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.

Publication History

Received: 09 June 2020

Accepted: 07 October 2020

Article published online:
01 January 2021

• References

• 1 Ofori E, Ramai D, John F. et al. Occupation-associated health hazards for the gastroenterologist/endoscopist. Ann Gastroenterol 2018; 31: 448-455
• 2 Levy I, Gralnek IM. Complications of diagnostic colonoscopy,upper endoscopy, and enteroscopy. Best Pract Res Clin Gastroenterol 2016; 30: 705-718
• 3 Bénard F, Barkun AN, Martel M. et al. Systematic review of colorectal cancer screening guidelines for average-risk adults: Summarizing the current global recommendations. World J Gastroenterol 2018; 1: 124-138
• 4 Shergill AK, Asundi KR, Barr A. et al. Pinch force and forearm muscle load during colonoscopy: a pilot study. Gastrointest Endosc 2009; 69: 142-146
• 5 Harvin G. Review of musculoskeletal injuries and prevention in the endoscopy practitioner. J Clin Gastroenterol 2014; 48: 590-594
• 6 Ridtitid W, Cote GA, Leung W. et al. Prevalence and risk factors for musculoskeletal injuries related to endoscopy. Gastrointest Endosc 2015; 81: 294-302.e4
• 7 Yung DE, Banfi T, Ciuti G. et al. Musculoskeletal injuries in gastrointestinal endoscopists: a systematic review. Expert Rev Gastroenterol Hepatol 2017; 11: 939-947
• 8 Mohankumar D, Garner H, Ruff K. et al. Characterization of right wrist posture during simulated colonoscopy: an application of kinematic analysis to the study of endoscopic maneuvers. Gastrointest Endosc 2014; 79: 480-489
• 9 Villa E, Attar B, Trick W. et al. Endoscopy-related musculoskeletal injuries in gastroenterology fellows. Endosc Int Open 2019; 07: E808-E812
• 10 Austin K, Schoenberger H, Sesto M. Musculoskeletal injuries are commonly reported among gastroenterology trainees: results of a national survey. Dig Dis Sci 2019; 64: 1439-1447
• 11 Kuwabara T, Urabe Y, Hiyama T. et al. Prevalence and impact of musculoskeletal pain in Japanese gastrointestinal endoscopists: a controlled study. World J Gastroenterol 2011; 17: 1488-1493
• 12 Morais R, Vilas-Boas F, Pereira P. et al. Prevalence, risk factors and global impact of musculoskeletal injuries among endoscopists: a nationwide European study. Endosc Int Open 2020; 8: E470-E480
• 13 Geraghty J, George R, Babbs C. A questionnaire study assessing overuse injuries in United Kingdom endoscopists and any effect from the introduction of the National Bowel Cancer Screening Program on these injuries. Gastrointest Endosc 2011; 73: 1069-1070
• 14 Buschbacher R. Overuse syndromes among endoscopists. Endoscopy 1994; 26: 539-544
• 15 Shergill AK, McQuaid KR. Ergonomic endoscopy: An oxymoron or realistic goal?. Gastrointest Endosc 2019; 90: 966-970
• 16 Cohen DL, Naik JR, Tamariz LJ. et al. The perception of gastroenterology fellows towards the relationship between hand size and endoscopic training. Dig Dis Sci 2008; 53: 1902-1909
• 17 Cappell MS. Colonoscopistʼs thumb: DeQuervainsʼs syndrome (tenosynovitis of the left thumb) associated with overuse during endoscopy. Gastrointest Endosc 2006; 64: 841-843
• 18 Pedrosa MC, Farraye FA. ASGE Technology Committee. et al. Minimizing occupational hazards in endoscopy: personal protective equipment, radiation safety, and ergonomics. Gastrointest Endosc 2010; 72: 227-235
• 19 Shergill AK, McQuaid KR, Rempel D. Ergonomics and GI endoscopy. Gastrointest Endosc 2009; 70: 145-153
• 20 Maciel DP, Millen RA, Xavier CA. et al. Musculoskeletal disorder related to the work of doctors who perform medical invasive evaluation. Work 2012; 41: 1860-1863
• 21 Khan R, Scaffidi MA, Satchwell J. et al. Impact of a simulation-based ergonomic training curriculum on work-related musculoskeletal injury risk in colonoscopy. Gastrointest Endosc 2020; 92: 1070-1080
• 22 Murphy J, Halloran S, Gray A. Cost-effectiveness of the faecal immunochemical test at a range of positivity thresholds compared with the guaiac faecal occult blood test in the NHS Bowel Cancer Screening Programme in England. BMJ Open 2017; 7: e017186