GI Endoscopy · 1 min read
Master the Art of Endoscopy Tattoos
Uncover the Pro Technique for Precise Creation of a Tattoo for Subsequent Lesion Identification
Experienced teaching points
Clinical Pearls
- When tattooing a lesion, always choose an injection site about 3 cm proximal to the tumor; NEVER inject directly underneath a polyp, as the ink will induce a dense fibrotic reaction that impedes proper subsequent resection.
- To ensure a localized, visible submucosal tattoo and prevent deep injection, always prime the injection needle with normal saline and create a saline submucosal cushion first before slowly pushing the India ink.
- Maintain an oblique, almost tangential needle angle during injection rather than a perpendicular ('squared off') approach to avoid piercing the muscularis propria and causing intraperitoneal ink spillage, which can mimic endometriosis or infection during laparoscopy.
�🌟 Welcome to the Practicing Endoscopist Newsletter!
In this edition, we're sharing valuable insights from our latest Five-Minute Friday’s series, where we reveal the secret to perfecting the India ink tattooing technique in endoscopy.
Learn how to create flawless India ink tattoos for accurate lesion identification and improved patient outcomes.
💡 5 Key Tips for the Perfect India Ink Tattoo
1. Choose the right needle and prime it with normal saline. The normal saline will fill-in the dead space within the needle channel and is the essential part of this technique.
2. Advance needle through the scope and choose a spot for injection, usually 3 cm proximal to the tumor. NEVER inject below a polyp as ink will create a fibrotic reaction and impede proper removal of the polyp.
The next figure shows an ideal injection to mark the location of a small bowel gastrointestinal tumor.
3. Placement of needle in relation to mucosa. Opt for an oblique, if possible, almost tangential position rather than a squared angle position one for more accurate submucosal tattooing. Injecting into the peritoneum will result in spillage, irritation and creation of reactive granulomas and nodules, which may mimic infection, tumor or endometriosis.
4. Create a submucosal cushion with the saline inside of the needle. The India ink syringe is connected to the needle and injected slowly. This pushes the saline out of the needle, to form a cushion before the ink arrives, to prevent intraperitoneal injection and ensure a localized tattoo.
5. Use the right amount of ink. Typically, half to one milliliters of India ink is sufficient to create a clear and lasting tattoo.
Additional reading:
Topics
For your teaching file
Save this article as a PDF
Drop your email and we'll open a print-ready version you can save as a PDF — and you'll start getting our weekly GI endoscopy newsletter.