Health hazards and endoscopy: the known and newly experienced--a personal report

American Society for Gastrointestinal Endoscopy guideline on the role of ergonomics for prevention of endoscopy-related injury: summary and recommendations

This clinical practice guideline from the American Society for Gastrointestinal Endoscopy provides an evidence-based approach to strategies to prevent endoscopy-related injury (ERI) in GI endoscopists. It is accompanied by the article subtitled "Methodology and Review of Evidence," which provides a detailed account of the methodology used for the evidence review. This document was developed using the Grading of Recommendations Assessment, Development and Evaluation framework. The guideline estimates the rates, sites, and predictors of ERI. Additionally, it addresses the role of ergonomics training, microbreaks and macrobreaks, monitor and table positions, antifatigue mats, and use of ancillary devices in decreasing the risk of ERI. We recommend formal ergonomics education and neutral posture during the performance of endoscopy, achieved through adjustable monitor and optimal procedure table position, to reduce the risk of ERI. We suggest taking microbreaks and scheduled macrobreaks and using antifatigue mats during procedures to prevent ERI. We suggest the use of ancillary devices in those with risk factors predisposing them to ERI.

Occupation-associated health hazards for the gastroenterologist/endoscopist

Advances in the field of endoscopy have allowed gastroenterologists to obtain detailed imaging of anatomical structures and to treat gastrointestinal diseases with endoscopic therapies. However, these technological developments have exposed endoscopists and staff to hazards such as musculoskeletal injuries, exposure to infectious agents, and ionizing radiation. We aimed to review the occupational hazards for the gastroenterologist and endoscopist. Using PubMed, Medline, Medscape, and Google Scholar, we identified peer-reviewed articles with the keywords “occupational hazards,” “health hazards,” “occupational health hazards,” “endoscopy,” “gastroenterologist,” “infectious agents,” “musculoskeletal injuries,” and “radiation.” Strategies for reducing exposure to infectious agents, radiation, and the risk of musculoskeletal injuries related to gastroenterology include compliance with established standard measures, the use of thyroid shields and radioprotective eyewear, and ergonomic practices. We conclude that educating endoscopic personnel and trainees in these practices, in addition to further research in these areas, will likely lead to the development of more efficient and user-friendly workspaces that are safer for patients and personnel.

Review of musculoskeletal injuries and prevention in the endoscopy practitioner

Practitioners of endoscopy often experience musculoskeletal pain and injury (most often in the back, neck, shoulders, hands, wrists, and thumbs) that are associated with the minute and repetitive strain that is placed on these areas during endoscopic procedures. This review of the current documentation of endoscopy-related pain and injuries among practitioners finds that such problems are widespread and specific in kind as well as strongly correlated with high procedure volume and procedure duration. Research on the nature and impact of cumulative trauma and overuse syndromes in other professions such as dentistry, pianists, production labor, and athletics is brought to bear on the work of the endoscopist. A more thorough understanding of the nature and prevalence of work-related pain and injury sustained by endoscopists should inform further development of ergonomic practices and equipment design. This article reviews current recommendations for ergonomic design in the endoscopy procedure space and finds that reported compliance with those recommendations is quite low. Strategies for the management of the risk of musculoskeletal injuries related to the practice of endoscopy include compliance with currently recommended ergonomic practices, education of trainees in ergonomic technique when practicing endoscopy, and research toward the modification and development of more ergonomic endoscopes and procedure spaces.

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.

Prevalence and impact of musculoskeletal injury among endoscopists: a controlled pilot study

BACKGROUND

Endoscopy-associated musculoskeletal injury has not been well studied. Our aim was to identify the frequency and significance of musculoskeletal injury among gastroenterologists compared with a similar group of nonprocedure-oriented internal medicine specialists and subspecialists.

METHODS

An electronic survey was developed and administered to all gastroenterologists and hepatologists [gastroenterologists (GI) group] and a sampling of nonprocedure-oriented internal medicine specialists and subspecialists (non-GI group) employed by Mayo Clinic. The questionnaire assessed several areas including current or past pain injury associated with performing endoscopy, location and description of pain or injury, impact of pain or injury, and prevention strategies. A modified survey was sent to the control group.

RESULTS

The response rate was 63% in the GI group and 45% in the non-GI group. The 2 groups were of similar age and level of physical activity. The frequency of musculoskeletal injury was higher in the GI group (74% vs. 35%; P<0.001). The most common sites of injury among the GI group were the thumb (19%), low back (19%), hand (17%), and neck (10%). There was no significant association between volume of endoscopy or years performing endoscopy and injury. Most of the GI group made modifications in their endoscopic practice to reduce injury risk.

CONCLUSIONS

Musculoskeletal injury occurs more commonly among gastroenterologists than nonprocedure-oriented internal medicine specialists. Most reported minor injuries, but members of the GI group tended to have more severe repercussions relating to ability to work. More attention to injury prevention is needed among gastroenterologists.

Randomized trial of a video headset vs. a conventional video monitor during colonoscopy

BACKGROUND

Head-mounted video displays recently became available for endoscopy. This study compared a video headset with a conventional monitor during colonoscopy.

METHODS

Five endoscopists were randomized to headset or to monitor use during colonoscopy. They completed a questionnaire that assessed image quality, procedure characteristics, and comfort. Medication use and length of procedure were recorded.

RESULTS

A total of 96 colonoscopies were performed. Image quality and comfort were rated as poorer during headset use (p < 0.05). However, neck strain was significantly reduced with the headset. Medication use and total procedure time were similar. There was a trend toward increased time to cecum with the headset (9.8 vs. 8.0 minutes, p = 0.055).

CONCLUSIONS

In this randomized study, comparing a video headset and a conventional monitor for colonoscopy, image quality and comfort were inferior with the headset, although neck strain was improved. Further improvements in technology are needed before headsets can be considered an acceptable alternative to the conventional video monitor for GI endoscopy.