Ī more recent report attested to India ink's safety in colonic tattooing. Tattooing has also been used to mark areas of a surgical resection on mucosal and cutaneous surfaces prior to ENT surgery. Tattooing has been used in the stomach to mark the site of malignant polyps, to demarcate antrum from body prior to highly selective vagotomy, and to mark areas of acute gastrointestinal hemorrhage preoperatively. Colonic tattooing has been used for preoperative tattooing of polypectomy sites, tattooing of postpolypectomy sites for future follow-up, endoscopic marking of specific colonic lesions, and in longitudinal endoscopic studies of specific colonic lesions (i.e. India ink has been successfully used to tattoo colonic and gastric mucosa. The product, India ink, has been used by multiple cultures for generations for use in writing, as well as with the addition of other pigments, for cutaneous tattooing. Lamp black is the amorphous carbon product formed when petroleum products such as oil, gas, or fuels are burned incompletely in an oxygen deprived environment. India ink is produced by the grinding of lamp black with glues, gums and other stabilizers. Thus, measurements obtained using the endoscope or barium studies cannot be used as a reliable guide for regression or progression of lesions especially if the studies include patients with reducible hiatal hernias and in those studies in which regression or change in a lesion site is being reported. found an average of 2.7 cm of migration of the upper border of the squamocolumnar junction up to seven weeks after the Nissen fundoplication was performed. The authors concluded that endoscopically measured differences in LES position and the most proximal level of Barrett's mucosa are significant enough to cause confusion in the diagnosis of BE.įurther evidence of the inadequacy of endoscope measurements was illustrated in an abstract regarding the Barrett's mucosal margin after Nissen fundoplication. In addition, 12 of 88 patients with BE had a greater than 4 cm change in the endoscopic measurement of the most proximal level of Barrett's mucosa. Ten of 111 patients had a change in the endoscopic LES location greater than 4 cms at 6 week follow-up endoscopy.
The inaccuracy of using the endoscope markings was recently confirmed in a study of sequential endoscopic measurements of the lower esophageal sphincter (LES) and the most proximal level of Barrett's esophagus (BE) mucosa. In addition, the precise location of esophageal lesions using the endoscope as a measuring tool can vary due to elongation of the esophagus during the forward advancement of the endoscope or as the esophagus foreshortens and telescopes over the endoscope. The use of different endoscopes and mouthpieces, as well as variable interpretation by different endoscopists, makes precise location and sizing of lesions in relation to their distance from the incisors, imprecise at best.
Measurement of esophageal lesions is typically performed by using the centimeter markings on the endoscope, with measurements taken from the incisors. Is India ink a more effective method for the follow-up of Barrett's mucosa?
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