Effects of endoscopy-related procedure time on musculoskeletal disorders in Japanese endoscopists: a cross-sectional study

Abstract

Background and study aims There has been little evidence assessing the prevalence of musculoskeletal disorders (MSDs) among endoscopists performing recent diagnostic and therapeutic endoscopic procedures requiring prolonged procedural times. We evaluated the prevalence and identified the risk factors for developing MSDs, focusing on procedural time.

Methods An electronic survey of endoscopists (n = 213) employed at the Nagoya University Hospital and its affiliated hospitals was developed by a multidisciplinary group. 

Results Of the 110 endoscopists (51.6 %) who responded to the survey, eighty-seven endoscopists (79.1 %) had experienced endoscopy-related MSDs during the previous 1 year, and 49 endoscopists (44.5 %) had experienced these MSDs during the previous week. Nineteen endoscopists (17.3 %) reported absence from work due to severe MSDs. The most frequent sites of MSDs were neck, low back, and shoulders. Logistic regression analyses showed that longer upper endoscopic submucosal dissection ESD, (odds ratio: 5.7; 95 %CI: 1.3–25.0), lower ESD (odds ratio 4.9; 95 %CI: 1.1–22.0), and lower gastrointestinal treatment (odds ratio: 5.6; 95 %CI: 2.3–13.3) were significantly associated with the development of MSDs in the low back area. Moreover, longer lower ESD (odds ratio: 5.0; 95 % CI: 1.2–20.2) was a risk factor for symptoms in the left shoulder.

Conclusion This study suggests a correlation between the volume of therapeutic endoscopic procedures including ESD and the risk of MSDs mainly low back area and left shoulder. Managing monthly total endoscopic time, in light of organizational ergonomics, could contribute to minimizing such risks of endoscopy-related MSDs.

Publication History

Received: 29 September 2020

Accepted: 30 November 2020

Article published online:
22 April 2021

• References

• 1 Hildebrandt VH, Bongers PM, van Dijk FJ. et al. Dutch Musculoskeletal Questionnaire: description and basic qualities. Ergonomics 2001; 44: 1038-1055
• 2 Smith AC, Wolf JG, Xie GY. et al. Musculoskeletal pain in cardiac ultrasonographers: results of a random survey. J Am Soc Echocardiogr 1997; 10: 357-362
• 3 van Det MJ, Meijerink WJ, Hoff C. et al. Optimal ergonomics for laparoscopic surgery in minimally invasive surgery suites: a review and guidelines. Surg Endosc 2009; 23: 1279-1285
• 4 Buschbacher R. Overuse syndromes among endoscopists. Endoscopy 1994; 26: 539-544
• 5 Liberman AS, Shrier I, Gordon PH. Injuries sustained by colorectal surgeons performing colonoscopy. Surg Endosc 2005; 19: 1606-1609
• 6 Byun YH, Lee JH, Park MK. et al. Procedure-related musculoskeletal symptoms in gastrointestinal endoscopists in Korea. World J Gastroenterol 2008; 14: 4359-4364
• 7 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
• 8 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
• 9 Ridtitid W, Cote GA, Leung W. et al. Prevalence and risk factors for musculoskeletal injuries related to endoscopy. Gastrointest Endosc 2015; 81: 294-302 e294
• 10 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
• 11 Villa E, Attar B, Trick W. et al. Endoscopy-related musculoskeletal injuries in gastroenterology fellows. Endosc Int Open 2019; 7: E808-E812
• 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 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
• 14 Campbell EV, Muniraj T, Aslanian H. Musculoskeletal pain syndromes and injuries among endoscopists who perform ERCP. Dig Dis Sci 2020;
• 15 Kaewboonchoo O, Yamamoto H, Miyai N. et al. The Standardized Nordic Questionnaire Applied to Workers Exposed to Hand-Arm Vibration. Journal of Occupational Health 1998; 40: 218-222
• 16 Rubin D. Multiple imputation for nonresponse in surveys. NY: John Wiley & Sons; 1987
• 17 Rubin D. Multiple Imputation after 18+ years. Journal of the American Statistical Association 1996; 91: 473-489
• 18 Ende AR, De Groen P, Balmadrid BL. et al. Objective differences in colonoscopy technique between trainee and expert endoscopists using the colonoscopy force monitor. Dig Dis Sci 2018; 63: 46-52
• 19 Anderson JT. Optimizing ergonomics during endoscopy training. Techniques in Gastrointestinal Endoscopy 2019; 21: 143-149
• 20 Berguer R, Hreljac A. The relationship between hand size and difficulty using surgical instruments: a survey of 726 laparoscopic surgeons. Surg Endosc 2004; 18: 508-512
• 21 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
• 22 Shergill AK, McQuaid KR, Rempel D. Ergonomics and GI endoscopy. Gastrointest Endosc 2009; 70: 145-153
• 23 Khanicheh A, Shergill AK. Endoscope design for the future. Techniques in Gastrointestinal Endoscopy 2019; 21: 167-173
• 24 Shergill AK, Harris Adamson C. Failure of an engineered system: The gastrointestinal endoscope. Techniques in Gastrointestinal Endoscopy 2019; 21: 116-123
• 25 Cromie JE, Robertson VJ, Best MO. Work-related musculoskeletal disorders in physical therapists: prevalence, severity, risks, and responses. Phys Ther 2000; 80: 336-351
• 26 Matern U, Faist M, Kehl K. et al. Monitor position in laparoscopic surgery. Surg Endosc 2005; 19: 436-440
• 27 Pedrosa MC, Farraye FA. ASGE Technical Committee, . et al. Minimizing occupational hazards in endoscopy: personal protective equipment, radiation safety, and ergonomics. Gastrointest Endosc 2010; 72: 227-235
• 28 Harvin G. Review of musculoskeletal injuries and prevention in the endoscopy practitioner. J Clin Gastroenterol 2014; 48: 590-594
• 29 Shergill AK, McQuaid KR. Ergonomic endoscopy: An oxymoron or realistic goal?. Gastrointest Endosc 2019; 90: 966-970
• 30 Ebara T, Kubo T, Inoue T. et al. Effects of adjustable sit-stand VDT workstations on workers' musculoskeletal discomfort, alertness and performance. Ind Health 2008; 46: 497-505
• 31 Matsuzaki I, Ebara T, Tsunemi M. et al. Sit-stand endoscopic workstations equipped with a wearable chair. VideoGIE 2019; 4: 498-500
• 32 Tsunemi M, Matsuzaki I, Hattori M. et al. Sit-stand endoscopic workstations with wobble stools for the endoscopist, assistant, and endoscopy nurses in an endoscopy unit. Endoscopy 2020; 52: E324-325
• 33 Rattan J, Rozen P. A new colonoscope holder. Dis Colon Rectum 1987; 30: 639-640
• 34 O'Sullivan S, Bridge G, Ponich T. Musculoskeletal injuries among ERCP endoscopists in Canada. Can J Gastroenterol 2002; 16: 369-374
• 35 Siau K, Anderson JT. Ergonomics in endoscopy: Should the endoscopist be considered and trained like an athlete?. Endosc Int Open 2019; 7: E813-E815