Take The N t Step In The Fight Against Colon Cancer

Ex

Spot® Ex Endoscopic Tattoo

Spot®

Ex Endoscopic Tattoo Take the next step in the fight against colon cancer

1ESGE Clinical Guideline. Colorectal polypectomy and endoscopic mucosal resection (EMR). 2017. 2Easier identification at follow-up procedures as compared to no tattoo. 3CMS 2018 National Payment for Tissues Marking (CPT 45381).

panded indications support adoption of guidelines 1

pedite localization at follow-up procedures 2

ceedingly cost- effective 3

Ex

Ex

Ex

Spot®

Ex: panded Indications Support Adoption of Guidelines

Ex

In 121 follow-up exams of patients previously tattooed with Spot, 100% were visible, up to 11 years later.2

Long-term Visibility of Endoscopic Tattoos Using Sterile Carbon Suspension in a Pre-filled Syringe

Jackson FW. Long-term Visibility of Endoscopic Tattoos Using Sterile Carbon Suspension in a Pre-filled Syringe. Am J Gastroenterol. 2017; 112:S1–S45.

Now Indicated for Clinical Surveillance

and Surgical Localization1

Spot®

Ex is Permanent1, Enabling a Lifetime of Follow-up Procedures

1Spot® Ex Indication. Instructions For Use. Rev 01. Jan 2018.2Jackson FW. Long-term Visibility of Endoscopic Tattoos Using Sterile Carbon Suspension in a Prefilled Syringe. Am J Gastroenterol. 2017; 112:S1–S45.

1 Ferlitsch M, Moss A, Hassan C, et al. Colorectal polypectomy and endoscopic mucosal resection (EMR): ESGE Clinical Guideline. 2017.2 Rex D, Schoenfeld P, Cohen J, et al. Quality Indicators for Colonoscopy. Am J Gastroenterol. 2014: 1-19.3 Rees C, Bevan R, Zimmerman-Fraedrich K, et al. Expert opinions and scientific evidence for colonoscopy key performance indicators. Gut BMJ. 2016. 4 SAGES. Guidelines for laparoscopic resection of curable colon and rectal cancer. 2012.

Spot

Ex Tattoos Are Society Recommended

“Colonoscopic tattooing is performed to enable future identification, at colonoscopy or surgery, of malignant lesions (proven or suspected), polypectomy, EMR, or ESD sites, difficult-to-detect polyps, or dysplastic areas. All such lesions, other than those definitely located in the cecum, adjacent to the ileocecal valve, or in the low rectum, should be tattooed.” 1

ESGE

1 Lee. P., Finding Endoscopic Tattoos: The Impact of Contrast. GI Supply. 2018.2 Spot Ex Luminosity Lab Results. Northwestern Biological Imaging Facility. Nov 2017

Even Easier To Use Spot Ex Is Easier To Find1

Zero-Step Prep™ syringe, and a Roll-Proof Cap

Because it is 50% darker than Spot2

Spot®

Ex: pedite Localization At Follow-up Procedures

Ex

Current Procedural Terminology (CPT) Copyright 2018 American Medical Association (AMA). Source: 2018 – CMS-1676-F, CMS-1678-F Addendum B, and CMS-1678-F Addendum AA

Colonoscopy with Polyp Removal,

Snare (CPT 45385)

If Tissue Marking Is Additionally

Done (CPT 45381)

Physician(Facility)

ASC

HospitalOutpatient

Spot® Ex: ceedingly Cost Effective

2018 CMS Tissue Marking National Payment

Ex

RVU: 4.57 RVU: 3.56

$269 $17

(Total $286)

$488 $244

(Total $732)

$936 $468

(Total $1,404)

+

+

+

Storage

Store uprightor on its side

Keep at room temperature

2-year shelf life 2yr

Getting Started

Preparation

Shake it

Attach it

Prime it

Mucosa

Submucosa

MuscleLayers

Serosa

Colon

LateralSpreadingTumor

2 -3cmDistal from Tumor

Spot® Ex InjectionSite

Tattoo 3 – 4Quadrants Around the Lumen

30-40˚

Submucosal Injection

Mucosa

Submucosa

MuscleLayers

Serosa

Colon

LateralSpreadingTumor

2 -3cmDistal from Tumor

Spot™ InjectionSite

Tattoo 3 – 4Quadrants Around the Lumen

30-40˚

Mucosa

Submucosa

MuscleLayers

Serosa

Colon

LateralSpreadingTumor

2 -3cmDistal from Tumor

Spot™ InjectionSite

Tattoo 3 – 4Quadrants Around the Lumen

30-40˚

Rex DK. Driving patient safety with endoscopic tattooing. Gastroenterology and Endoscopy News. 2015 May

1. Place injection 2-3 cm distal (downstream) of the area of interest.

2. Inject tangentially, at a 30-40˚ angle to the mucosa.

3. Create a saline bleb to find the submucosal plane prior to injecting Spot® Ex to reduce risk of intramural injection.

4. Place Spot® Ex tattoos in 3-4 quadrants around the lumen to increase likelihood of visualization.

5. Use 0.5-0.75 mL per injection site, and no more than 8 mL per patient.

Documentation

• Use text and photo documentation in your reports with unambiguous terminology.

• Document both the depth of scope and anatomic location of each tattoo.

• Indicate where and how many tattoos were placed at each area of interest.

Rex DK. Driving patient safety with endoscopic tattooing. Gastroenterology and Endoscopy News. 2015 May

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