Journal of Surgery Concepts & Practice >

2026 , Vol. 31 >Issue 03: 270 - 276

DOI: https://doi.org/10.16139/j.1007-9610.2026.03.14

Review

Research advances in endoscopic tattooing technology

  • YANG Yunyi ,
  • LAI Yongkang ,
  • WANG Shige ,
  • ZHAO Jiulong ,
  • LI Zhaoshen
Expand
  • 1 Department of Gastroenterology, the First Affiliated Hospital of Naval Medical University (Shanghai Changhai Hospital), Shanghai 200433, China
    2 School of Materials and Chemistry, University of Shanghai for Science and Technology, Shanghai 200093, China

Received date: 2025-11-19

  Online published: 2026-08-11

Fold

Abstract

Endoscopic tattooing (ET) technology plays a crucial role in the diagnosis and treatment of gastrointestinal diseases. This article provided a systematic review of the development and current status of ET technology. It focused on the characteristics, advantages, and limitations of commonly used dyes such as India ink, Spot®, nanocarbon, indocyanine green, and methylene blue, as well as new types of marking materials. In terms of clinical applications, the article discussed in detail the practical value of this technique in various scenarios, including pre-surgical localization, lymph node tracking, post-endoscopic follow-up examinations, small bowel endoscopy rendezvous, navigation during endoscopic retrograde cholangiopancreatography (ERCP), and marking before neoadjuvant therapy. ET enables precise tracking of lesions and lymphatic drainage, providing essential visual guidance for diagnostic and therapeutic procedures. This thereby significantly enhances the accuracy and safety of treatments.

Key words： Endoscopic examination; Precise localization; Endoscopic tattooing(ET)

Cite this article

YANG Yunyi , LAI Yongkang , WANG Shige , ZHAO Jiulong , LI Zhaoshen . Research advances in endoscopic tattooing technology[J]. Journal of Surgery Concepts & Practice, 2026 , 31(03) : 270 -276 . DOI: 10.16139/j.1007-9610.2026.03.14

References

[1] ASGE Technology Committee, Kethu SR, Banerjee S, et al. Endoscopic tattooing[J]. Gastrointest Endosc, 2010, 72(4):681-685.
[2] Sauntry J P, Knudtson K P. A technique for marking the mucosa of the gastrointestinal tract after polypectomy[J]. Cancer, 1958, 11(3):607-610.
[3] Ponsky J L, King J F. Endoscopic marking of colonic lesions[J]. Gastrointest Endosc, 1975, 22(1):42-43.
[4] Shaffer R T, Francis J M, Carrougher J G, et al. India ink tattooing in the esophagus[J]. Gastrointest Endosc, 1998, 47(3):257-260.
[5] Wang Z, Zhang F, Zeng Z, et al. Application of Indian ink markers for locating gastric varices under endoscopic ultrasonography[J]. Surg Endosc, 2024, 38(2):633-639.
[6] Liou Y J, Weng S C, Chang P C, et al. Localization and laparoscopic excision of gastric heterotopic pancreas in a child by endoscopic SPOT(?) tattooing[J]. Children (Basel), 2023, 10(2):201.
[7] Price N, Gottfried M R, Clary E, et al. Safety and efficacy of India ink and indocyanine green as colonic tattooing agents[J]. Gastrointest Endosc, 2000, 51(4 Pt 1):438-442.
[8] Trakarnsanga A, Akaraviputh T. Endoscopic tattooing of colorectal lesions: is it a risk-free procedure?[J]. World J Gastrointest Endosc, 2011, 3(12):256-260.
[9] Sun B. Endoscopic tattooing: a risk for tumor implantation[J]. Int J Colorectal Dis, 2020, 35(3):571-574.
[10] ASGE Technology Committee, Bhatt A, Bucobo J C, et al. Submucosal injection fluid and tattoo agents[J]. Gastrointest Endosc, 2024, 100(5):797-806.
[11] Fu K I, Fujii T, Kato S, et al. A new endoscopic tattooing technique for identifying the location of colonic lesions during laparoscopic surgery: a comparison with the conventional technique[J]. Endoscopy, 2001, 33(8):687-691.
[12] Askin M P, Waye J D, Fiedler L, et al. Tattoo of colonic neoplasms in 113 patients with a new sterile carbon compound[J]. Gastrointest Endosc, 2002, 56(3):339-342.
[13] 中华医学会消化内镜学分会. 消化内镜下纳米炭注射标记定位技术临床操作专家共识[J]. 中华消化内镜杂志, 2022, 39(11):860-869.
  Chinese Society of Digestive Endoscopology. Expert consensus on the practice of endoscopic nanocarbon tattooing[J]. Chin J Dig Endosc, 2022, 39(11):860-869.
[14] Zhu C, Wang J, Wu Q, et al. Safety and efficacy of carbon nanoparticle-labeled lymph node dissection in radical resection of gastric cancer: a systematic review and meta-analysis[J]. Technol Cancer Res Treat, 2023, 22:15330338231154094.
[15] Curell A, Balibrea J M. Finding lymph nodes with carbon nanoparticle suspension injection[J]. JAMA Netw Open, 2022, 5(4):e227759.
[16] Qu T, Zeng G, Yang J, et al. Sentinel lymph node biopsy mapped with carbon nanoparticle suspensions in patients with cervical cancer: a systematic review and meta-analysis[J]. Jpn J Clin Oncol, 2025, 55(8):889-900.
[17] Wang W, Wang R, Wang Y, et al. Preoperative colonic lesion localization with charcoal nanoparticle tattooing for laparoscopic colorectal surgery[J]. J Biomed Nanotechnol, 2013, 9(12):2123-2125.
[18] Hammond D C, Lane F R, Welk R A, et al. Endoscopic tattooing of the colon. An experimental study[J]. Am Surg, 1989, 55(7):457-461.
[19] Watanabe M, Tsunoda A, Narita K, et al. Colonic tattooing using fluorescence imaging with light-emitting diode-activated indocyanine green: a feasibility study[J]. Surg Today, 2009, 39(3):214-218.
[20] Nagata J, Fukunaga Y, Akiyoshi T, et al. Colonic marking with near-infrared, light-emitting, diode-activated indocyanine green for laparoscopic colorectal surgery[J]. Dis Colon Rectum, 2016, 59(2):e14-e18.
[21] Morimoto Y, Kobayashi A, Yamazaki N, et al. Preoperative indocyanine green tattooing for robotic‐assisted surgery in rectal cancer[J]. Asian J Endosc Surg, 2025, 18(1):e70035.
[22] 张再重, 王瑜. 内镜下染色标记技术在精准胃肠外科中的应用[J]. 中华胃肠外科杂志, 2017, 20(10):1203-1205.
  Zhang Zaizhong, Wang Yu. Application of endoscopic staining and marking technique in precise gastrointestinal surgery[J]. Chin J Gastrointest Surg, 2017, 20(10):1203-1205.
[23] Jeong O, Cho S B, Joo Y E, et al. Novel technique for intraoperative tumor localization during totally laparoscopic distal gastrectomy: endoscopic autologous blood tattooing[J]. Surg Endosc, 2012, 26(6):1778-1783.
[24] Lee S H, Kim D Y, Oh S Y, et al. Preoperative localization of early colorectal cancer or a malignant polyp by using the patient's own blood[J]. Ann Coloproctol, 2014, 30(3):115-117.
[25] Kim H K, Kim H S, Nam J H, et al. Safety and efficacy of autologous blood tattooing for preoperative colonic loca-lization: a comparative study with conventional India ink tattooing[J]. Tech Coloproctol, 2024, 28(1):117.
[26] 陈伟, 陈永梅, 郑成辉. 内镜黏膜下注射自体血在早期肠癌内镜标记定位中的应用研究[J]. 中国当代医药, 2026, 33(1):59-62,67.
  Chen Wei, Chen Yongmei, Zheng Chenghui. Study on application of endoscopic submucosal injection of autologous blood for the localization of endoscopic markers in early colorectal cancer[J]. China Modern Medicine, 2026, 33(1):59-62,67.
[27] 张海斌, 张顺, 蒋小华, 等. 术前内镜下自体血标记定位应用于腹腔镜结直肠肿瘤手术的临床效果分析[J]. 中华消化内镜杂志, 2022, 39(11):925-927.
  Zhang Haibin, Zhang Shun, Jiang Xiaohua, et al. Application of preoperative colonoscopic autologous blood labeling to localization for laparoscopic colorectal surgery[J]. Chin J Dig Endosc, 2022, 39(11):925-927.
[28] Wlodarczyk J, Kim D, Finney C, et al. Inking outside the box: systematic review on the utility of tattooing lesions in rectal cancer[J]. Int J Colorectal Dis, 2022, 37(10):2101-2112.
[29] Barberio M, Pizzicannella M, Laracca G G, et al. Endoscopic preoperative tattooing and marking in the gastrointestinal tract: a systematic review of alternative methods[J]. J Laparoendosc Adv Surg Tech A, 2020, 30(9):953-961.
[30] Lai Y, Jiang M, Zhang X, et al. Novel endoscopic tattooing dye based on polyvinylpyrrolidone-modified polydopamine nanoparticles for labeling gastrointestinal lesions[J]. J Mater Chem B, 2024, 12(37):9345-9356.
[31] Zhang L, Jiang M, Chen Z, et al. A novel polymer platform for endoscopic tattooing with high efficacy and safety[J]. Front Bioeng Biotechnol, 2024, 12:1409681.
[32] Thomaschewski M, Lipp M, Engelke C, et al. Near-infrared fluorescence tattooing: a new approach for endoscopic marking of tumors in minimally invasive colorectal surgery using a persistent near-infrared marker[J]. Surg Endosc, 2023, 37(12):9690-9697.
[33] Kwon H J, Shin H H, Hyun D H, et al. Carbon black-containing self-healing adhesive hydrogels for endoscopic tattooing[J]. Sci Rep, 2023, 13(1):1880.
[34] Jeong S H, Seo K W, Min J S. Intraoperative tumor locali-zation of early gastric cancers[J]. J Gastric Cancer, 2021, 21(1):4-15.
[35] 谢永伟, 周顺楷, 冯学刚, 等. 术前超声内镜下染色定位技术在食管胃结合部腺癌中的应用[J]. 中华胸心血管外科杂志, 2019, 35(10):612-616.
  Xie Yongwei, Zhou Shunkai, Feng Xuegang, et al. Application of preoperative endoscopic ultrasonography locali-zation in adenocarcinoma of the esophagogastric junction[J]. Chin J Thorac Cardiovasc Surg, 2019, 35(10):612-616.
[36] Bartels S A L, van der Zaag E S, Dekker E, et al. The effect of colonoscopic tattooing on lymph node retrieval and sentinel lymph node mapping[J]. Gastrointest Endosc, 2012, 76(4):793-800.
[37] Tian Y, Pang Y, Yang P, et al. Effect of carbon nanoparticle suspension injection versus indocyanine green tracer in guiding lymph node dissection during radical gastrectomy (FUTURE-01): a randomized clinical trial[J]. Int J Surg, 2025, 111(1):609-616.
[38] Cassinotti E, Al-Taher M, Antoniou S A, et al. European Association for Endoscopic Surgery (EAES) consensus on indocyanine green (ICG) fluorescence-guided surgery[J]. Surg Endosc, 2023, 37(3):1629-1648.
[39] Ahn H-M, Son G M, Lee I Y, et al. Optimal ICG dosage of preoperative colonoscopic tattooing for fluorescence-guided laparoscopic colorectal surgery[J]. Surg Endosc, 2022, 36(2):1152-1163.
[40] Koimtzis G, Stefanopoulos L, Alexandrou V, et al. The role of carbon nanoparticles in lymph node dissection and parathyroid gland preservation during surgery for thyroid cancer: a systematic review and meta-analysis[J]. Cancers (Basel), 2022, 14(16):4016.
[41] Kuczma P, Demarchi MS, Leboulleux S, et al. Central node dissection in papillary thyroid carcinoma in the era of near-infrared fluorescence[J]. Front Endocrinol (Lausanne), 2023, 14:1110489.
[42] Medina-Prado L, Hassan C, Dekker E, et al. When and how to use endoscopic tattooing in the colon: an international delphi agreement[J]. Clin Gastroenterol Hepatol, 2021, 19(5):1038-1050.
[43] 李由, 冷蔚, 缪克红, 等. 纳米炭在结直肠肿瘤内镜下切除后追加腹腔镜手术中的应用[J]. 中外医学研究, 2021, 19(5):40-42.
  Li You, Leng Wei, Miao Kehong, et al. Application of carbon nanoparticles in laparoscopic surgery after endoscopic resection of colorectal tumors[J]. Chin Foreign Med Res, 2021, 19(5):40-42.
[44] 中华医学会消化内镜学分会小肠镜和胶囊内镜学组. 中国小肠镜临床应用指南[J]. 中华消化内镜杂志, 2018, 35(10):693-702.
  Enteroscopy Group of Chinese Society of Digestive Endoscopy. Clinical guidelines for enteroscopy in China[J]. Chin J Dig Endosc, 2018, 35(10):693-702.
[45] 王源钊, 张文昊, 杨劲, 等. 内镜纳米炭标记技术辅助直肠癌新辅助放化疗后原位切除46例临床分析[J]. 中国微创外科杂志, 2023, 23(12):891-897.
  Wang Yuanzhao, Zhang Wenhao, Yang Jin, et al. Endoscopic carbon nanoparticles labeling technique assisted in situ resection after neoadjuvant chemoradiotherapy for rectal cancer: clinical analysis of 46 cases[J]. Chin J Minim Invasive Surg, 2023, 23(12):891-897.
Options
Outlines

/

〈 〉