The risks of GI endoscopy

Design, simulation, and fabrication of an ingestible capsule with gastric balloon for obesity treatment

The treatment of obesity based only on lifestyle changes has been shown ineffectiveness in a long-term period. The development of more definitive and non-invasive therapies has been the subject of study. In this paper, a magnetically driven ingestible capsule with the capacity to inflate a gastric balloon is devised, simulated, and fabricated. The balloon is inflated to a volume of 150 ml using an acid-base reaction between citric acid and potassium bicarbonate. Finite element method simulations were performed to study the interaction between the permanent external magnet and the ingestible capsule and confirm the magnetic activation mechanism. A fabrication process was proposed to manufacture a polydimethylsiloxane (PDMS) balloon in a simple, functional, and reproducible way. The two layers and 1:8 ratio balloons are the most cost-effective without compromising their mechanical properties. The capsule body parts manufactured by a three-dimensional (3D) printing process - Digital Light Processing (DLP) showed high accuracy and excellent resolution. This study demonstrated that the proposed ingestible capsule would successfully inflate the gastric balloon to treat obesity.

Ergonomic Injuries in Endoscopists and Their Risk Factors

BACKGROUND/AIMS

Prolonged repetitive strain caused by the continuous performance of complex endoscopic procedures enhances the risk of ergonomic injuries among health-care providers (HCPs), specifically endoscopists. This study aimed to assess the risk factors of ergonomic injuries among endoscopists and non-endoscopists.

METHODS

This cross-sectional study was conducted at the Gastroenterology Department of Liaquat National Hospital, Karachi, Pakistan. A total of 92 HCPs were enrolled, of whom 61 were involved in endoscopic procedures and 31 were non-endoscopists. Data were collected through a self-administered questionnaire during national gastroenterology conferences and analyzed using SPSS version 22 (IBM Corp. Chicago, IL, USA).

RESULTS

Of the total study population, 95.08% of endoscopists were observed to have ergonomic injuries, whereas only 54.83% of non-endoscopists had ergonomic injuries (p<0.00). The most common injury associated with musculoskeletal (MSK) pain sites was back (41%), leg (23%), and hand (19.7%) pain among endoscopists. Of 28 endoscopists performing ≥20 procedures/week, 26 had MSK injury. However, 95.08% of endoscopists had developed MSK injury irrespective of working hours (>5 or <5 hr/wk).

CONCLUSION

Endoscopists are at high risk of developing ergonomic injuries, representing the negative potential of the endoscopy-associated workload. To overcome these issues, an appropriate strategic framework needs to be designed to avoid occupational compromises.

Musculoskeletal injuries in gastrointestinal endoscopists: a systematic review

Gastrointestinal(GI) endoscopy forms a significant proportion of clinicians' workloads. However, little attention is given to the ergonomic aspects of endoscopy. This systematic review of musculoskeletal pain and/or injuries in GI endoscopists aims to better understand the types of occupational injuries resulting from endoscopic procedures and associated risk factors. Areas covered: Systematic literature search conducted for articles evaluating prevalence, risk factors and mechanism of musculoskeletal pain and/or injuries related to GI endoscopy. In 13 included studies, 39-89% of surveyed endoscopists reported pain and/or injuries related to endoscopy. Common areas of pain were the back(15-57%), neck(9-46%), shoulders(9-19%), elbows(8-15%) and hands/fingers(14-82%). Risk factors included procedure volume, time spent doing endoscopy, cumulative time in practice and endoscopist age. Experimental studies showed that forces and loads placed on endoscopists' bodies during procedures place them at risk of occupational injury. Areas of pain differed between novice and experienced endoscopists implying separate mechanisms of injury. Expert commentary: Comprehensive investigation into the prevalence, types, pathophysiology and methods to minimise endoscopy-related musculoskeletal injuries is vital to ensure the continued efficient provision of endoscopy services in the face of rising demands worldwide. A paradigm shift is required in endoscopic devices and techniques to improve safety and comfort.

Prevalence and impact of musculoskeletal pain in Japanese gastrointestinal endoscopists: A controlled study

AIM: To examine the frequency and prevention of musculoskeletal pain in Japanese gastrointestinal endoscopists and non-endoscopist physicians.

METHODS: Questionnaires were sent to 275 endoscopists and 173 non-endoscopists working in Hiroshima University Hospital and its affiliated hospitals.

RESULTS: The completed questionnaires were returned by 190 (69%) endoscopists and 120 (69%) non-endoscopists. The frequency of pain in the hand and wrist, and especially the left thumb, was significantly higher in endoscopists than in non-endoscopists (17% vs 6%, P = 0.004). Using multivariate analysis, the only significant factor associated with this pain was the age of the endoscopist (odds ratio 2.77, 95% confidence interval, 1.23-6.71, P = 0.018). Interestingly, endoscopists had made significantly fewer modifications to their endoscopic practices than non-endoscopists (12% vs 33%, P < 0.0001) to prevent pain.

CONCLUSION: Pain in the hand and wrist may be endoscopy-related. However, endoscopists made little modifications in practice to prevent such pain. More attention to prevention appears necessary.

Accidental occupational injuries to endoscopy personnel in a high-volume endoscopy suite during the last decade: mechanisms, workplace hazards, and proposed remediation

INTRODUCTION

Scant data exist about accidental occupational injuries in endoscopy suites. This work systematically analyzes injuries, identifies workplace hazards, and proposes hazard remediation to potentially reduce risks.

METHODS

A retrospective study was performed on 14 previously unreported injuries among 120 endoscopy suite personnel in a high-volume endoscopy suite during 2000-2010, identified by medical records, employee records, and interviews. Injuries, mechanisms, outcomes, and workplace hazards were analyzed.

RESULTS

Seventeen endoscopy personnel suffered occupational accidents in an endoscopy suite, including three previously reported cases of tripping on exposed wires (rate = 1.35/100 worker-years). The 14 newly reported accidents include: hand crushed against narrow doorway while transporting patients, 4; striking head against ceiling-mounted video monitors, 3; slip and fall on wet floor, 3; injury while breaking patient's fall, 2; injury while turning patient during colonoscopy, 1; and tripping over misplaced wheelchair, 1. Injuries included: hand-crush injury, 4; myofascial back strain, 2; scalp laceration, 2; knee contusion, 2; and other, 4 (mean = 6.1 ± 15.5 lost workdays, 6.1 ± 10.1 restricted workdays). Two gastroenterologists suffered a torn tendon or coccyx fracture from slip and falls while working in the hospital. Proposed hazard remediation includes: replace bulky, heavy CRT video monitors with sleek, light LCD-flat-panel-screens to reduce likelihood and impact of head collisions; eliminate sharp edges on video monitor supports; widen doorways to accommodate extra-wide stretchers; slip-resistant flooring for rooms with frequent liquid spills; and parking wheelchairs away from traffic areas.

CONCLUSIONS

Potentially correctable design flaws may frequently contribute to accidents in endoscopy suites, including: bulky overhead video monitors, too narrow doors for extra-wide stretchers, absence of slip-resistant flooring, and wires exposed above the floor.