Introduction Quality Assurance Guidelines for colonoscopy in the Bowel Cancer Screening Programme recommend tattooing of all lesions that may require later surgical or endoscopic localisation, using local protocols as guidance.¹ The St. Mark's Hospital colonoscopic tattooing protocol stated that all suspicious lesions should be tattooed, with the exception of those in the caecum and within 20 cm of the anal verge. Three tattoos should be placed (120° apart, close to the lesion) and distal to lesions proximal to the splenic flexure (SpFlx). Left sided lesions should have tattoos placed proximal to the lesion. Our aim was to audit compliance with the tattooing protocol in patients undergoing surgery for colorectal neoplasia.

Methods We reviewed endoscopy reports of all patients who had surgery for colorectal neoplasia during a 12-month period. The report was deemed fully compliant if the following were clearly documented: location of the tattoos, correct location of the tattoos, the number of tattoos placed and a correct number of tattoos placed, hence, scoring 4/4. Non-compliance was defined if none of the parameters was mentioned and partial compliance was awarded to those scoring between one and three points.

Results 155 patients were identified, of which 114 had reports available. The overall compliance with the protocol was observed in 71 cases (62%) whereas 19 cases (17%) were partially compliant and 24 cases (21%) were non-compliant. Rates for full, partial and incomplete compliance were better for patients diagnosed though the BCSP (71% 26% and 3% respectively) when compared to those diagnosed through non-screening (58%, 13% and 29% respectively). Incomplete documentation (22 cases) and inability to place tattoos proximal to obstructing lesions (19 cases) were the major causes of reduced compliance.

Conclusion Educational intervention is necessary to address poor documentation. However, changes to our protocol are also required. We have therefore revised our protocol recommending that all tattoos should be placed distal to the lesion regardless of the anatomical position.

Competing interests None declared.

Reference 1. Quality Assurance Guidelines for colonoscopy. NHS BCSP Publication No 6 February 2011. http://www.cancerscreening.nhs.uk/bowel/publications/nhsbcsp06.pdf