Introduction The Joint Advisory Group on gastrointestinal endoscopy and the National Bowel Cancer Screening Programme (BCSP) have published guidelines on the tattooing of malignant and suspicious lesions at colonoscopy. Our endoscopy department has a local protocol for the tattooing of these lesions based on these guidelines. The BCSP has led to an increase in the number of colonoscopies performed and the number of lesions identified.
Aim To assess adherence to a local protocol in a single endoscopy unit and identify if lesions identified through the BCSP are more likely to be tattooed than lesions identified for other reasons.
Methods A retrospective review of a prospectively maintained database was performed. All colonoscopies performed between 1 April 2010 and 31 March 2011 were reviewed and screening cases identified.
Results 4023 colonoscopies were performed, 307 (8%) as part of the BCSP. Malignancy or polyps were identified in 192 (63%) of BSCP colonoscopies compared to 26% (958/3716) of non-BCSP colonoscopies. Significantly more polyps and malignancies were identified during BCSP colonoscopies than non-BCSP colonoscopies (p<0.0001 χ2 test). Our local protocol states that any malignant/suspicious/>1 cm lesion distal to the right colon should be marked by placing three tattoos just distal to the lesion. 94 (49%) lesions were identified during BCSP colonoscopies that met these criteria. Of these 54 (57%) were tattooed, and 20 (21 %) were tattooed by the method advised. This compared to 262 non-BCSP lesions identified that should have been tattooed of which 77 (29%) were tattooed and 20 (8%) were tattooed by the method advised. Tattooing rate was significantly higher in BCSP detected lesions (54/94 compared with 77/262, p≤0.0001, χ2 test).
Conclusion Tattooing practice in our endoscopy unit is poor despite the presence of a local protocol. However, tattooing practice is significantly better in lesions identified through the BCSP. Reasons for this may include the higher yield of lesions in screening colonoscopies or lack of awareness of the protocol. We aim to improve adherence by increasing awareness among all endoscopy staff to ensure optimum management of malignant and suspicious lesions.
Competing interests None declared.
References 1. Chilton A, Rutter M, et al. Quality assurance guidelines for colonoscopy. NHS BCSP Publication 6. 2010.
2. BSG Quality and Safety indicators for Endoscopy, Joint Advisory Group on GI Endoscopy. 2007. http://www.thejag.org.uk/downloads%5CUnit%20Resources%5CBSG%20Quality%20and%20Safety%20Indicators.pdf
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