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

Lucía Medina-Prado, Cesare Hassan, Evelien Dekker, Raf Bisschops, Sergio Alfieri, Pradeep Bhandari, Michael J. Bourke, Raquel Bravo, Marco Bustamante-Balen, Jason Dominitz, Monika Ferlitsch, Paul Fockens, Monique van Leerdam, David Lieberman, Maite Herráiz, Charles Kahi, Michal Kaminski, Takahisa Matsuda, Alan Moss, Maria PelliséHeiko Pohl, Colin Rees, Douglas K. Rex, Manuel Romero-Simó, Matthew D. Rutter, Prateek Sharma, Aasma Shaukat, Siwan Thomas-Gibson, Roland Valori, Rodrigo Jover

Research output: Contribution to journalArticlepeer-review

7 Scopus citations


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.

Original languageEnglish (US)
Pages (from-to)1038-1050
Number of pages13
JournalClinical Gastroenterology and Hepatology
Issue number5
StatePublished - May 2021

ASJC Scopus subject areas

  • Hepatology
  • Gastroenterology


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