Should all endoscopically excised rectal polyps be tattooed? A plea for localization.

Area of Science:

• Gastroenterology
• Surgical Oncology
• Colorectal Surgery

Background:

• A significant percentage (5-8%) of rectal polyps removed endoscopically and presumed benign harbor invasive carcinoma.
• Tattooing the polypectomy site is recommended for accurate follow-up localization.
• Current practice often omits tattooing, complicating management when malignancy is later discovered.

Purpose of the Study:

• To assess the frequency of tattooing after endoscopic rectal polyp excision.
• To characterize polyp features and evaluate the accuracy of predicting malignancy pre-operatively.
• To determine the impact of tattooing on the management of rectal neoplasia.

Main Methods:

• Retrospective review of patients undergoing endoscopic polypectomy for rectal neoplasia from 2003-2010.
• Data extraction included polyp characteristics, pathology, resection margins, location, and tattooing status.
• Analysis of subsequent management strategies for incomplete resections.

Main Results:

• Of 49 patients with neoplasia, only two polyps were tattooed at initial removal.
• Three polyps were suspicious for malignancy, none were tattooed; one was adenocarcinoma.
• Polyp distance from the anal verge was rarely recorded; hot snare polypectomy was the predominant technique.

Conclusions:

• Malignant rectal polyps are frequently not diagnosed or tattooed during initial colonoscopy.
• Inconsistent measurement of polyp location and poor description of gross characteristics are common.
• Routine tattooing of all endoscopically excised rectal polypectomy sites is recommended to prevent management confusion.