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Endoscopic placement of a permanent tattoo has become an important clinical tool for locating colonic tumors during subsequent surgical resection when there are no reliable endoscopic landmarks. This technique is particularly critical during laparoscopic colectomy because surgeons cannot palpate the bowel to identify tumors. Further, tattooing is useful for marking polypectomy scars for subsequent colonoscopic surveillance. India ink generally has been used for tattooing lesions, but it has been associated with rare complications, which are presumably related to inflammatory responses to additives in the ink. SPOT is a pure carbon-based permanent marker that contains no additives and that has been approved by the FDA for colonic tattooing. …