CHICAGO—Accumulating research is revealing the scope of occupational injuries to providers in the endoscopy suite. Repetitive movements, high procedural volume and lack of foundational ergonomic education mean endoscopists are prone to occupational injuries, resulting in missed or unproductive workdays and increased disability. New research presented at Digestive Disease Week 2023 shows that approximately two-thirds have reported an injury and about one-third are currently in pain.
7 in 10 Endoscopists
Two new meta-analyses have demonstrated much the same results as previous single-center surveys: Around two-thirds of endoscopists are reporting injuries; many of them are injuries to the back. In one meta-analysis of 18 studies involving around 5,000 endoscopists, 65% reported endoscopy-related injuries. Just shy of 10% said they missed workdays or reported low productivity on workdays, and 1% developed long-term disability as a result of their injuries. In addition, nearly 70% said they would like to be trained in ergonomics, while only 37% reported they had received such training, according to researcher Achintya D. Singh, MD, MBBS, a first-year GI fellow at MetroHealth Medical Center and Case Western Reserve University, in Cleveland (abstract Sa1146).
“Workplace injuries were reported by nearly seven out of 10 endoscopists. This leads to missed workdays, modification in clinical practice to reduce the number of daily procedures, and short-term and long-term disabilities,” Dr. Singh said. “Like athletes, endoscopists need to remain mindful of our techniques and high injury risks.”
In another meta-analysis involving 12 cross-sectional studies, general back injury was the most commonly reported musculoskeletal injury (43%), followed by neck (21%) and thumb (20%) injuries; 8% of endoscopists reported taking a leave of absence because of such injuries.
“Injuries involving the extremities were somewhat less prevalent, which is surprising because of our repetitive movements,” said researcher Parth M. Desai, DO, a GI fellow at Tower Health-Reading Hospital, in West Reading, Pa. (abstract Sa1063). “While about half of endoscopists were using adjustable beds, tables and monitors, other ergonomic strategies were not highly employed. Even routine breaks were uncommon, reported by only 18% of physicians.
But Dr. Desai predicted that younger endoscopists will suffer fewer ergonomic injuries. “In our training now, we do have a general awareness of the potential for injury, and our attendings are focused on helping us prevent the kinds they have suffered. I think that with this heightened awareness, the field will be seeing less workplace injury,” Dr. Desai offered.
Linking Surveys To Physical Exams
In another new study, investigators at the University of Utah queried its own group of 35 endoscopists (faculty and fellows) about symptoms and confirmed their complaints via objective testing. The study seems to be the first to correlate symptoms of injury with physical exam findings of decreased function, said lead investigator John C. Fang, MD, the division chief and a professor of medicine in the Division of Gastroenterology, Hepatology and Nutrition at the University of Utah Hospital and Huntsman Cancer Institute, in Salt Lake City (abstract Mo1065).
Endoscopists completed two questionnaires: a self-report of symptoms related to performing endoscopy procedures (43 questions) and the QuickDASH (Disability of Arm, Shoulder, Hand) questionnaire evaluating the impact of symptoms on activities. Participants then underwent evaluation by occupational therapists, consisting of strength testing and a series of provocative tests to identify clinical evidence of injury. The researchers also analyzed demographic factors, symptoms and signs of injury for correlations.
Over one-third reported current pain and nearly one-fifth reported numbness. In the week prior, almost half of the participants had been bothered by pain, and others reported tingling, interrupted sleep and limitations in work duties.
Physical testing indicated that many endoscopists had below normal strength in right grip (48.6%) and left grip (42.9%), and the majority had below normal pinch strengths for their age and sex (88.6%). Finally, 71.4% of the group had at least one abnormal positive provocative test. In the correlation analysis, the researchers were able to link different symptoms:
- Higher QuickDASH disability scores were linked with numbness at night and current pain.
- Current pain was associated with performing at least 20 procedures per week.
- A positive provocative test of the neck or elbow was linked with below normal pinch and grip strength.
- Fewer years or hours of procedures were associated with lower QuickDASH disability scores.
- Performing endoscopic retrograde cholangiopancreatography 20% to 60% of the week was linked to decreased bilateral pinch strength.
“The results from our self-report survey suggest that symptoms of repetitive use injury are high in our inclusive group of endoscopists and in the range reported previously (29%-89%),” Dr. Fang said, emphasizing these were largely confirmed by physical examination and provocative testing. “The reported symptoms and physical evidence of repetitive use injury are related to the duration of performing the endoscopy and the type of procedure.”
GI Field ‘Can’t Afford’ Workplace Injuries
Amandeep Shergill, MD, MS, a professor of clinical medicine at the University of California, San Francisco, and the chief of the Division of Gastroenterology at the San Francisco VA Health Care System, lectured on endoscopy-related injuries at DDW 2023 and commented on the topic for Gastroenterology & Endoscopy News. These injuries, she noted, are the result of high-risk exposures that occur “when interacting with our tools and our work environment during a busy endoscopy day.”
Pain in the back, neck and lower extremities is related to the static loads from prolonged standing during endoscopy; these can be exacerbated if room setup is not optimized to accommodate a neutral standing posture for the breadth of endoscopists. Pain in the distal upper extremities is related to both the static load of the endoscope and the high-force, repetitive movements in non-neutral postures that are required to mechanically manipulate the endoscope control section and insertion tube, Dr. Shergill explained. (See box on page 18 for tips to make your setup more ergonomic.)
“With a projected shortage of over 1,500 gastroenterologists by 2025, we cannot afford to lose additional gastroenterologists to injury from performing endoscopy,” she said. “Ergonomic education is foundational to ensuring best practice.”
—Caroline Helwick
Drs. Desai and Singh reported no relevant financial disclosures. Dr. Fang reported a financial relationship with Merit Medical. Dr. Shergill reported financial relationships with Boston Scientific, Intuitive Surgical, Neptune and Pentax.
This article is from the September 2023 print issue.