Endoscopy 2018; 50(09): E231-E232
DOI: 10.1055/a-0624-1362
E-Videos
© Georg Thieme Verlag KG Stuttgart · New York

Underwater endoscopic mucosal resection of a laterally spreading tumor overlying a previous endoscopic carbon tattoo

Jaime P. Rodrigues
Gastroenterology Department, Centro Hospitalar Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
,
Rolando Pinho
Gastroenterology Department, Centro Hospitalar Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
,
Mafalda Sousa
Gastroenterology Department, Centro Hospitalar Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
,
João Carlos Silva
Gastroenterology Department, Centro Hospitalar Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
,
Catarina Gomes
Gastroenterology Department, Centro Hospitalar Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
,
João Carvalho
Gastroenterology Department, Centro Hospitalar Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
› Author Affiliations
Further Information

Corresponding author

Jaime Pereira Rodrigues, MD
Gastroenterology Department
Centro Hospitalar Vila Nova de Gaia/Espinho
Rua Conceição Fernandes
4434-502, Vila Nova de Gaia
Portugal   
Fax: +351-227-865100   

Publication History

Publication Date:
19 June 2018 (eFirst)

 

A 53-year-old man with no relevant past medical history was referred to our department for resection of a laterally spreading tumor (LST) on the descending colon, which had been tattooed previously.

The procedure was performed with a transparent cap attached to the tip of the colonoscope (Q185; Olympus Medical Systems, Tokyo, Japan), with the patient under deep propofol sedation. A 40-mm nongranular, homogeneous LST was identified, overlying a previously placed carbon tattoo ([Fig. 1]), with resulting severe fibrosis that precluded elevation for conventional endoscopic mucosal resection (EMR). Therefore, underwater piecemeal EMR was performed, after marking the lesion limits with snare tip coagulation ([Video 1]). Complete resection was achieved without complications. The procedure exposed involvement of almost all of the submucosa by the ink ([Fig. 2]). The patient was discharged on the same day.

Zoom Image
Fig. 1 On the descending colon, a 40-mm nongranular, homogeneous, laterally spreading tumor (LST) was identified, overlying a previously placed carbon tattoo. a White-light imaging. b Narrow-band imaging.

Video 1 Underwater piecemeal endoscopic mucosal resection of a laterally spreading tumor overlying a previous endoscopic carbon tattoo with associated severe fibrosis.

Georg Thieme Verlag. Please enable Java Script to watch the video.
Zoom Image
Fig. 2 Endoscopic image showing the involvement of almost all of the submucosa beneath the scar by the carbon ink.

Histopathological analysis revealed a tubular adenoma with low grade dysplasia, and with carbon pigment in the margins of most fragments. On surveillance colonoscopy 3 months later, the scar had no endoscopic or histological recurrence ([Fig. 3]).

Zoom Image
Fig. 3 Surveillance colonoscopy 3 months later showed the scar with no signs of recurrence. a White-light imaging. b Narrow-band imaging.

Endoscopic tattooing is a widely used technique to facilitate the identification of colorectal lesions for subsequent endoscopic or surgical treatments [1] [2]. However, tattooing has been associated with clinically significant complications, including peritonitis [1] [2]. Additionally, tattooing under a lesion can result in technical difficulties because of associated submucosal fibrosis, which makes endoscopic resection procedures hazardous and has contributed to perforation [1] [2] [3]. In fact, carbon particles can spread across a significant distance within the submucosal plane; it is therefore recommended that tattoos are placed 2 – 3 cm anatomically distal to the lesion [1] [2]. Underwater EMR has been shown to be a useful technique for lesions that are difficult to resect, including those associated with fibrosis [4] [5]. In the present report, we present the first case of a successful underwater EMR of a lesion associated with fibrosis secondary to tattoo.

Endoscopy_UCTN_Code_CPL_1AJ_2AD

Endoscopy E-Videos is a free access online section, reporting on interesting cases and new techniques in gastroenterological endoscopy. All papers include a high quality video and all contributions are freely accessible online.
This section has its own submission website at https://mc.manuscriptcentral.com/e-videos


#

Competing interests

None


Corresponding author

Jaime Pereira Rodrigues, MD
Gastroenterology Department
Centro Hospitalar Vila Nova de Gaia/Espinho
Rua Conceição Fernandes
4434-502, Vila Nova de Gaia
Portugal   
Fax: +351-227-865100   


Zoom Image
Fig. 1 On the descending colon, a 40-mm nongranular, homogeneous, laterally spreading tumor (LST) was identified, overlying a previously placed carbon tattoo. a White-light imaging. b Narrow-band imaging.
Zoom Image
Fig. 2 Endoscopic image showing the involvement of almost all of the submucosa beneath the scar by the carbon ink.
Zoom Image
Fig. 3 Surveillance colonoscopy 3 months later showed the scar with no signs of recurrence. a White-light imaging. b Narrow-band imaging.