Colonoscopy-related injury among colonoscopists: an international survey

Abstract

Background and study aims Colonoscopy is physically demanding for endoscopists and patients. Repetitive movements during colonoscopy can lead to overuse injuries. We aimed to explore the prevalence and range of colonoscopy-related musculoskeletal injuries (CRIs) in endoscopists. Methods A cross-sectional electronic survey of 1825 endoscopists was performed. The sample was composed of members of the British Society of Gastroenterology, European Society of Gastrointestinal Endoscopy, and National Nurse Endoscopy Group (UK). The survey comprised 20 questions. These included: endoscopists’ workload, level of experience, and their perceived CRIs. All endoscopists who perform colonoscopy independently were included in the analysis. Results A total of 368 questionnaires were completed of 1825 surveyed (20.16 %). Of those, 319 participants (17.48 %) were fully independent in colonoscopy. Of 319 endoscopists, 254 (79.6 %) have experienced musculoskeletal injuries. These were reported as either possibly (n = 143, 56.3 %) or definitely (n = 90, 35.4 %) related to colonoscopy. Commonly injured areas were the lower back (n = 85, 36.5 %), neck (n = 82, 35.2 %) and left thumb (n = 79, 33.9 %). Of the injured endoscopists, 98 (30.7 %) made some modification to their practice, such as stretching exercises and ergonomic changes. Of the endoscopists, 134 (42.0 %) thought that repetitive limb strain was a likely causative mechanism. Around 40 % believed that torquing the scope and challenging body position were precipitating CRIs. Several treatment modalities were used to treat CRIs. These included; physiotherapy (n = 109), medications (n = 70), rest (n = 43), splinting (n = 31), steroid injections (n = 26) and surgery (n = 11). Conclusions A significant proportion of colonoscopists experience CRIs. The majority of the suggested modifications to practice can be adopted by any endoscopist. These results highlight the need to recognise CRI as an important occupational health hazard and to adopt preventative strategies routinely in the future.

Gastrointestinal endoscopy and work-related injuries: an international survey

“…Recently, awareness of MSIs among gastrointestinal endoscopists has increased in response to their impact on clinicians and subsequent effects on resources, cost, and quality of the health care system 5 7 9 . In this study, 53 % of the interviewed endoscopists had experienced at least one work-related MSI, in line with previous publications reporting an occurrence between 37 % and 89 % 8 9 10 11 12 14 15 17 18 19 20 . More than 30 % of those experiencing MSIs had such severe problems that they were not be able to work.…”

“…In line with previous studies 8 9 10 14 15 18 20 33 , neck, upper and lower back, shoulder, wrist, and thumb were the primary locations of MSIs. Women were more likely than men to have neck (52 % vs. 43 %) and thumb pain (49 % vs. 31 %), while male clinicians more frequently reported lower back pain (37 % vs. 15 %) 9 .…”

“…Gastrointestinal endoscopy can be considered an extremely high-intensity endurance activity 1 , with long standing periods and a continuous application of forces and torques 9 12 17 18 25 , especially in colonoscopy and ERCP. Performing a warmup (stretching or mobility exercise) before a procedure has been demonstrated to be beneficial for gastrointestinal endoscopists, as it is for athletes 1 .…”

“…As a result, only considering hand size as an injury risk factor is not sufficient, since due to the movement adaptation, each user is overloading a particular joint differently from other endoscopists [6]. Gastrointestinal endoscopy can be considered an extremely high-intensity endurance activity [1], with long standing periods and a continuous application of forces and torques [9,12,17,18,25], especially in colonoscopy and ERCP. Performing a warmup (stretching or mobility exercise) before a procedure has been demonstrated to be beneficial for gastrointestinal endoscopists, as it is for athletes [1].…”

“…MSIs are frequent in gastrointestinal endoscopy: Previous studies show that MSIs range from 37 % to 89 % among gastrointestinal endoscopists 8 9 10 11 12 14 15 17 18 19 20 , and are experienced in many joints, from the lumbar area to neck and upper limbs’ joints 8 9 12 14 17 18 . The most reported MSIs are hand numbness, DeQuervain’s tenosynovitis, and carpal tunnel syndrome 9 13 15 21 22 .…”