tyneside NHS Foundation Trust, South Shields, United Kingdom.

Douglas K Rex (DK)

Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, Indiana.

Manuel Romero-Simó (M)

Unidad de Coloproctología, Servicio de Cirugía General, Hospital General Universitario de Alicante, Instituto de Investigación Biomédica Instituto de Investigación Sanitaria y Biomédica de Alicante, Alicante, Spain.

Matthew D Rutter (MD)

University Hospital of North Tees, Stockton on Tees, United Kingdom; Northern Institute for Cancer Research, Newcastle University, Newcastle-upon-Tyne, United Kingdom.

Prateek Sharma (P)

Department of Gastroenterology and Hepatology, VA Medical Center, University of Kansas School of Medicine, Kansas City, Kansas.

Aasma Shaukat (A)

Section of Gastroenterology, Department of Medicine, Minneapolis VA Medical Center, University of Minnesota, Minneapolis, Minnesota.

Siwan Thomas-Gibson (S)

Wolfson Unit for Endoscopy, St. Mark's Hospital, Harrow, and Imperial College, London, United Kingdom.

Roland Valori (R)

Gloucestershire Hospitals National Health Service Foundation Trust, Gloucestershire, United Kingdom.

Rodrigo Jover (R)

Servicio de Medicina Digestiva, Hospital General Universitario de Alicante, Instituto de Investigación Biomédica Instituto de Investigación Sanitaria y Biomédica de Alicante, Alicante, Spain. Electronic address: rodrigojover@gmail.com.

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