Large polyps: Pearls for the referring and receiving endoscopist

Figure 2 Guidelines for placing an endoscopic tattoo prior to resection. As an overarching principle, the location of the tattoo relative to a polyp should be guided by anatomical factors and institutional practices in addition to being well-described and photodocumented in the procedure report. A: When tattooing with the intent of referral for surgical resection, the tattoo should generally be placed immediately distal to the polyp and circumferentially in multiple quadrants to facilitate intraoperative visualization; B: When tattooing with the intent of referral for advanced endoscopic resection, tattoo should not be injected into or under the polyp, and care should be taken to not inject an excess volume of ink, as this may spread submucosally toward the polyp and subsequently complicate resection; a single tattoo, 3-5 cm distal to the polyp (or one haustral fold distal), is generally appropriate.