Upper Gastrointestinal Bleed Embolization with Onyx(®): The “Tattoo Effect”

Endoscopic intervention is well validated for the control of upper gastrointestinal bleeding (UGIB). In cases of refractory bleeding, transarterial embolization is a safe and effective alternative. Ethylene vinyl alcohol (EVOH) commonly known as Onyx(®) is an inherently black liquid embolic approved for use in cerebrovascular arteriovenous malformations and is increasingly used as an embolic agent in multiple peripheral and visceral territories. Onyx(®) has a uniquely undesirable property of causing black color discoloration when used in peripheral applications adjacent to the skin akin to a “tattoo effect.” Knowledge of the agents used by the interventional radiologist, clinical correlation, and close follow-up can be of paramount importance to avoid unnecessary surgical intervention. Here, we report a case demonstrating this “tattoo effect” on the gastric mucosa following UGIB embolization.