Can single-use versus standard duodenoscope improve ergonomics in ERCP? A comparative, simulation-based pilot study

Abstract

Background and study aims Musculoskeletal disorders (MSDs) and injuries (MSIs) are frequent in gastrointestinal endoscopy. The aim of this study was to assess potential ergonomic advantages of a lighter single-use duodenoscope compared with a standard reusable one for endoscopists performing endoscopic retrograde cholangiopancreatography (ERCP).

Methods Three experienced endoscopists performed an ergonomic, preclinical, comparative protocol-guided simulation study of a single-use and a standard reusable duodenoscope using an anatomic bench model. Surface EMG signals from left forearm and arm muscles were recorded. A commercial inertial sensor-based motion capture system was applied to record body posture as well.

Results A significant lowering of root mean square amplitude and amplitude distribution of biceps brachii signal (ranging from 13% to 42%) was recorded in all the participants when using a single-use duodenoscope compared with a reusable one. An overall reduction of muscle activation amplitude and duration was also associated with the single-use duodenoscope for forearm muscles, with different behaviors among subjects. Participants spent most of the time in wrist extension (> 80%) and ulnar deviation (> 65%). A consistent pattern of functional range of motion employed for completing all procedures was observed.

Conclusions Our study showed that a lighter scope has a promising effect in reducing upper arm muscle activity during ERCP with potential benefit on musculoskeletal health in the ERCP setting.

Keywords

ERC topics - Pancreatobiliary (ERCP/PTCD) - Diagnostic ERC - Quality and logistical aspects - Quality management

Publikationsverlauf

Eingereicht: 14. September 2023

Angenommen nach Revision: 12. Dezember 2023

Accepted Manuscript online:
18. Dezember 2023

Artikel online veröffentlicht:
18. März 2024

• References

• 1 Shergill AK, Asundi KR, Barr A. et al. Pinch force and forearm-muscle load during routine colonoscopy: a pilot study. Gastrointest Endosc 2009; 69: 142-146
• 2 Campbell 3rd EV, Muniraj T, Aslanian HR. et al. Musculoskeletal pain symptoms and injuries among endoscopists who perform ERCP. Dig Dis Sci 2021; 66: 56-62
• 3 O'Sullivan S, Bridge G, Ponich T. Musculoskeletal injuries among ERCP endoscopists in Canada. Can J Gastroenterol 2002; 16: 369-374
• 4 ASGE Technology Committee, Pedrosa MC, Farraye FA. et al. Minimizing occupational hazards in endoscopy: personal protective equipment, radiation safety, and ergonomics. Gastrointest Endosc 2010; 72: 227-235
• 5 Shergill AK, McQuaid KR, Rempel D. Ergonomics and GI endoscopy. Gastrointest Endosc 2009; 70: 145-153
• 6 Muthusamy VR, Bruno MJ, Kozarek RA. et al. Clinical evaluation of a single-use duodenoscope for endoscopic retrograde cholangiopancreatography. Clin Gastroenterol Hepatol 2020; 18: 2108-2117.e3
• 7 Gobba F, Ghersi R, Martinelli S. et al. Traduzione in lingua italiana e validazione del questionario standardizzato Nordic IRSST per la rilevazione di disturbi muscoloscheletrici [Italian translation and validation of the Nordic IRSST standardized questionnaire for the analysis of musculoskeletal symptoms]. Med Lav 2008; 99: 424-443
• 8 Ross AS, Bruno MJ, Kozarek RA. et al. Novel single-use duodenoscope compared with 3 models of reusable duodenoscopes for ERCP: a randomized bench-model comparison. Gastrointest Endosc 2020; 91: 396-403
• 9 Bassi M, Apolito P, Aspide R. et al. Workforce availability on the intraprocedural stage of endoscopy procedures: a single-center time and motion preliminary efficiency study. iGIE April 2023;
• 10 Merletti R, Cerone GL. Tutorial. Surface EMG detection, conditioning and pre-processing: Best practices. J Electromyogr Kinesiol 2020; 54: 102440
• 11 Kim D, Nicoletti C, Soedirdjo SDH. et al. Effect of Periodic Voluntary Interventions on Trapezius Activation and Fatigue During Light Upper Limb Activity. Hum Factors 2021; 65: 1491-1505
• 12 Shiang A, Wang JS, Cho DH. et al. Patient factors affect ergonomic strain of endoscopists during colonoscopy. Dig Dis Sci 2023; 68: 736-743
• 13 Lai K-H, Mo L-R, Wang H-P. Basic Technique of ERCP in Biliopancreatic Endoscopy: Practical Application. Singapore: Springer; 2018
• 14 Harvin G. Review of musculoskeletal injuries and prevention in the endoscopy practitioner. J Clin Gastroenterol 2014; 48: 590-594
• 15 O'Driscoll SW, Horii E, Ness R et. al. The relationship between wrist position, grasp size, and grip strength. J Hand Surg Am 1992; 17: 169-177
• 16 Putz-Anderson V. Cumulative Trauma Disorders: a manual for Musculoskeletal diseases of the Upper Limbs - CRC Press; 1st edition. 1988
• 17 Caumes M, Goislard de Monsabert B, Hauraix H et. al. Complex couplings between joints, muscles and performance: the role of the wrist in grasping. Sci Rep 2019; 9: 19357
• 18 Pawa S, Kwon RS, Fishman DS. et al. American Society for Gastrointestinal Endoscopy guideline on the role of ergonomics for prevention of endoscopy-related injury: summary and recommendations. Gastrointest Endosc 2023; 98: 482-491
• 19 Hori Y, Nagai T, Hayashi K. et al. Ability of ergonomic timeout to reduce musculoskeletal discomfort related to fluoroscopic endoscopy. Endosc Int Open 2021; 9: E1909-E1913
• 20 Rothmore P. Lead aprons, radiographers, and discomfort: A pilot study. J Occupat Health Safety - Australia and New Zealand 2002; 18: 357-365
• 21 Nivatvongs S, Goldberg SM. Holder for the fiberoptic colonoscope. Dis Colon Rectum 1974; 17: 273-274
• 22 Singla M, Kwok RM, Deriban G. et al. Training the endo-athlete: an update in ergonomics in endoscopy. Clin Gastroenterol Hepatol 2018; 16: 1003-1006
• 23 Shergill A. Ergonomics in endoscopy. Gastroenterol Hepatol (N Y) 2020; 16: 644-647
• 24 Hislop J, Tirosh O, McCormick J. et al. Muscle activation during traditional laparoscopic surgery compared with robot-assisted laparoscopic surgery: a meta-analysis. Surg Endosc 2020; 34: 31-38
• 25 Korman LY, Egorov V, Tsuryupa S. et al. Characterization of forces applied by endoscopists during colonoscopy by using a wireless colonoscopy force monitor. Gastrointest Endosc 2010; 71: 327-334
• 26 Korman LY, Brandt LJ, Metz DC. et al. Segmental increases in force application during colonoscope insertion: quantitative analysis using force monitoring technology. Gastrointest Endosc 2012; 76: 867-872