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Ayoub F, Kim GE, Wang W, Chen D, Siddiqui UD. Delays in definitive endoscopic resection of previously manipulated colorectal polyps as a risk factor for inferior resection outcomes. Gastrointest Endosc 2024:S0016-5107(24)00019-1. [PMID: 38215857 DOI: 10.1016/j.gie.2024.01.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Revised: 12/03/2023] [Accepted: 01/09/2024] [Indexed: 01/14/2024]
Abstract
BACKGROUND AND AIMS Manipulation of colorectal polyps by biopsy, incomplete resection, or tattoo placement under the lesion has been shown to cause submucosal fibrosis and associated inferior outcomes. The effect of delays between index manipulation and definitive resection on the incidence of fibrosis is unknown. METHODS Patients undergoing endoscopic mucosal resection (EMR) of previously manipulated colorectal polyps ≥10 mm from 2016 to 2021 at a tertiary referral center were included. Time from index manipulation to definitive resection and the presence of fibrosis were noted. The effects of fibrosis on EMR outcomes were assessed. RESULTS Among 221 previously manipulated lesions (180 biopsy, 23 incomplete/failed resection, 1 tattoo under lesion, 17 multiple types of manipulation), 51 (23%) demonstrated fibrosis. Fibrotic lesions were found to have been resected significantly later than nonfibrotic lesions (76 vs 61 days; P = .014). In a multivariate analysis controlling for other predictors of fibrosis, each 2-week delay was associated with a 14% increase in the odds of fibrosis. Fibrotic lesions had inferior outcomes with a lower en-bloc resection rate (8% vs 24%; P = .014) and longer procedure time (71 vs 52 minutes; P < .001). Adverse event and recurrence rates were similar between groups. CONCLUSIONS Delays in definitive resection of previously manipulated polyps are associated with an increased incidence of fibrosis with time and associated inferior outcomes. Manipulation should be discouraged, and if it occurs, prompt referral and scheduling for definitive resection should be prioritized.
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Affiliation(s)
- Fares Ayoub
- Section of Gastroenterology and Hepatology, Baylor College of Medicine, Houston, Texas
| | - Grace E Kim
- Section of Gastroenterology, Hepatology, and Nutrition, University of Chicago, Chicago, Illinois
| | - Wenfei Wang
- Section of Gastroenterology, Hepatology, and Nutrition, University of Chicago, Chicago, Illinois; MNGI Digestive Health, Minneapolis, Minnesota
| | - Dennis Chen
- Center for Endoscopic Research and Therapeutics, University of Chicago Medicine, Chicago, Illinois, USA
| | - Uzma D Siddiqui
- Center for Endoscopic Research and Therapeutics, University of Chicago Medicine, Chicago, Illinois, USA
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Komatsu Y, Yoshitomi T, Furuya K, Ikeda T, Terasaki A, Hoshi A, Kawazoe N, Chen G, Matsui H. Long-Term Fluorescent Tissue Marking Using Tissue-Adhesive Porphyrin with Polycations Consisting of Quaternary Ammonium Salt Groups. Int J Mol Sci 2022; 23:4218. [PMID: 35457034 DOI: 10.3390/ijms23084218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 04/05/2022] [Accepted: 04/07/2022] [Indexed: 11/17/2022] Open
Abstract
Localization of tumors during laparoscopic surgery is generally performed by locally injecting India ink into the submucosal layer of the gastrointestinal tract using endoscopy. However, the location of the tumor is obscured because of the black-stained surgical field and the blurring caused by India ink. To solve this problem, in this study, we developed a tissue-adhesive porphyrin with polycations consisting of quaternary ammonium salt groups. To evaluate the ability of tissue-adhesive porphyrin in vivo, low-molecular-weight hematoporphyrin and tissue-adhesive porphyrin were injected into the anterior wall of the exposed stomach in rats. Local injection of low-molecular-weight hematoporphyrin into the anterior wall of the stomach was not visible even after 1 day because of its rapid diffusion. In contrast, the red fluorescence of the tissue-adhesive porphyrin was visible even after 7 days due to the electrostatic interactions between the positively-charged moieties of the polycation in the tissue-adhesive porphyrin and the negatively-charged molecules in the tissue. In addition, intraperitoneal injection of tissue-adhesive porphyrin in rats did not cause adverse effects such as weight loss, hepatic or renal dysfunction, or organ adhesion in the abdominal cavity. These results indicate that tissue-adhesive porphyrin is a promising fluorescent tissue-marking agent.
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Calborean A, Macavei S, Mocan M, Ciuce C, Bintintan A, Cordos A, Pestean C, Chira R, Zarbo L, Barbu-Tudoran L, Dindelegan G, Nickel F, Mocan B, Surlin V, Bintintan V. Non-invasive laparoscopic detection of small tumors of the digestive tract using inductive sensors of proximity. Sci Rep 2022; 12:760. [PMID: 35031673 PMCID: PMC8760327 DOI: 10.1038/s41598-022-04822-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Accepted: 12/17/2021] [Indexed: 11/18/2022] Open
Abstract
The precise location of gastric and colorectal tumors is of paramount importance for the oncological surgeon as it dictates the limits of resection and the extent of lymphadenectomy. However, this task proves sometimes to be very challenging, especially in the laparoscopic setting when the tumors are small, have a soft texture, and do not invade the serosa. In this view, our research team has developed a new instrument adapted to minimally-invasive surgery, and manipulated solely by the operating surgeon which has the potential to locate precisely tumors of the digestive tract. It consists of an inductive proximity sensor and an electronic block encapsulated into an autoclavable stainless-steel cage that works in tandem with an endoscopic hemostatic clip whose structure was modified to increase detectability. By scanning the serosal side of the colon or stomach, the instrument is capable to accurately pinpoint the location of the clip placed previously during diagnostic endoscopy on the normal bowel mucosa, adjacent to the tumor. In the current in-vivo experiments performed on large animals, the modified clips were transported without difficulties to the point of interest and attached to the mucosa of the bowel. Using a laparoscopic approach, the detection rate of this system reached 65% when the sensor scanned the bowel at a speed of 0.3 cm/s, and applying slight pressure on the serosa. This value increased to 95% when the sensor was guided directly on the point of clip attachment. The detection rate dropped sharply when the scanning speed exceeded 1 cm/s and when the sensor-clip distance exceeded the cut-off value of 3 mm. In conclusion, the proposed detection system demonstrated its potential to offer a swift and convenient solution for the digestive laparoscopic surgeons, however its detection range still needs to be improved to render it useful for the clinical setting.
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Affiliation(s)
- Adrian Calborean
- National Institute for Research and Development of Isotopic and Molecular Technologies, Donath Street, No 67-103, Cluj-Napoca, Romania.
| | - Sergiu Macavei
- National Institute for Research and Development of Isotopic and Molecular Technologies, Donath Street, No 67-103, Cluj-Napoca, Romania
| | - Mihaela Mocan
- Iuliu Hatieganu University of Medicine and Pharmacy Cluj-Napoca, V. Babeş Street No. 8, 400012, Cluj-Napoca, Romania
| | - Catalin Ciuce
- Iuliu Hatieganu University of Medicine and Pharmacy Cluj-Napoca, V. Babeş Street No. 8, 400012, Cluj-Napoca, Romania
| | - Adriana Bintintan
- Iuliu Hatieganu University of Medicine and Pharmacy Cluj-Napoca, V. Babeş Street No. 8, 400012, Cluj-Napoca, Romania
| | - Adrian Cordos
- Iuliu Hatieganu University of Medicine and Pharmacy Cluj-Napoca, V. Babeş Street No. 8, 400012, Cluj-Napoca, Romania
| | - Cosmin Pestean
- University of Agricultural Sciences and Veterinary Medicine of Cluj-Napoca, Calea Manastur Street No. 3-5, Cluj-Napoca, Romania
| | - Romeo Chira
- Iuliu Hatieganu University of Medicine and Pharmacy Cluj-Napoca, V. Babeş Street No. 8, 400012, Cluj-Napoca, Romania
| | - Liviu Zarbo
- National Institute for Research and Development of Isotopic and Molecular Technologies, Donath Street, No 67-103, Cluj-Napoca, Romania
| | - Lucian Barbu-Tudoran
- National Institute for Research and Development of Isotopic and Molecular Technologies, Donath Street, No 67-103, Cluj-Napoca, Romania
| | - George Dindelegan
- Iuliu Hatieganu University of Medicine and Pharmacy Cluj-Napoca, V. Babeş Street No. 8, 400012, Cluj-Napoca, Romania
| | - Felix Nickel
- Clinic for General, Visceral and Transplantation Surgery, University of Heidelberg, INF 110, Heidelberg, Germany
| | - Bogdan Mocan
- Technical University Cluj-Napoca, Memorandumului, Street No.28, Cluj-Napoca, Romania
| | - Valeriu Surlin
- University of Medicine and Pharmacy Craiova, Petru Rares Street No. 2, 700115, Craiova, Romania
| | - Vasile Bintintan
- Iuliu Hatieganu University of Medicine and Pharmacy Cluj-Napoca, V. Babeş Street No. 8, 400012, Cluj-Napoca, Romania
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Albayati A, Ozkan B, Atilgan AO, Sencelikel T, Uysal CA, Ertas NM. Does methylene blue increases capsular contracture in immediate breast reconstruction with silicone implant? An experimental study. J Plast Surg Hand Surg 2021; 55:56-65. [PMID: 33030384 DOI: 10.1080/2000656x.2020.1828901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 08/25/2020] [Accepted: 09/22/2020] [Indexed: 10/23/2022]
Abstract
Recently, most of the immediate breast reconstructions following mastectomy are being carried out with the use of silicone implants. In these patients, methylene blue is being used for the detection of sentinel lymph nodes. This experimental study was performed to determine the effect of methylene blue on capsular contracture around breast implants. Thirty-two Sprague Dawley rats were divided into 4 groups. Custom made silicone blocks were placed on the back of animals. In group 1, the incision was closed without performing any additional procedure. In group 2 (control), 0.1 mL of 0.9% normal saline was instilled into the pocket. Group 3 and 4 (study groups) received 0.1 and 0.2 mL of 1% methylene blue, respectively. On postoperative day 60, implants and capsular tissue were extracted. Capsule formation was evaluated both macroscopically and microscopically. The histological evaluation included capsule thickness, inflammation, neovascularization, and fibrosis gradients. Regarding capsule thickness, there were statistically significant differences between groups 1-3, 1-4, 2-3, and 2-4. Although there were more moderate and severe inflammation gradients in groups III and IV, there was no significant difference regarding inflammation severity between control and study groups. In respect of vascular proliferation, there was a statistically significant difference between control and study groups. Similarly, fibrosis gradients were higher in both groups 3 and 4. The study showed that the injection of methylene blue around silicone implants enhanced the formation of capsular contracture. In this case, the degree of contracture was independent of the dose given. Abbreviations: CC: capsular contracture; MM: methylene blue; SLNB: sentinel lymph node biopsy; NS: normal saline; H&E: hematoxylin and eosin; D: dorsal; V: ventral; L: lateral; n: frequency.
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Affiliation(s)
- Abbas Albayati
- Department of Plastic Reconstructive and Aesthetic Surgery, Faculty of Medicine, Baskent University, Ankara, Turkey
| | - Burak Ozkan
- Department of Plastic Reconstructive and Aesthetic Surgery, Faculty of Medicine, Baskent University, Ankara, Turkey
| | - Alev O Atilgan
- Department of Clinical Pathology, Faculty of Medicine, Baskent University, Ankara, Turkey
| | - Tugce Sencelikel
- Department of Biostatistics, Faculty of Medicine, Baskent University, Ankara, Turkey
| | - Cagri A Uysal
- Department of Plastic Reconstructive and Aesthetic Surgery, Faculty of Medicine, Baskent University, Ankara, Turkey
| | - Nilgun M Ertas
- Department of Plastic Reconstructive and Aesthetic Surgery, Faculty of Medicine, Baskent University, Ankara, Turkey
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Satoyoshi T, Okita K, Ishii M, Hamabe A, Usui A, Akizuki E, Okuya K, Nishidate T, Yamano H, Nakase H, Takemasa I. Timing of indocyanine green injection prior to laparoscopic colorectal surgery for tumor localization: a prospective case series. Surg Endosc 2020; 35:763-769. [PMID: 32072278 PMCID: PMC7819920 DOI: 10.1007/s00464-020-07443-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Accepted: 02/10/2020] [Indexed: 12/18/2022]
Abstract
Background Accurate identification of tumor sites during laparoscopic colorectal surgery helps to optimize oncological clearance. We aimed to assess the timing of the local injection preoperatively and clarify the usefulness and limitation of tumor site marking using indocyanine green (ICG) fluorescence imaging. Methods Consecutive patients who underwent primary colorectal cancer surgery from September 2017 to January 2019 were included. Preoperatively, lower endoscopy was used to inject the ICG solution into the submucosal layer near the tumor. During laparoscopic surgery, ICG fluorescence marking as the tumor site marking was detected using a laparoscopic near-infrared camera system. The detection rate and factors associated with successful intraoperative ICG fluorescence visualization including the interval between local injection and surgery were evaluated. Results One hundred sixty-five patients were enrolled. Using the laparoscopic near-infrared system, the intraoperative detection rates of ICG marking were 100% for ICG injection within 6 days preoperatively, 60% for injection between 7 and 9 days preoperatively, and 0% for injection earlier than 10 days preoperatively. There were no complications associated with ICG marking. Additionally, this method did not disturb the progress of the surgical procedure because injected ICG in the submucosal layer did not cause any tissue inflammation, and if ICG spilled into the serosa, it was invisible by white light. Conclusion Advantages of ICG fluorescence tumor site marking were high visibility of infrared imaging during laparoscopic colorectal surgery and minimal adverse events of surgery. One of the most important findings regarding practical use was a rapid decrease in fluorescence marking visibility if one week passed from the time of ICG local injection.
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Affiliation(s)
- Tetsuta Satoyoshi
- Department of Surgery, Surgical Oncology and Science, Sapporo Medical University, S1, W16, Chuo-ku, Sapporo, 060-8543, Japan.
| | - Kenji Okita
- Department of Surgery, Surgical Oncology and Science, Sapporo Medical University, S1, W16, Chuo-ku, Sapporo, 060-8543, Japan
| | - Masayuki Ishii
- Department of Surgery, Surgical Oncology and Science, Sapporo Medical University, S1, W16, Chuo-ku, Sapporo, 060-8543, Japan
| | - Atsushi Hamabe
- Department of Surgery, Surgical Oncology and Science, Sapporo Medical University, S1, W16, Chuo-ku, Sapporo, 060-8543, Japan
| | - Akihiro Usui
- Department of Surgery, Surgical Oncology and Science, Sapporo Medical University, S1, W16, Chuo-ku, Sapporo, 060-8543, Japan
| | - Emi Akizuki
- Department of Surgery, Surgical Oncology and Science, Sapporo Medical University, S1, W16, Chuo-ku, Sapporo, 060-8543, Japan
| | - Koichi Okuya
- Department of Surgery, Surgical Oncology and Science, Sapporo Medical University, S1, W16, Chuo-ku, Sapporo, 060-8543, Japan
| | - Toshihiko Nishidate
- Department of Surgery, Surgical Oncology and Science, Sapporo Medical University, S1, W16, Chuo-ku, Sapporo, 060-8543, Japan
| | - Hiroo Yamano
- Department of Gastroenterology and Hepatology, School of Medicine, Sapporo Medical University, S1, W16, Chuo-ku, Sapporo, 060-8543, Japan
| | - Hiroshi Nakase
- Department of Gastroenterology and Hepatology, School of Medicine, Sapporo Medical University, S1, W16, Chuo-ku, Sapporo, 060-8543, Japan
| | - Ichiro Takemasa
- Department of Surgery, Surgical Oncology and Science, Sapporo Medical University, S1, W16, Chuo-ku, Sapporo, 060-8543, Japan
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Blouhos K, Boulas KA, Paraskeva A, Gravalidou I, Chatzipourganis K, Triantafyllidis A, Hatzigeorgiadis A. Preoperative endoscopic tattooing for colonic polyp localization: From blue to black. Clin Case Rep 2019; 7:2258-2259. [PMID: 31788295 PMCID: PMC6878057 DOI: 10.1002/ccr3.2428] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Revised: 07/12/2019] [Accepted: 08/22/2019] [Indexed: 11/23/2022] Open
Abstract
When surgical polypectomy and not segmental resection is planned, preoperative endoscopic tattooing with high-volume undiluted methylene blue should be avoided as it can result in colon perforation.
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Milone M, Vignali A, Manigrasso M, Velotti N, Sarnelli G, Aprea G, De Simone G, Maione F, Gennarelli N, Elmore U, De Palma GD. Sterile carbon particle suspension vs India ink for endoscopic tattooing of colonic lesions: a randomized controlled trial. Tech Coloproctol 2019; 23:1073-1078. [PMID: 31667693 DOI: 10.1007/s10151-019-02101-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2019] [Accepted: 10/10/2019] [Indexed: 01/26/2023]
Abstract
BACKGROUND Different markers have been used preoperatively to mark colonic lesions, especially India ink. In recent years, another kind of marker has been developed: sterile carbon particle suspension (SCPS). No comparison between these two markers has yet been made. The aim of the present study was to compare the pyrogenic, inflammatory and intraperitoneal effect of these two markers. METHODS From September 2015 to December 2018, adult patients who were candidates for elective laparoscopic colon resection were randomized to the SCPS or conventional India ink injection group using computer-based randomization. The primary endpoint of the study was the presence of intraoperative adhesions related to the endoscopic tattoo. Secondary endpoints were differences in white blood cell, C-reactive protein, and fibrinogen levels as well as, abdominal pain and body temperature at baseline (before endoscopic tattooing) and 6 and 24 h after colonoscopy. Finally, the visibility of the tattoo during the minimally invasive intervention was assessed. RESULTS Ninety-four patients were included in the study, 47 for each arm. There were 45/94 females (47.9%) and 49/94 males (52.1%), with a median age of 67.85 ± 9.22 years. No differences were found between groups in WBC, fibrinogen levels, body temperature or VAS scores, but we documented significantly higher CRP values at 6 and 24 h after endoscopic tattooing with India ink injection. There were significantly fewer adhesions in the SCPS Endoscopic Marker group. All the endoscopic tattoos were clearly visible. CONCLUSIONS SCPS is an effective method for tattooing colonic lesions and has a better safety profile than traditional India ink in terms of post-procedure inflammatory response and intraoperative bowel adhesions. CLINICAL TRIAL REGISTRATION clinicaltrials.gov (ID: NCT03637933).
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Affiliation(s)
- M Milone
- Department of Clinical Medicine and Surgery, Federico II University of Naples, Via Sergio Pansini, 5, 80131, Naples, Italy
| | - A Vignali
- Department of Gastrointestinal Surgery, San Raffaele Hospital and San Raffaele Vita-Salute University, Via Olgettina 60, 20132, Milan, Italy
| | - M Manigrasso
- Department of Clinical Medicine and Surgery, Federico II University of Naples, Via Sergio Pansini, 5, 80131, Naples, Italy
| | - N Velotti
- Department of Clinical Medicine and Surgery, Federico II University of Naples, Via Sergio Pansini, 5, 80131, Naples, Italy
| | - G Sarnelli
- Department of Clinical Medicine and Surgery, Federico II University of Naples, Via Sergio Pansini, 5, 80131, Naples, Italy
| | - G Aprea
- Department of Clinical Medicine and Surgery, Federico II University of Naples, Via Sergio Pansini, 5, 80131, Naples, Italy
| | - G De Simone
- Department of Clinical Medicine and Surgery, Federico II University of Naples, Via Sergio Pansini, 5, 80131, Naples, Italy
| | - F Maione
- Department of Clinical Medicine and Surgery, Federico II University of Naples, Via Sergio Pansini, 5, 80131, Naples, Italy
| | - N Gennarelli
- Department of Clinical Medicine and Surgery, Federico II University of Naples, Via Sergio Pansini, 5, 80131, Naples, Italy
| | - U Elmore
- Department of Gastrointestinal Surgery, San Raffaele Hospital and San Raffaele Vita-Salute University, Via Olgettina 60, 20132, Milan, Italy.
| | - G D De Palma
- Department of Clinical Medicine and Surgery, Federico II University of Naples, Via Sergio Pansini, 5, 80131, Naples, Italy
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Affiliation(s)
- Salmaan Jawaid
- Division of Gastroenterology, Hepatology and Nutrition, University of Florida Health, Gainesville, Florida, USA
| | - Dennis Yang
- Division of Gastroenterology, Hepatology and Nutrition, University of Florida Health, Gainesville, Florida, USA
| | - Peter V Draganov
- Division of Gastroenterology, Hepatology and Nutrition, University of Florida Health, Gainesville, Florida, USA
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Gasljevic G, Boc N, Brecelj E, But Hadzic J, Klancic M, Mlakar J. Overstaged Rectal Cancer by MRI due to Fibrosis Induced by Tattoo Marker. Case Rep Gastroenterol 2018; 12:602-607. [PMID: 30386199 PMCID: PMC6206972 DOI: 10.1159/000492811] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Accepted: 08/09/2018] [Indexed: 11/19/2022] Open
Abstract
Endoscopic colorectal tattooing with carbon-based dyes is commonly employed in order to assist with later localization of the lesion. Although carbon is thought to be nontoxic, there usually is some inflammatory reaction with fibrosis and granuloma formation after tissue injection. The aim of this report is to alert to a possible underestimated, late consequence of colorectal carbon-based marker tattooing, namely pronounced fibrosis at the site of the injection that could lead to a blurring and misinterpretation of changes evaluated by radiological techniques. We describe a case of cT stage overestimation due to fibrosis of the rectal wall and perirectal fat, induced by carbon-based dye injection in a 66-year-old patient. In our case it was an overestimation of MR evaluation in the case of early invasive carcinoma. Although there have been some studies on tissue effect of carbon-based dyes, the possible scenario consequence of cancer stage overestimation due to fibrosis has not yet been described. Such a mistake could lead to inappropriate overtreatment. Clinicians must be aware of the possible consequences of dye injection and resultant overestimation of T stage of colorectal cancer. More histological studies concerning histological changes after carbon-based marker tattooing are needed to establish the extent of its significance.
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Affiliation(s)
- Gorana Gasljevic
- Department of Pathology, Institute of Oncology Ljubljana, Ljubljana, Slovenia
| | - Nina Boc
- Department of Radiology, Institute of Oncology Ljubljana, Ljubljana, Slovenia
| | - Erik Brecelj
- Department of Surgery, Institute of Oncology Ljubljana, Ljubljana, Slovenia
| | - Jasna But Hadzic
- Department of Radiotherapy, Institute of Oncology Ljubljana, Ljubljana, Slovenia
| | - Marko Klancic
- KlanMedic Diagnostic Center, Sempeter pri Gorici, Slovenia
| | - Jernej Mlakar
- Institute of Pathology, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
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Emmanuel A, Gulati S, Burt M, Hayee B, Haji A. Safe and Effective Endoscopic Resection of Massive Colorectal Adenomas ≥8 cm in a Tertiary Referral Center. Dis Colon Rectum 2018; 61:955-63. [PMID: 29944575 DOI: 10.1097/DCR.0000000000001144] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Endoscopic resection of large colorectal lesions is well reported and is the first line of treatment for all noninvasive colorectal neoplasms in many centers, but little is known about the outcomes of endoscopic resection of truly massive colorectal lesions ≥8 cm. OBJECTIVE We report on the outcomes of endoscopic resection for massive (≥8 cm) colorectal adenomas and compare the outcomes with resection of large (2.0-7.9 cm) lesions. DESIGN This was a retrospective study. SETTINGS The study was conducted in a tertiary referral unit for interventional endoscopy. PATIENTS A total of 435 endoscopic resections of large colorectal polyps (≥2 cm) were included, of which 96 were ≥8 cm. MAIN OUTCOME MEASURES Outcomes included initial successful resection, complications, recurrence, surgery, and hospital admission. RESULTS Endoscopic resection was successful for 91 of 96 massive lesions (≥8 cm). Mean size was 10.1 cm (range, 8-16 cm). A total of 75% had previous attempts at resection or heavy manipulation before referral. Thirty two were resected using endoscopic submucosal dissection or hybrid endoscopic submucosal dissection and the rest using piecemeal endoscopic mucosal resection. No patients required surgery for a perforation. Five patients had postprocedural bleeding. There were 25 recurrences: 2 were treated with transanal endoscopic microsurgery, 2 with right hemicolectomy, and the rest with endoscopic resection. Compared with patients with large lesions, more patients with massive adenomas had complications (19.8% versus 3.3%), required admission (39.6% versus 11.0%), developed recurrence (30.8% versus 9.9%), or required surgery for recurrence (5.0% versus 0.8%). LIMITATIONS This was a retrospective study. CONCLUSIONS Endoscopic resection of massive colorectal adenomas ≥8 cm is achievable with few significant complications, and the majority of patients avoid surgery. Systematic assessment is required to appropriately select patients for endoscopic resection, which should be performed in specialist units. See Video Abstract at http://links.lww.com/DCR/A653.
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Abstract
Aims and Background Intraoperative localization, during open and laparoscopic surgery, of small, nonpalpable colonic lesions located at peculiar sites or with concurrent inflammatory bowel alterations (diverticulosis, perivisceritis) is often difficult. The aim of our work was to assess the validity of radioguided identification after preoperative labeling. Methods and Study Design Patients who were candidates for colon surgery for occult lesions that, because of their size and location, were assumed to be difficult to detect, underwent colonoscopy 1 to 2.5 hours before surgery. A small dose of labeled albumin macroaggregates was injected with a sclerotherapy needle into the subserosa underneath the lesion. Immediately following injection the lesion was identified with a transcutaneously placed gamma detecting probe. Intraoperative tracer detection was performed either during open surgery or by means of a laparoscopic probe (detection time 3-5 mins). The position of the lesion was marked with a suture or with a clip. Surgery was performed according to the type of lesion to be treated. Results In our initial clinical experience 15 colon lesions were preoperatively marked in 14 patients and were subsequently detected during surgery (four under laparoscopy) with a gamma detecting probe. This technique allows highly accurate, fast, and inexpensive surgical localization of lesions without irradiation and without complications. Conclusion Our experience shows that preoperative endoscopic marking of nonpalpable colon lesions with 99mTc-labeled albumin macroaggregates followed by intraoperative detection with a gamma probe is a useful clinical method that is highly accurate and without complications.
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Affiliation(s)
- R Rezzo
- Division of General Surgery, EO Galliera, Genoa, Italy.
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Chiba H, Tachikawa J, Kurihara D, Ashikari K, Takahashi A, Kuwabara H, Nakaoka M, Morohashi T, Goto T, Ohata K, Nakajima A. Successful endoscopic submucosal dissection of colon cancer with severe fibrosis after tattooing. Clin J Gastroenterol 2017; 10:426-430. [PMID: 28785991 DOI: 10.1007/s12328-017-0770-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Accepted: 07/31/2017] [Indexed: 11/30/2022]
Abstract
Endoscopic tattooing is often used to facilitate the identification of colorectal lesions before endoscopic treatments. However, tattooing under the lesion can result in technical difficulties because of the dark endoscopic field and submucosal fibrosis. A 65-year-old man with a non-granular-type laterally spreading tumor was referred to our hospital after tattooing with India ink for surgery. However, endoscopic submucosal dissection (ESD) was selected for the resection of this lesion because the findings of magnifying endoscopy suggested an intramucosal cancer. Dissection around a dense section was difficult because of the dark endoscopic field and non-lifting as a result of severe fibrosis. We performed ESD using the following strategy: (1) injection with a smaller amount of indigo carmine and (2) cut and dissection from the side of the thinly tattooed area. The lesion was curatively resected en bloc without any complications. This finding suggests that endoscopic tattooing before endoscopic treatment should be performed one or two folds away from the lesion.
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Affiliation(s)
- Hideyuki Chiba
- Department of Gastroenterology, Omori Red Cross Hospital, 4-30-1, Chuo, Ota-Ku, Tokyo, 143-8527, Japan.
| | - Jun Tachikawa
- Department of Gastroenterology, Omori Red Cross Hospital, 4-30-1, Chuo, Ota-Ku, Tokyo, 143-8527, Japan
| | - Daisuke Kurihara
- Department of Gastroenterology, Omori Red Cross Hospital, 4-30-1, Chuo, Ota-Ku, Tokyo, 143-8527, Japan
| | - Keiichi Ashikari
- Department of Gastroenterology, Omori Red Cross Hospital, 4-30-1, Chuo, Ota-Ku, Tokyo, 143-8527, Japan
| | - Akihiro Takahashi
- Department of Gastroenterology, Nerima-Hikarigaoka Hospital, 2-11-1, Hikarigaoka, Nerima-Ku, Tokyo, 179-0072, Japan
| | - Hiroki Kuwabara
- Department of Gastroenterology, Omori Red Cross Hospital, 4-30-1, Chuo, Ota-Ku, Tokyo, 143-8527, Japan
| | - Michiko Nakaoka
- Department of Gastroenterology, Omori Red Cross Hospital, 4-30-1, Chuo, Ota-Ku, Tokyo, 143-8527, Japan
| | - Taiki Morohashi
- Department of Gastroenterology, Omori Red Cross Hospital, 4-30-1, Chuo, Ota-Ku, Tokyo, 143-8527, Japan
| | - Toru Goto
- Department of Gastroenterology, Omori Red Cross Hospital, 4-30-1, Chuo, Ota-Ku, Tokyo, 143-8527, Japan
| | - Ken Ohata
- Department of Gastroenterology, NTT Medical Center Tokyo, 5-9-22, Higashigotanda, Shinagawa-Ku, Tokyo, 141-8625, Japan
| | - Atsushi Nakajima
- Department of Gastroenterology, Yokohama City University, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan
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Gonzalez-Tallon AI, Rivero-Fernandez M, Calvo-Ramos I, Diaz-Sanchez A, Del Rosario Gonzalez-Alonso M, la Fuente-Briongos ED, Manzano-Fernandez R, Moya-Valverde E, Riesco-Lopez JM, Campos-Cantero R. Hematemesis With Gastric Laceration After Tattooing a Polyp With Purified Carbon: A Review of the Literature. Gastroenterology Res 2017; 10:45-49. [PMID: 28270877 PMCID: PMC5330693 DOI: 10.14740/gr728w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/18/2017] [Indexed: 11/11/2022] Open
Abstract
Endoscopic tattooing is a simple and effective technique for marking small lesions, so they can be localized during surgery or in later endoscopies. Various agents can be used such as India ink or a solution of purified carbon particles. The number of complications from tattooing is relatively small, but not rare. The majority of the literature on the subject refers to complications in the colon. We present a case of gastric bleeding secondary to a laceration following tattooing with purified carbon, and a literature review.
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Affiliation(s)
| | - Miguel Rivero-Fernandez
- Department of Gastroenterology, Hospital Universitario del Sureste, Arganda del Rey, Madrid, Spain
| | - Irina Calvo-Ramos
- Department of Gastroenterology, Hospital Universitario del Sureste, Arganda del Rey, Madrid, Spain
| | - Antonio Diaz-Sanchez
- Department of Gastroenterology, Hospital Universitario del Sureste, Arganda del Rey, Madrid, Spain
| | | | | | - Rebeba Manzano-Fernandez
- Department of Gastroenterology, Hospital Universitario del Sureste, Arganda del Rey, Madrid, Spain
| | - Eloisa Moya-Valverde
- Department of Gastroenterology, Hospital Universitario del Sureste, Arganda del Rey, Madrid, Spain
| | - Jose Maria Riesco-Lopez
- Department of Gastroenterology, Hospital Universitario del Sureste, Arganda del Rey, Madrid, Spain
| | - Rocio Campos-Cantero
- Department of Gastroenterology, Hospital Universitario del Sureste, Arganda del Rey, Madrid, Spain
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Zako T, Ito M, Hyodo H, Yoshimoto M, Watanabe M, Takemura H, Kishimoto H, Kaneko K, Soga K, Maeda M. Extra-luminal detection of assumed colonic tumor site by near-infrared laparoscopy. Surg Endosc 2016; 30:4153-9. [PMID: 26659227 DOI: 10.1007/s00464-015-4669-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2015] [Accepted: 10/14/2015] [Indexed: 01/05/2023]
Abstract
BACKGROUND Localization of colorectal tumors during laparoscopic surgery is generally performed by tattooing into the submucosal layer of the colon. However, faint and diffuse tattoos may lead to difficulties in recognizing cancer sites, resulting in inappropriate resection of the colon. We previously demonstrated that yttrium oxide nanoparticles doped with the rare earth ions (ytterbium and erbium) (YNP) showed strong near-infrared (NIR) emission under NIR excitation (1550 nm emission with 980 nm excitation). NIR light can penetrate deep tissues. In this study, we developed an NIR laparoscopy imaging system and demonstrated its use for accurate resection of the colon in swine. METHODS The NIR laparoscopy system consisted of an NIR laparoscope, NIR excitation laser diode, and an NIR camera. Endo-clips coated with YNP (NIR clip), silicon rubber including YNP (NIR silicon mass), and YNP solution (NIR ink) were prepared as test NIR markers. We used a swine model to detect an assumed colon cancer site using NIR laparoscopy, followed by laparoscopic resection. The NIR markers were fixed at an assumed cancer site within the colon by endoscopy. An NIR laparoscope was then introduced into the abdominal cavity through a laparoscopy port. RESULTS NIR emission from the markers in the swine colon was successfully recognized using the NIR laparoscopy imaging system. The position of the markers in the colon could be identified. Accurate resection of the colon was performed successfully by laparoscopic surgery under NIR fluorescence guidance. The presence of the NIR markers within the extirpated colon was confirmed, indicating resection of the appropriate site. CONCLUSIONS NIR laparoscopic surgery is useful for colorectal cancer site recognition and accurate resection using laparoscopic surgery.
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15
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Lee JH, Chang CH, Park CH, Kim JK. Methylene blue dye-induced skin necrosis in immediate breast reconstruction: evaluation and management. Arch Plast Surg 2014; 41:258-63. [PMID: 24883277 DOI: 10.5999/aps.2014.41.3.258] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2013] [Revised: 08/22/2013] [Accepted: 09/09/2013] [Indexed: 11/18/2022] Open
Abstract
Background For early breast cancer patients, skin-sparing mastectomy or nipple-sparing mastectomy with sentinel lymph node biopsy has become the mainstream treatment for immediate breast reconstruction in possible cases. However, a few cases of skin necrosis caused by methylene blue dye (MBD) used for sentinel lymph node localization have been reported. Methods Immediate breast reconstruction using a silicone implant was performed on 35 breasts of 34 patients after mastectomy. For sentinel lymph node localization, 1% MBD (3 mL) was injected into the subareolar area. The operation site was inspected in the postoperative evaluation. Results Six cases of immediate breast reconstruction using implants were complicated by methylene blue dye. One case of local infection was improved by conservative treatment. In two cases, partial necrosis and wound dehiscence of the incision areas were observed; thus, debridement and closure were performed. Of the three cases of wide skin necrosis, two cases underwent removal of the dead tissue and implants, followed by primary closure. In the other case, the breast implant was salvaged using latissimus dorsi musculocutaneous flap reconstruction. Conclusions The complications were caused by MBD toxicity, which aggravated blood disturbance and skin tension after implant insertion. When planning immediate breast reconstruction using silicone implants, complications of MBD should be discussed in detail prior to surgery, and appropriate management in the event of complications is required.
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Cyr AE, Margenthaler JA. Axillary ultrasound and sentinel lymph node biopsy: an evolving paradigm for management of the axilla. Breast Cancer Management 2014. [DOI: 10.2217/bmt.14.11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
SUMMARY Axillary lymph node dissection was used to treat and to provide staging information for women with invasive breast cancer. With the adoption of sentinel lymph node biopsy over the past two decades, evaluation and management of the axilla has become less invasive for many patients. However, as treatment decisions are more frequently based on tumor biology rather than anatomic staging information, the information obtained from even more minimal axillary surgery may be less clinically relevant, and any surgery may cause morbidity. Imaging technologies, such as axillary ultrasound, offer the capability of providing some staging information without the risks associated with surgery. In addition, the therapeutic need for axillary surgery is in question, and less invasive means of managing the axilla are under investigation.
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Affiliation(s)
- Amy E Cyr
- Department of Surgery, Washington University School of Medicine, 660 S Euclid Avenue, Campus box 8109, St Louis, MO 63110, USA
| | - Julie A Margenthaler
- Department of Surgery, Washington University School of Medicine, 660 S Euclid Avenue, Campus box 8109, St Louis, MO 63110, USA
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Sweeney SA, Hicks LD, Ranallo N, Snyder N 4th, Soldano AC. Perforating granulomatous dermatitis reaction to exogenous tattoo pigment: a case report and review of the literature. Am J Dermatopathol 2013; 35:754-6. [PMID: 21986232 DOI: 10.1097/DAD.0b013e318209f117] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
: The majority of cutaneous hypersensitivity reactions to exogenous tattoo pigments can be histologically classified as lichenoid or granulomatous. The etiology is still uncertain but is generally accepted to be a delayed-type hypersensitivity reaction to either the pigment itself or its carrier solution. In this report, we review the literature concerning adverse reactions to tattoos. In addition, we describe the second case of a localized granulomatous dermatitis to the red dye within a tattoo that histologically resembled granuloma annulare. This is the first reported example of a perforating granuloma annulare-like reaction.
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Kim BK, Song MH, Yang HJ, Kim DS, Lee NK, Jeon YS. Use of cystoscopic tattooing in laparoscopic partial cystectomy. Korean J Urol 2012; 53:401-4. [PMID: 22741048 PMCID: PMC3382689 DOI: 10.4111/kju.2012.53.6.401] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2012] [Accepted: 05/04/2012] [Indexed: 12/16/2022] Open
Abstract
Purpose During laparoscopic partial cystectomy (LPC), lesion identification is essential to help to determine the appropriate bladder incisions required to maintain adequate resection margins. The inability to use tactile senses makes it difficult for surgeons to locate lesions during laparoscopic surgery. Endoscopic India ink marking techniques are often used in laparoscopic gastroenterological surgery. We present our experience with performing LPC with India ink during the surgical resection of various bladder lesions. Materials and Methods LPC with cystoscopic fine needle tattooing was performed on 10 patients at our institute. Tattooing was performed at 1- to 2-cm intervals approximately 1 cm away from the outer margin of the lesion with enough depth (the deep muscle layer) under cystoscopic guidance. LPC was performed by the transperitoneal approach. The clinical courses and pathologic results were analyzed. Results All LPC with cystoscopic tattooing cases were performed successfully. The mean patient age was 39.1 years. The mean operative time was 130.5 minutes, and the mean estimated blood loss was 93 ml. The mean hospital stay was 13.1 days, and the mean duration of indwelling Foley catheterization was 10.7 days. There were no significant intraoperative or postoperative complications except 1 case of delayed urinary leak and 1 case of delayed wound healing. The pathological diagnosis included 1 urachal cancer, 1 urachal remnant, 4 urachal cysts, 2 pheochromocytomas, and 2 inflammatory masses. All specimens showed adequate surgical margins. Conclusions Cystoscopic tattooing in LPC is a simple and effective technique to assist in locating pathological bladder lesions intraoperatively. This technique can help to determine appropriate resection margins during LPC without incurring additional complicated procedures.
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Affiliation(s)
- Bong Ki Kim
- Department of Urology, Soonchunhyang University Cheonan Hospital, Soonchunhyang University College of Medicine, Cheonan, Korea
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Hwang MR, Sohn DK, Park JW, Kim BC, Hong CW, Han KS, Chang HJ, Oh JH. Small-dose India ink tattooing for preoperative localization of colorectal tumor. J Laparoendosc Adv Surg Tech A 2010; 20:731-4. [PMID: 20879870 DOI: 10.1089/lap.2010.0284] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
INTRODUCTION India ink tattooing is widely used for tumor localization; however, the tattooing procedure is not yet standardized. This study aims to evaluate the efficacy of small-dose tattooing with sterile India ink using a saline test-injection method. PATIENTS AND METHODS Between April 2009 and August 2009, 20 patients underwent colonoscopic tattooing with prepackaged sterile India ink before resection of colorectal tumor. We injected 0.5 cc of India ink at three circumferential sites at the distal tumor using a saline test-injection method. Observation and leakage of India ink were evaluated during laparoscopic surgery, and the diameter of tattooing in the specimen was assessed. RESULTS Tattoos were observed intraoperatively in 18 patients (90%). In 2 patients, tattoos were not observed on the serosal surface but were detected on the mucosal surface. Localized leakage of ink was identified during surgery in 1 patient (5%), without fever or abdominal pain. Mean tattoo diameter was 2.1 cm on the serosal surface and 2.0 cm on the mucosal surface. CONCLUSIONS Small-dose tattooing with sterile India ink using a saline test-injection method is effective for tumor localization.
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Affiliation(s)
- Mi Ri Hwang
- Center for Colorectal Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Korea
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21
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Cappell MS, Courtney JT, Amin M. Black macular patches on parietal peritoneum and other extraintestinal sites from intraperitoneal spillage and spread of India ink from preoperative endoscopic tattooing: an endoscopic, surgical, gross pathologic, and microscopic study. Dig Dis Sci 2010; 55:2599-605. [PMID: 19957037 DOI: 10.1007/s10620-009-1044-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2009] [Accepted: 10/26/2009] [Indexed: 12/19/2022]
Abstract
BACKGROUND Three cases, including one case report and two clinical images, have been reported of extraintestinal or peritoneal black maculae detected at laparoscopy after colonoscopic tattooing, presumably from intraperitoneal spillage of India ink during tattooing. AIMS Report three cases of inadvertent extraintestinal tattooing from endoscopic tattooing of intestinal lesions, provide histologic evidence for the presumed pathophysiology, and promulgate recommendations to prevent this complication. METHODS Three patients underwent endoscopic tattooing of intestinal lesions using India ink, surgery for lesion removal, and pathologic analysis. RESULTS Three patients had black macular patches or streaks identified intraoperatively at extraintestinal sites after endoscopic tattooing of intestinal lesions with India ink: (1) black patches on peritoneum 7 days after colonoscopic tattooing of cecal cancer, (2) black streaks on band connecting cecum to peritoneum 13 days after colonoscopic tattooing of cecal cancer, and (3) blackish band on jejunal mesentery 28 days after tattooing presumptive bleeding jejunal lesion. Pigmentation was detected at both injection and extraintestinal sites in all patients by (1) surgery, (2) gross pathology, and (3) microscopic examination demonstrating intracellular black pigmentation within mesothelial cells and macrophages. Special histologic stains were consistent with a carbon-based pigment, and inconsistent with iron or melanin as the pigment. The proposed mechanism is intraperitoneal India ink spillage from deep intestinal injection, as supported by histologic findings of subserosal pigment accumulation. An alternative histologic mechanism is migration of pigment-laden macrophages via lymphovascular channels. CONCLUSIONS Endoscopic injection of India ink using standard sclerotherapy needles can inadvertently tattoo extraintestinal sites in addition to tattooing the primary lesion. Despite its striking appearance, this intraoperative, gross, and microscopic finding is likely not pathologically significant, given its proposed pathophysiology. Surgical recognition of this entity is important, however, to prevent misinterpretation of findings as peritoneal melanoma, endometrial implants, infarcted mesentery, or tattooed cancer. This complication may be prevented by proper tattooing technique.
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Abstract
OBJECTIVE Laparoscopic surgery for colorectal cancer is now widespread. Small lesions in the colon can be difficult to palpate and with lack of tactile sensation, it is essential to accurately localize them preoperatively. This is a review article on current methods of tattooing including the use of different agents and associated complications. Aim To review current techniques in preoperative tumour localization and methods used for colonic tattooing including agents used, dosage and potential complications. METHOD A literature search (Medline and Pubmed) was performed with manual cross referencing of all articles related to colonic tattooing. RESULTS Methods for localizing colonic tumours for laparoscopic resection include preoperative barium enema examination, CT colonography and intraoperative colonoscopy. The most effective method is, however, by tattooing with India ink performed endoscopically before surgery. CONCLUSION India ink is a reliable method of marking tumour location within the colon as prelude to laparoscopic resection. Surgeons must, however, be aware of potential complications associated with this technique.
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Affiliation(s)
- J M C Yeung
- Department of General Surgery, Queens Medical Centre, Nottingham, UK.
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Watanabe M, Tsunoda A, Narita K, Kusano M, Miwa M. Colonic tattooing using fluorescence imaging with light-emitting diode-activated indocyanine green: a feasibility study. Surg Today 2009; 39:214-8. [PMID: 19280280 DOI: 10.1007/s00595-008-3849-9] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2007] [Accepted: 07/06/2008] [Indexed: 01/23/2023]
Abstract
PURPOSE We investigated the feasibility of a fluorescence imaging technique using light-emitting diode (LED)-activated indocyanine green (ICG) fluorescence. METHODS Indocyanine green injections were given to patients undergoing preoperative colonoscopy for early colon cancer or colon adenoma. During subsequent laparotomy, the colon was first observed with the naked eye, and then using a prototype machine with a charge-coupled device (CCD) video camera equipped with a cutoff filter and a LED at a wavelength of 760 nm as the light source. RESULTS LED-induced fluorescence showed tumor localization clearly and accurately in all ten patients (100%) enrolled in this study, whereas it was seen with the naked eye as a green spot in only two patients (20%) (P = 0.0077; Wilcoxon's signed-rank test). There were no complications of LED-induced fluorescence and no inflammatory signs were noted on the hematoxylin-eosin-stained slides for the identified injection sites in the resected specimens. CONCLUSIONS Colonic tattooing using this fluorescence imaging technique of LED-activated ICG fluorescence is a new concept of colonic marking based on the characteristics that ICG is a near infrared fluorescent dye, and is useful, without any adverse effects, to identify perioperatively the tumor localization.
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Affiliation(s)
- Makoto Watanabe
- Department of General and Gastroenterological Surgery, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo, 142-8666, Japan
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Ono S, Fujishiro M, Goto O, Kodashima S, Omata M. Endoscopic submucosal dissection for colonic laterally spreading tumors is difficult after target tattooing. Gastrointest Endosc 2009; 69:763-6. [PMID: 19251026 DOI: 10.1016/j.gie.2008.08.024] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2008] [Accepted: 08/18/2008] [Indexed: 02/08/2023]
Affiliation(s)
- Satoshi Ono
- Department of Gastroenterology, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
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Cho C, Jain S, Pilbeam M, Tait N, Thomson A. Colonoscopic preoperative localization using submucosal injection of radiolabelled colloid. Can J Gastroenterol 2008; 22:637-9. [PMID: 18629395 DOI: 10.1155/2008/575278] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Malignant colonic polyps can be removed endoscopically but surgical resection is sometimes required. However, the polypectomy site can be difficult to locate. Current methods use various tattooing agents, with varying degrees of success. A new technique using preoperative injection of technetium-99m-labelled antimony colloid, with intraoperative localization using a handheld gamma probe, is described. Although unsuccessful in terms of localizing a previously partially resected polyp, the technique itself proved safe and simple, and has some advantages over other endoscopic approaches.
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Zakaria S, Hoskin TL, Degnim AC. Safety and technical success of methylene blue dye for lymphatic mapping in breast cancer. Am J Surg 2008; 196:228-33. [PMID: 18367146 DOI: 10.1016/j.amjsurg.2007.08.060] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2007] [Revised: 07/30/2007] [Accepted: 08/08/2007] [Indexed: 11/28/2022]
Abstract
BACKGROUND We aimed to evaluate the safety and efficacy of methylene blue dye (MBD) for sentinel lymph node (SLN) mapping in breast cancer. METHODS A total of 398 patients undergoing 401 SLN biopsy procedures with MBD were retrospectively reviewed and divided into 3 groups based on dye concentration and location of dye injection. Technical success and complication rates were compared. RESULTS Overall technical success of SLN biopsy was 99.7%. Technical success of SLN mapping with MBD was lowest in the group receiving full strength dye in a peritumoral location (74%) and highest in the group that received very dilute MBD (1.25 mg/mL) in the subareolar location (92%, P = .004). The complication rate was highest in the first group (21%) and lowest in the latter (2%, P = .0003). CONCLUSIONS Dilute MBD (1.25 mg/mL) successfully maps SLNs with very few complications.
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Affiliation(s)
- Shaheen Zakaria
- Department of Surgery, Mayo Clinic and Mayo Foundation, Rochester, MN, USA
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Frudinger A, Ballon M, Taylor SA, Halligan S. The natural history of clinically unrecognized anal sphincter tears over 10 years after first vaginal delivery. Obstet Gynecol. 2008;111:1058-1064. [PMID: 18448736 DOI: 10.1097/aog.0b013e31816c4433] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To estimate the influence of clinically unrecognized anal sphincter injuries detected by endoanal ultrasonography 3 months after first vaginal delivery on symptoms of anal incontinence over the subsequent 10-year period. METHODS One-hundred fifty-six consecutive primigravid women were recruited, anal endosonography performed, and bowel habit predelivery characterized by means of a validated 24-point questionnaire. After excluding four women with a clinically recognized sphincter tear after delivery and 18 who delivered by cesarean, these procedures were repeated 3 months postpartum. The questionnaire was repeated at 5 and 10 years to estimate continence change over the decade after delivery. Logistic regression was used to examine the effect of clinically unrecognized sphincter tears on continence. RESULTS After delivery, continence deteriorated from baseline in 37 (28%) women, eight of whom had anal sphincter tears. Continence did not deteriorate in 97 women, six of whom had anal sphincter tears. At 10 years, 59 (55%) of 107 contactable women had continence scores greater than zero, 23 of whom had deteriorated from baseline. There was a significant relationship between a sphincter tear that was symptomatic after delivery and continence deterioration sustained at 5 and 10 years (odds ratio 2.8 for change in continence score). However, no relationship was found over 10 years for those women who sustained a sphincter tear but whose continence did not deteriorate postpartum. CONCLUSION Ultrasonographic anal sphincter defects without postpartum incontinence are not associated with deterioration in continence over the following decade. LEVEL OF EVIDENCE II.
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Magno P, Giday SA, Gabrielson KL, Shin EJ, Clarke JO, Ko CW, Buscaglia JM, Jagannath SB, Canto MI, Kantsevoy SV. EUS-guided submucosal implantation of a radiopaque marker: a simple and effective procedure to facilitate subsequent surgical and radiation therapy. Gastrointest Endosc 2008; 67:1147-52. [PMID: 18513556 DOI: 10.1016/j.gie.2008.02.053] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2007] [Accepted: 02/15/2008] [Indexed: 02/08/2023]
Abstract
BACKGROUND Endosonography (EUS) is widely used for locoregional staging of malignant GI tumors. Delineation of a tumor's margins with a long-lasting fluoroscopically visible material will facilitate subsequent surgical and radiation therapy. OBJECTIVE To assess the feasibility of EUS-guided submucosal implantation of a radiopaque marker in a porcine model. SETTING Survival experiments on four 50-kg pigs. METHODS A linear array echoendoscope was introduced into the esophagus and advanced to the stomach. With a 19-gauge FNA needle, a submucosal bleb was created by injecting 3 mL of normal saline solution into the gastric and esophageal wall followed by injection of 1 mL of tantalum suspension under fluoroscopic observation. Fluoroscopy was repeated after 1, 2, and 4 weeks followed by euthanasia and necropsy. MAIN OUTCOME MEASUREMENTS Long-term depositions of the marker in the injection sites. RESULTS Submucosal injections of tantalum were easily performed through the 19-gauge FNA needle, resulting in good fluoroscopic opacification of injected material. Follow-up fluoroscopy in 1, 2, and 4 weeks demonstrated stable deposition of the tantalum at the sites of injection. There were no complications during and after the tantalum implantation. Histologic examination of the injection sites demonstrated submucosal tantalum depositions without signs of infection, inflammation, tissue damage, or necrosis. LIMITATIONS Animal experiments with 4 weeks' follow-up. CONCLUSIONS EUS-guided implantation of tantalum as a radiopaque marker into the submucosal layer of the GI tract in a porcine model is technically feasible and safe. Long-lasting fluoroscopically visible tantalum markings could facilitate subsequent surgical and radiation therapy.
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Affiliation(s)
- Priscilla Magno
- Department of Medicine, Division of Gastroenterology, Johns Hopkins University, Baltimore, Maryland 21205, USA
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Miyoshi N, Ohue M, Noura S, Yano M, Sasaki Y, Kishi K, Yamada T, Miyashiro I, Ohigashi H, Iishi H, Ishikawa O, Imaoka S. Surgical usefulness of indocyanine green as an alternative to India ink for endoscopic marking. Surg Endosc 2008; 23:347-51. [PMID: 18443867 DOI: 10.1007/s00464-008-9938-4] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2007] [Revised: 03/23/2008] [Accepted: 04/05/2008] [Indexed: 02/07/2023]
Abstract
BACKGROUND India ink has been commonly used for preoperative colonic tattooing, but various complications have been reported. This study aimed to evaluate the usefulness of indocyanine green (ICG) marking as a replacement for India ink. METHODS This study enrolled 40 patients who between January 2005 and February 2006 underwent laparoscopic or open surgery for colorectal lesions considered difficult to locate intraoperatively. Because one patient had a history of allergy to iodinated contrast material, metal clipping was used instead of ICG to mark the lesion. Endoscopists injected 5 ml of ICG suspension and saline solution adjacent to the lesion at duplicate locations to evaluate the visibility, duration, and adverse effects of the dye. For 39 patients, the date of the preoperative colonoscopy was not set for examination of the appropriate interval between endoscopic marking and the surgical operation. RESULTS The median interval between ICG marking and surgery was 4 days (range, 1-73 days). All 29 patients who underwent surgery within 8 days after marking had positive green ICG staining at the time of surgery. After 9 days or more, however, positive staining was seen clearly in only two of the remaining 10 patients. The staining tended to grow weaker and fainter over the time course, eventually dissipating. No perioperative adverse reactions to the dye were observed. CONCLUSION This study supports the use of ICG as a safe technique that can be identified reliably during operations performed within 8 days after endoscopic injection.
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Affiliation(s)
- Norikatsu Miyoshi
- Department of Surgery, Osaka Medical Center for Cancer and Cardiovascular Diseases, 1-3-3, Nakamichi, Higashinari, Osaka, 537-8511, Japan
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Cul Y, Spann AP, Couch LH, Gopee NV, Evans FE, Churchwell MI, Williams LD, Doerge DR, Howard PC. Phtodeceomposition of Pigment Yellow 74, a Pigment Used in Tattoo Inks¶. Photochem Photobiol 2007. [DOI: 10.1111/j.1751-1097.2004.tb00068.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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Beck DE. Advances in gastrointestinal endoscopic techniques. Surg Clin North Am 2006; 86:849-65. [PMID: 16905413 DOI: 10.1016/j.suc.2006.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
An increasing number of techniques for endoscopic diagnosis and treatment is being described. Endoscopic surgeons should be familiar with these techniques. Although many of the diagnostic techniques, other than marking, do not have widespread clinical application, the therapeutic techniques that were described in this article are being used successfully in increasing numbers of appropriately selected patients. Additional experience and technologic advances will refine the endoscopic therapy that is available to patients with colorectal diseases.
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Affiliation(s)
- David E Beck
- Department of Colon and Rectal Surgery, Ochsner Clinic Foundation, 1514 Jefferson Highway, New Orleans, LA 70121, USA.
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Abstract
OBJECTIVE To test a modified saline (0.9% NaCl) solution joint washing (lavage) technique that includes the use of vitamin B12 as an internal marker for the evaluation of synovial fluid dilution in lavage samples from canine joints. SAMPLE POPULATION 9 plasma samples obtained from blood samples of 9 healthy dogs and 9 synovial fluid samples aspirated from stifle joints of 9 cadaveric dogs. PROCEDURE Photometric absorbances of 25% vitamin B12 solution, canine synovial fluid, and canine plasma were measured in a spectrophotometer to establish an optimal wavelength for analysis. Canine synovial fluid and plasma samples were mixed with the 25% vitamin B12 solution to obtain 1%, 3%, 5%, 10%, 20%, and 50% solutions of synovial fluid or plasma. Diluted synovial fluid and plasma samples were used to simulate joint lavage samples and to examine the possible interference of these substances (synovial fluid or plasma) with the absorbance of the 25% vitamin B12 solution in photometric analysis. RESULTS The optimal wavelength was found to be at 550 nm. Canine synovial fluid and plasma samples did not interfere with the absorbance measurements of the 25% vitamin B12 solution up to a 50% dilution of plasma or synovial fluid. CONCLUSIONS AND CLINICAL RELEVANCE The modified saline solution joint lavage method with the use of a 25% vitamin B12 solution as an internal standard provides an accurate and reliable technique for the evaluation of synovial fluid dilution in lavage samples from canine joints.
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Affiliation(s)
- Tanya de Bruin
- Department of Diagnostic Imaging of Domestic Animals, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium
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Salhab M, Al sarakbi W, Mokbel K. Skin and fat necrosis of the breast following methylene blue dye injection for sentinel node biopsy in a patient with breast cancer. Int Semin Surg Oncol 2005; 2:26. [PMID: 16313674 PMCID: PMC1308848 DOI: 10.1186/1477-7800-2-26] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/27/2005] [Accepted: 11/28/2005] [Indexed: 11/17/2022]
Abstract
Sentinel lymph node biopsy (SLNB) is a simple technique that uses subdermal or peri-tumoral injection of vital blue dye and/or radioactive isotope to identify the first lymph node(s) draining the primary tumor. It has been shown to accurately predict axillary node status in patients with clinically node negative breast cancer. The SLNB is emerging as a new standard of care in patients with early breast cancer. However, the use of methylene blue (MB) dye can be associated with a number of local complications due to its tissue reactive properties. We report a rare case of skin and fat necrosis followed by a dry gangrene of the skin in a female patient with breast cancer who underwent SLNB localization using peri-tumoral injection of MB dye in another institution. This case and literature review suggest that the use of MB dye for SLNB identification should be avoided and replaced with alternative types of blue dye such as Patent Blue V preferably in conjunction with a radioactive isotope tracer.
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Affiliation(s)
- M Salhab
- St Georges and The Princess Grace Hospitals, London, UK
| | - W Al sarakbi
- St Georges and The Princess Grace Hospitals, London, UK
| | - K Mokbel
- St Georges and The Princess Grace Hospitals, London, UK
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Abstract
AIM: To tattoo gastric mucosa with a novel medical device which could be used to monitor and follow-up gastric mucosal lesions.
METHODS: Combining endoscopic biopsy with sclerotherapy injection, we designed a new device that could perform biopsy and injection simultaneously. We performed endoscopies on a pig by using a novel endoscope tattoo biopsy forceps for 15 mo. At the same time, we used two-step method combining sclerotherapy injection needle with endoscopic biopsy. The acuity, inflammation and duration of endoscopy were compared between two methods.
RESULTS: Compared with the old two-step method, although the inflammation induced by our new device was similar, the duration of procedure was markedly decreased and the acuity of tattooing was better than the old two-step method. All characteristics of the novel device complied with national safety guidelines. Follow-up gastroscopy after 15 mo showed the stained site with injection of 1:100 0.5 mL of India ink was still markedly visible with little inflammatory reaction.
CONCLUSION: Endoscopic tattooing biopsy forceps can be widely used in monitoring precancerous lesions. Its safety and effectiveness has been established in animals.
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Affiliation(s)
- Jian-Min Si
- Department of Gastroenterology, Sir Run Run Shaw Hospital, Hangzhou 310016, Zhejiang Province, China.
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Feingold DL, Addona T, Forde KA, Arnell TD, Carter JJ, Huang EH, Whelan RL. Safety and reliability of tattooing colorectal neoplasms prior to laparoscopic resection. J Gastrointest Surg 2004; 8:543-6. [PMID: 15239988 DOI: 10.1016/j.gassur.2003.12.016] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Accurate tumor localization is critical to performing minimally invasive colorectal resection. This study reviews the safety and reliability of tattooing colorectal neoplasms prior to laparoscopic resection. We retrospectively reviewed 50 consecutive patients with colorectal neoplasms who underwent endoscopic tattooing prior to laparoscopic resection. Data were obtained from medical charts, endoscopy records, and pathology reports. No complications related to endoscopy or tattooing were incurred. Five neoplasms (10%) were in the ascending colon, five (10%) were in the transverse colon, eight (16%) were in the descending colon, 23 (46%) were in the sigmoid colon, and nine (18%) were in the rectum. Tattoos were visualized intraoperatively and accurately localized the neoplasm in 44 patients (88%). Six patients (12%) did not have tattoos visualized laparoscopically and required intraoperative localization. On average, the pathology specimens in this series had a 15 cm proximal margin, a 12 cm distal margin, and 15 lymph nodes. In the context of laparoscopic colorectal resection, preoperative endoscopic tattooing is a safe and reliable method of tumor localization in most cases. Localizing colon and proximal rectal lesions with tattoos may be preferable to other localization techniques including intraoperative endoscopy.
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Affiliation(s)
- Daniel L Feingold
- Department of Surgery, College of Physicians and Surgeons, Columbia University, New York, New York 10032, USA
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Singh-Ranger G, Mokbel K. Capsular contraction following immediate reconstructive surgery for breast cancer - An association with methylene blue dye. Int Semin Surg Oncol 2004; 1:3. [PMID: 15285809 PMCID: PMC483033 DOI: 10.1186/1477-7800-1-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/22/2004] [Accepted: 05/11/2004] [Indexed: 11/21/2022]
Abstract
Capsular contraction following implantation of breast prostheses occurs in 2–33% of patients undergoing breast augmentation. This condition can be debilitating for patients, and often requires revisional surgery. The aetiology of capsular contraction is unclear, but may be due to infection, haematoma or foreign body-type reactions. Methylene blue dye is a substance known to cause localised tissue inflammation, and is often used during breast cancer surgery to allow identification of the sentinel lymph node. We report a case of Baker Grade 4 capsular contraction necessitating revisional surgery, occurring in a patient who underwent immediate breast reconstruction during surgery for breast cancer. Methylene blue dye was used to locate the sentinel nodes during the original surgery, and was found to have heavily discoloured the prosthesis at subsequent revisional surgery. Capsular contraction may have been caused in part by a localised tissue reaction initiated by, or involving the dye.
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Affiliation(s)
| | - Kefah Mokbel
- Breast Surgery Unit St. George's Hospital and Medical School, London, England, UK
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Cui Y, Spann AP, Couch LH, Gopee NV, Evans FE, Churchwell MI, Williams LD, Doerge DR, Howard PC. Photodecomposition of Pigment Yellow 74, a Pigment Used in Tattoo Inks¶. Photochem Photobiol 2004; 80:175-84. [PMID: 15362942 DOI: 10.1562/2004-04-06-ra-136.1] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Tattooing has become a popular recreational practice among younger adults over the past decade. Although some of the pigments used in tattooing have been described, very little is known concerning the toxicology, phototoxicology or photochemistry of these pigments. Seven yellow tattoo inks were obtained from commercial sources and their pigments extracted, identified and quantitatively analyzed. The monoazo compound Pigment Yellow 74 (PY74; CI 11741) was found to be the major pigment in several of the tattoo inks. Solutions of commercial PY74 in tetrahydrofuran (THF) were deoxygenated using argon gas, and the photochemical reaction products were determined after exposure to simulated solar light generated by a filtered 6.5 kW xenon arc lamp. Spectrophotometric and high-pressure liquid chromatography (HPLC) analyses indicated that PY74 photodecomposed to multiple products that were isolated using a combination of silica chromatography and reversed-phase HPLC. Three of the major photodecomposition products were identified by nuclear magnetic resonance and mass spectrometry as N-(2-methoxyphenyl)-3-oxobutanamide (o-acetoacetanisidide), 2-(hydroxyimine)-N-(2-methoxyphenyl)-3-oxobutanamide and N,N''-bis(2-methoxyphenyl)urea. These results demonstrate that PY74 is not photostable in THF and that photochemical lysis occurs at several sites in PY74 including the hydrazone and amide groups. The data also suggest that the use of PY74 in tattoo inks could potentially result in the formation of photolysis products, resulting in toxicity at the tattoo site after irradiation with sunlight or more intense light sources.
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Affiliation(s)
- Yanyan Cui
- Division of Biochemical Toxicology, National Center for Toxicological Research, U.S. Food and Drug Administration, Jefferson, AR 72079, USA
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Dewitt J, McHenry L, Fogel E, Leblanc J, McGreevy K, Sherman S. EUS-guided methylene blue pancreatography for minor papilla localization after unsuccessful ERCP. Gastrointest Endosc 2004; 59:133-6. [PMID: 14722569 DOI: 10.1016/s0016-5107(03)02278-8] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- John Dewitt
- Department of Gastroenterology and Hepatology, Indiana University Medical Center, Indianapolis, Indiana 46202-5121, USA
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Dominitz JA, Eisen GM, Baron TH, Goldstein JL, Hirota WK, Jacobson BC, Johanson JF, Leighton JA, Mallery JS, Raddawi HM, Vargo JJ, Waring JP, Fanelli RD, Wheeler-Harbough J, Faigel DO. Complications of colonoscopy. Gastrointest Endosc 2003; 57:441-5. [PMID: 12665750 DOI: 10.1016/s0016-5107(03)80005-6] [Citation(s) in RCA: 136] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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Abstract
BACKGROUND Methylene blue dye (MBD) is being used as an alternative to isosulfan blue dye in sentinel lymph node (SLN) biopsies for breast cancer patients. Complications using MBD for SLN localization have not previously been reported. METHODS A retrospective study was conducted of 24 consecutive patients who received MBD. Patients were given 3 to 5 cc of 1% MBD as peritumoral injections within the breast parenchyma and intradermally. Patients who developed local skin lesions at the injection site were queried regarding lesion appearance and when subsequent adjuvant therapy was initiated. RESULTS Five of the 24 patients (21%) developed skin lesions at the injection site. Intradermal injections were discontinued, and only deep parenchymal injections were performed. All 5 patients had improvement of their skin lesions with silver sulfadiazine cream and no patient required debridement. Each patient received adjuvant therapy after surgery without delay. CONCLUSIONS Our institution has experienced patients who developed skin lesions at the MBD injection site when using combined deep parenchymal and intradermal injections. With the increased use of MBD, caution should be used to avoid intradermal injections with SLN localization.
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Affiliation(s)
- Benjamin Stradling
- Chicago College of Osteopathic Medicine of Midwestern University, Chicago, IL, USA
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Abstract
BACKGROUND Endoscopic marking of intestinal lesions is essential when difficulty is anticipated with subsequent localization during surgical resection or postpolypectomy surveillance. The most commonly used indelible marker has been India ink, which must be diluted and sterilized, a cumbersome process. SPOT, a prepackaged, sterile Food and Drug Administration-approved formulation of pure carbon particles in suspension, eliminates the need for preinjection preparation. METHODS Ten patients with colonic polyps deemed endoscopically unresectable or malignant-appearing had the area surrounding the lesions injected with SPOT and subsequently underwent surgical resection. An additional 103 patients underwent colonoscopic injection with SPOT and were followed endoscopically or underwent surgery at another hospital. RESULTS The SPOT injection sites were visible to the surgeons in all 10 cases. On histopathologic evaluation, none of the resection specimens exhibited necrosis or abscess formation. In total, there were 118 SPOT injections in 113 patients; none had fever, abdominal pain, or any other signs or symptoms of inflammation develop. In the nonoperated group, 42 patients subsequently underwent colonoscopies at our institution, and in all cases stains were readily identifiable at the injection sites. CONCLUSIONS SPOT is a safe and effective marker for use at colonoscopy when surgical resection is anticipated. It is also useful for endoscopic follow-up of patients who have not undergone surgery.
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Affiliation(s)
- Matthew P Askin
- Division of Gastroenterology, Mount Sinai Medical Center, New York, New York, USA
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Abstract
Indocyanine green has been reported previously as a useful agent for colonic tattooing, but its durability, ease of use, cost, and safety have not been compared with India ink. Eight pigs were randomized to colonic tattooing using sterile indocyanine green or India ink injected through tandem filters. The animals were recovered and killed after 2 weeks and were examined. All animals survived the study period with no complications. We identified 17 of 29 (59%) indocyanine green tattoos and 48 of 52 (92%) India ink tattoos at autopsy (p = 0.0003). Histologic reactions were mild and were distributed similarly in each group and the intensity of the tattoos diminished similarly in both groups. Although indocyanine green was slightly more expensive, it was easier to handle compared with India ink. Both indocyanine green and India ink tattoos cause only mild histologic reaction in the swine colon when examined 2 weeks after injection. India ink is superior to indocyanine green, when used for colonic tattooing.
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Affiliation(s)
- J G Lee
- Division of Gastroenterology, UC Davis Medical Center, Sacramento, California 95817, USA.
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Price N, Gottfried MR, Clary E, Lawson DC, Baillie J, Mergener K, Westcott C, Eubanks S, Pappas TN. Safety and efficacy of India ink and indocyanine green as colonic tattooing agents. Gastrointest Endosc 2000; 51:438-42. [PMID: 10744816 DOI: 10.1016/s0016-5107(00)70445-7] [Citation(s) in RCA: 77] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Controversy exists concerning the safety and efficacy of colonic tattooing for the intraoperative identification of polypectomy sites. The purpose of this study was to determine (1) the concentrations of India ink and indocyanine green that resulted in high-visibility tattoos without significant tissue inflammation and (2) the India ink injection volume that produces best visibility at colonoscopy, laparoscopy, and laparotomy. METHODS Twenty-two New Zealand white rabbits (2 kg) were anesthetized and injected with India ink (undiluted 1:10, 1:50, 1:100, 1:1000, 1:10,000) and indocyanine green as an undiluted, concentrated formulation (25 mL/2 mL solvent) or in a diluted form (25 mg/5 mL solvent) at various concentrations (1:10, 1:50, 1:100). Tuberculin syringes were used to create a 0.1 mL serosal bleb at two injection sites 2 cm apart. Laparotomy was repeated at days 1, 3, and 7 after injection. Additionally, 16 rabbits were injected with India ink at laparotomy and re-explored at 1 and 5 months. Twelve mongrel dogs (20 kg) were injected with 1.0 mL volumes. Re-exploration by colonoscopy, laparoscopy, and laparotomy was done at 7 days and 1 month. Tattoo visibility at re-exploration in both animal models was graded on a scale (0 = agent not seen, 1 = seen with difficulty, 2 = easily seen). Histology in the rabbit was judged by degrees of inflammation (0 = no inflammation, 2 = mild inflammation, 4 = moderate inflammation, 6 = severe inflammation). RESULTS The concentrated indocyanine green solution was easily visible only on day 1 in the rabbit. Injections of both concentrated and diluted indocyanine green caused mucosal ulceration and moderate to severe inflammation. India ink studied at 7 days, 1 month, and 5 months after injection in the rabbit model was visible at all concentrations. The undiluted and 1:10 concentrations were easily seen and showed evidence of mucosal ulceration. Tattoos produced with all other India ink concentrations were visible without gross inflammation. India ink was also studied at 7 days and 1 month in dogs. The tattoo with the 1:100 concentration at 0.5 mL was seen consistently at colonoscopy, laparoscopy, and laparotomy with only a mild submucosal reaction at 7 days. The tattoos produced with the 1:100 and 1:1000 concentrations at 0.5 mL and 1.0 mL injection volumes were easily seen by all methods of intraabdominal visualization at 1 month with similar histology. CONCLUSION Indocyanine green was an ineffective colonic tattooing agent. India ink was an effective colonic tattooing agent. Dilute concentrations that caused little to no inflammation could be visualized at 7 days and 1 month in rabbits and dogs and at 5 months in rabbits. India ink, at appropriated concentrations, appears to be a safe short- and long-term colonic tattooing agent.
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Affiliation(s)
- N Price
- Departments of Surgery and Pathology, Division of Gastroenterology, and Veterans Affairs Medical Center, Durham, North Carolina, USA
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Sorbi D, Gostout CJ. Polyp identification and marking: Chromoscopy, high-resolution and high-magnification endoscopy, tattooing, and clipping. Techniques in Gastrointestinal Endoscopy 2000. [DOI: 10.1016/s1096-2883(00)80035-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Seshadri PA, Mamazza J, Poulin EC, Schlachta CM. Technique for Laparoscopic Gastric Surgery. Surg Laparosc Endosc Percutan Tech 1999. [DOI: 10.1097/00129689-199908000-00003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Affiliation(s)
- J D Cragan
- Division of Birth Defects and Developmental Disabilities, National Center for Environmental Health, Centers for Disease Control and Prevention, Public Health Service, US Department of Health and Human Services, Atlanta, Georgia 30333, USA
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Matsukuma S, Goda K, Sakai Y, Ikegawa K, Morita D, Kuwabara N. Histopathologic studies of colorectal postendoscopic resection sites: "skipping electrothermal injury" associated with endoscopic resection procedures. Am J Surg Pathol 1999; 23:459-64. [PMID: 10199476 DOI: 10.1097/00000478-199904000-00011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
To elucidate the pathologic changes due to endoscopic resection (ER), 32 post-ER sites in 24 surgically removed colorectal specimens and the previous ER specimens were examined. The depth of all the previous ER specimens was restricted to the submucosa, and all post-ER sites showed submucosal stromal changes of various degrees. Fourteen sites (43.8%) showed muscular or serosal changes. One of these lesions was considered to be a reaction to a tattoo agent, but all the other lesions were considered to represent skipping electrothermal injury caused by electrical current passing through the colorectal wall. The lesions consisted of muscular depletion in the inner layer of the muscularis propria (12 sites, 37.5%), hemorrhage or fibrosis between the inner and outer layers of the muscularis propria (3 sites, 9.4%), and serosal changes (10 sites, 31.3%). These skip regions would be vulnerable to electrical current. These findings suggest that asymptomatic electrothermal injury associated with ER is frequent. Statistically, the electrothermal injury appeared to be related to the size of the previous ER specimens. However. these results also reveal that the ER of tissues <10 mm can cause electrothermal injury and can result in full-thickness necrosis.
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Affiliation(s)
- S Matsukuma
- Department of Pathology, Japan Self Defense Forces Central Hospital, Tokyo
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