Prevalence of endoscopy-related injuries and their impact on clinical practice: a systematic review and meta-analysis

Abstract

Background Endoscopy-related musculoskeletal injuries (ERIs) are commonly reported but their exact prevalence and clinical impact remain obscure. We conducted a systematic review and meta-analysis of the current literature aiming to answer these questions.

Methods The MEDLINE, EMBASE, and SCOPUS databases were searched for studies evaluating ERIs in gastroenterologists and surgeons. The co-primary outcome was the prevalence of ERIs (i.e. carpal tunnel syndrome, de Quervain’s tenosynovitis, and hand numbness). The second co-primary outcome was the prevalence of endoscopy-related pain syndromes.

Results 12 studies, including 4563 respondents, were included. The majority of respondents were men (n = 3321; 72.8%) and most were right-handed (86.2%). The career prevalence of carpal tunnel syndrome (pooled from 10 studies) was 5.3% (95%CI 1.5%–8.9%; I ² = 97.1%), while the prevalence of de Quervain’s tenosynovitis (five studies) was 8.5% (95%CI 0.1%–17.0%). The pooled prevalences of thumb pain, neck pain, and back pain were 25.4%, 23.1%, and 19.7%, respectively, but the prevalence varied according to the type of questionnaire used. Only 341/864 respondents (39.5%) had received prior training in ergonomics, while 623/889 respondents (70.1%) expressed a desire for further training in ergonomics. Overall, there is a moderate risk of bias in the present literature.

Conclusion ERIs, including carpal tunnel syndrome, de Quervain’s tenosynovitis, and endoscopy-related pain, are very common. These injuries can be severe, requiring surgery, and lead to loss of productivity. Most gastroenterologists report an unmet need for training in the proper ergonomics of endoscopy.

Publication History

Received: 05 November 2023

Accepted after revision: 16 February 2024

Accepted Manuscript online:
16 February 2024

Article published online:
25 April 2024

• References

• 1 Pedrosa MC, Farraye FA, Shergill AK. et al. Minimizing occupational hazards in endoscopy: personal protective equipment, radiation safety, and ergonomics. Gastrointest Endosc 2010; 72: 227-235 DOI: 10.1016/j.gie.2010.01.071. (PMID: 20537638)
• 2 Shergill AK, McQuaid KR. Ergonomic endoscopy: an oxymoron or realistic goal?. Gastrointest Endosc 2019; 90: 966-970 DOI: 10.1016/j.gie.2019.08.023. (PMID: 31449788)
• 3 Nabi Z, Nageshwar Reddy D, Ramchandani M. Recent advances in third-space endoscopy. Gastroenterol Hepatol 2018; 14: 224-232 (PMID: 29942220)
• 4 Ofori E, Ramai D, John F. et al. Occupation-associated health hazards for the gastroenterologist/endoscopist. Ann Gastroenterol 2018; 31: 448-455 DOI: 10.20524/aog.2018.0265. (PMID: 29991889)
• 5 Rempel DM, Harrison RJ, Barnhart S. Work-related cumulative trauma disorders of the upper extremity. JAMA 1992; 267: 838-842 (PMID: 1732657)
• 6 Han S, Hammad HT, Wagh MS. High prevalence of musculoskeletal symptoms and injuries in third space endoscopists: an international multicenter survey. Endosc Int Open 2020; 8: E1481-E1486 DOI: 10.1055/a-1236-3379. (PMID: 33043117)
• 7 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
• 8 Yung DE, Banfi T, Ciuti G. et al. Musculoskeletal injuries in gastrointestinal endoscopists: a systematic review. Expert Rev Gastroenterol Hepatol 2017; 11: 939-947 DOI: 10.1080/17474124.2017.1356225. (PMID: 28705042)
• 9 Walsh CM, Qayed E, Aihara H. et al. Core curriculum for ergonomics in endoscopy. Gastrointest Endosc 2021; 93: 1222-1227 DOI: 10.1016/j.gie.2021.01.023. (PMID: 33820648)
• 10 Pawa S, Banerjee P, Kothari S. et al. Are all endoscopy-related musculoskeletal injuries created equal? Results of a national gender-based survey. Am J Gastroenterol 2021; 116: 530-538 DOI: 10.14309/ajg.0000000000001136. (PMID: 33560650)
• 11 Higgins J, Green S. The Cochrane Collaboration. Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 (updated March 2011). 2011 Accessed February 27, 2024 at: https://handbook-5–1.cochrane.org/
• 12 National Heart, Lung, and Blood Institute. Study Quality Assessment Tools. Accessed: Available from. https://nhlbi.nih.gov/health-topics/study-quality-assessment-tools
• 13 Matsuzaki I, Ebara T, Tsunemi M. et al. Effects of endoscopy-related procedure time on musculoskeletal disorders in Japanese endoscopists: a cross-sectional study. Endosc Int Open 2021; 9: E674-E683 DOI: 10.1055/a-1352-3850. (PMID: 33937507)
• 14 Al-Rifaie A, Gariballa M, Ghodeif A. et al. Colonoscopy-related injury among colonoscopists: an international survey. Endosc Int Open 2021; 9: E102-E109
• 15 Austin K, Schoenberger H, Sesto M. et al. Musculoskeletal injuries are commonly reported among gastroenterology trainees: results of a national survey. Dig Dis Sci 2019; 64: 1439-1447
• 16 Bessone V, Adamsen S. Gastrointestinal endoscopy and work-related injuries: an international survey. Endosc Int Open 2022; 10: E562-E569 DOI: 10.1055/a-1789-0506. (PMID: 35571470)
• 17 Campbell EV, Muniraj 3rd T, Aslanian HR. et al. Musculoskeletal pain symptoms and injuries among endoscopists who perform ERCP. Dig Dis Sci 2021; 66: 56-62
• 18 Hansel SL, Crowell MD, Pardi DS. et al. Prevalence and impact of musculoskeletal injury among endoscopists: a controlled pilot study. J Clin Gastroenterol 2009; 43: 399-404
• 19 Liberman AS, Shrier I, Gordon PH. Injuries sustained by colorectal surgeons performing colonoscopy. Surg Endosc Interv Tech 2005; 19: 1606-1609 DOI: 10.1007/s00464-005-0219-1. (PMID: 16222467)
• 20 Morais R, Vilas-Boas F, Lopes P. et al. Prevalence, risk factors, and global impact of musculoskeletal injuries among endoscopists in Portugal. Am J Gastroenterol 2019; 114: S325-S326
• 21 Pawa S, Martindale SL, Gaidos JKJ. et al. Endoscopy-related injury among gastroenterology trainees. Endosc Int Open 2022; 10: E1095-E1104
• 22 Ruan W, Walsh CM, Pawa S. et al. Musculoskeletal injury and ergonomics in pediatric gastrointestinal endoscopic practice. Surg Endosc 2023; 37: 248-254 DOI: 10.1007/s00464-022-09455-9. (PMID: 35920909)
• 23 Sturm N, Leukert J, Perkhofer L. et al. The impact of endoscopic activity on musculoskeletal disorders of high-volume endoscopists in Germany. Sci Rep 2022; 12: 8538 DOI: 10.1038/s41598-022-12400-4. (PMID: 35595856)
• 24 Miller AT, Herberts MB, Hansel SL. et al. Procedural and anthropometric factors associated with musculoskeletal injuries among gastroenterology endoscopists. Appl Ergon 2022; 104: 103805
• 25 Villa E, Attar B, Trick W. et al. Endoscopy-related musculoskeletal injuries in gastroenterology fellows. Endosc Int Open 2019; 7: E808-E812 DOI: 10.1055/a-0811-5985. (PMID: 31198844)
• 26 Han S, Hammad HT, Wagh MS. High prevalence of musculoskeletal symptoms and injuries in third space endoscopists: an international multicenter survey. Endosc Int Open 2020; 8: E1481-E1486 DOI: 10.1055/a-1236-3379. (PMID: 33043117)
• 27 O’Sullivan S, Bridge G, Ponich T. Musculoskeletal injuries among ERCP endoscopists in Canada. Can J Gastroenterol 2002; 16: 369-374 DOI: 10.1155/2002/523125. (PMID: 12096300)
• 28 Buschbacher R. Overuse syndromes among endoscopists. Endoscopy 1994; 26: 539-544 DOI: 10.1055/s-2007-1009030. (PMID: 7828567)
• 29 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 DOI: 10.1016/j.gie.2023.05.056. (PMID: 37245720)
• 30 Campbell EV, Muniraj T, Aslanian HR. et al. Musculoskeletal pain symptoms and injuries among endoscopists who perform ERCP. Presidential Poster Award: 754. Am J Gastroenterol 2018; 113: S425-S426
• 31 Workplace Health Promotion. , Centers for Disease Control and Prevention. Work-related musculoskeletal disorders & ergonomics. 2021 Accessed: . Available from: https://cdc.gov/workplacehealthpromotion/health-strategies/musculoskeletal-disorders/index.html
• 32 National Institute for Occupational Safety and Health (NIOSH). Centers for Disease Control and Prevention.. Musculoskeletal disorders and workplace factors – a critical review of epidemiologic evidence for work-related musculoskeletal disorders of the neck, upper extremity, and low back. . 1997 https://cdc.gov/niosh/docs/97–141/
• 33 Epstein S, Sparer EH, Tran BN. et al. Prevalence of work-related musculoskeletal disorders among surgeons and interventionalists. JAMA Surg 2018; 153: e174947
• 34 Zibert K, Singla M, Young PE. Using ergonomics to prevent injuries for the endoscopist. Am J Gastroenterol 2019; 114: 541-543 DOI: 10.1038/s41395-018-0399-7. (PMID: 30420635)
• 35 Migliavaca CB, Stein C, Colpani V. et al. Meta-analysis of prevalence: I2 statistic and how to deal with heterogeneity. Res Synth Methods 2022; 13: 363-367