Tattoos Claimed Unnecessary for Finding EMR Scars

Tattoos Claimed Unnecessary for Finding EMR Scars

Douglas K. Rex, MD, MASGE, reviewing Shahidi N, et al. Endoscopy 2021 Mar 30.

Referring physicians sometimes tattoo large nonpedunculated lesions before referral, and resectionists sometimes tattoo the resection site for easy identification of the scar later.

Neither practice is based on controlled evidence, and tattooing has certain potential downsides. In a study from an Australian consortium, 1023 large nonpedunculated polyps underwent successful EMR and first surveillance colonoscopy. Of these, 12.1% had a tattoo. The scar was identified in 100% of the tattooed cases and 99.7% of the non-tattooed cases; the only 3 failures were attributed to bowel preparation. Prior to the surveillance colonoscopy, photographs of the initial EMR were reviewed to study the scar and its relationship to adjacent haustral folds and other colonic features.

Douglas K. Rex, MD, FASGE


This study suggests that tattooing large nonpedunculated colorectal lesions either before or after EMR is unnecessary. However, it should be recognized that the authors are all extreme experts in EMR. Certainly, it is valuable to study the photographs from EMR procedures. In my experience, scars are most easily seen initially with the colon fully gas-distended and may disappear when the lumen is collapsed, including in underwater views.

Note to readers: At the time we reviewed this paper, its publisher noted that it was not in final form and that subsequent changes might be made.


Shahidi N, Gupta S, Whitfield A, et al. Simple optical evaluation criteria reliably identify the post-endoscopic mucosal resection scar for benign large non-pedunculated colorectal polyps without tattoo placement. Endoscopy 2021 Mar 30. (Epub ahead of print) (

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