Introduction

Musculoskeletal disorders (MSDs) are disorders of the musculoskeletal system (muscles, tendons, skeleton, etc.). Work-related MSDs are MSDs caused or aggravated by working conditions.
Endoscopic activity is known for the non-ergonomic positions it imposes on the practitioner, responsible for joint constraints and a physical and mental workload.

Aims & Methods

The aim of our work is to measure the prevalence of MSDs among hepato-gastroenterologists (HGE) and to evaluate the risk factors.
This is an international multicenter observational, descriptive and analytical study from 04/01/2022 to 18/10/22, conducted among digestive endoscopy practitioners who voluntarily responded to a self-administered questionnaire via Google Form containing three parts: socio-professional characteristics of the surveyed HGEs, questions for the evaluation of MSDs and treatments taken and questions for the evaluation of the psychosocial environment and workload.
Data analysis was done by Jamovi 2.2.5 software.

Results

We recruited 417 participants with a median age of 37 [32; 48] with female predominance 250(60%) and a mean BMI of 24.9 (±3.44).
A participation of 79(19%) Residents, 246(59%) specialists and 92(22%) professors in HGE. The median endoscopic practice time was 84 months [84; 196].
Regarding MSDs, 171 (41%) of the participants had a history of muscular and joint disorders, the incidence of MSDs in the 12 months preceding the study was 120 (28.7%) and in the last 7 days 183 (43.88%).
The lower back 130(71%), neck 120(65.5%) and right wrist 75(41%) were the most affected areas. The least affected areas were the hips 20(11%) and the elbows 12(6.5%).
MSDs were found in 101 (43.7%) of the participants with a BMI > 24 kg/m2 against 53 (23.2%) who had a BMI < 18 kg/m2.
Practitioners with a long history of muscular and joint disorders had a higher risk of MSDs in the year compared to practitioners without a history of MSDs, with a statistically significant p value of p< 0.003 (52.6% vs 37.8%); there was also a statistically significant relationship between age; length of time practicing endoscopy; practice of therapeutic endoscopy and the presence of MSDs in our participants, with respective p values of p<. 001(40-60years 61.2% vs <40years 30.5%); p=0.024; p<.001.
There was also a statistically significant relationship between the practice of advanced endoscopy (EE+ ERCP) and the presence of MSD in our participants with a p value p<.001.

Conclusion

Work-related MSDs remain a neglected subject, yet according to our study one practitioner out of 3 suffers from them. Age, overweight, length of time in endoscopic practice, and the number of endoscopies performed are the main risk factors for MSD.
Our results underline the importance of a rigorous and adequate prevention, by an adaptation of the work ergonomics and physical exercise to reduce the incidence of this professional pathology.

Disclosure

no conflicts of interest

Introduction

Musculoskeletal disorders (MSDs) are the leading cause of occupational disease and represent a major public health concern. Endoscopy plays a central role in hepatogastroenterology, and its practice is associated with a high prevalence of MSDs, ranging from 40% to 90% among endoscopists. The increasing complexity of endoscopic procedures may further exacerbate musculoskeletal strain on practitioners. However, few studies have been conducted on this topic, and most rely on observational and self-reported data, limiting their level of evidence. Quantitative studies assessing the impact of digestive endoscopy, particularly endoscopic retrograde cholangiopancreatography (ERCP), on MSD risk under real working conditions remain scarce.

Aims & Methods

To obtain objective and reliable data, we used the KIMEA tool, which analyzes an operator’s movements by generating a digital twin based on data collected through a depth camera and wrist-mounted sensors. This system allows for an objective assessment of musculoskeletal strain by estimating MSD risk using the Rapid Upper Limb Assessment (RULA) method. Our study was conducted on two experienced endoscopists performing a total of 10 ERCP procedures.

Results

Motion analysis revealed an average global RULA score of 4.2, indicating a moderate risk of MSDs. Musculoskeletal strain was predominantly observed in the forearms, particularly in the wrists, which remained in constrained postures for more than 50% of the procedure time. The musculoskeletal load was asymmetrical, with greater strain on the left side. These findings were consistent across all 10 procedures.

Conclusion

Discussion: This study confirms the significant musculoskeletal strain on the upper limbs during ERCP procedures. Our findings align with existing literature. The KIMEA tool appears to be a suitable method for analyzing movements in digestive endoscopy and represents a methodological advancement for the objective evaluation of musculoskeletal strain in this field.
Conclusion: Motion analysis using the KIMEA tool provides objective evidence that ERCP practice poses a risk for MSD development. Further studies with larger sample sizes are needed to strengthen the level of evidence, assess the impact of factors such as age, experience, gender, and procedure type, and promote the integration of ergonomic measures into endoscopic practice to reduce MSD risk.

Introduction

Musculoskeletal (MSK) injuries are frequent occupational hazards amongst endoscopists, partly attributed to the physically demanding nature and prolonged durations of endoscopic procedures. Understanding the prevalence and patterns of these injuries is crucial to improve the endoscopist’s occupational health by implementing appropriate preventive strategies.

Aims & Methods

Aim: The primary aim of this study was to determine the prevalence and distribution of MSK injuries among endoscopists. Endoscopists from across the world were surveyed regarding the types and frequencies of procedures they perform to evaluate the prevalence of MSK injuries among endoscopists with varying procedural type and frequency. The secondary aim was to investigate whether additional factors, such as exercise habits during adulthood and adolescence and the endoscopy environment, influence the frequency of reported MSK injuries.
Method: An international questionnaire-based study was conducted among endoscopists practising in numerous healthcare centres. Data gathered included the frequency and localisation of injuries, type of endoscopic procedures carried out, access to occupational health (OH) and ergonomics of the endoscopy theatre. Additionally, the study explored the potential impact of past and present exercise practice during adulthood and adolescence on the prevalence of MSK injuries.

Results

174 endoscopists participated in this study, from 25 countries. The most commonly reported MSK complaints were back, neck, shoulder and hand pain (table 1).

	Percentage of endoscopists reporting pain
Back Pain	23.6%
Neck Pain	19.5%
Shoulder Pain	16.0%
Hand Pain	14.9%
Thumb Pain	13.2%
Hip Pain	7.4%
Elbow Pain	6.7%
Finger Pain	5.1%

Table 1: Pain in endoscopists;
Endoscopists’ experience was as follows; 32.2% -0-5 years, 46% -5-20 years and 21.8% -20 years of experience. Only 35.1% of participants had formal training on scope handling at the start of training.
Participants reported to use 1, 2, 3 and 4 monitors respectively during endoscopy sessions: 37.9%, 56.0%, 4.6% and 0.6%. 75.9 % of participants ensure that their screen is at eye level during endoscopies, whilst 75.3% ensure that the monitor is the right distance away.
23% of participants stated that they have had a formal diagnosis of an occupation related injury or have been reviewed by a physiotherapist / orthopaedic surgeon because of an endoscopy related injury. In contrast, only 13.2% of patients have reported their occupational injury to OH services.
51.1% of participants have had MSK injuries that they think are attributable to current endoscopy practices. However, only 13.2% have sought help from the OH team. 74% of these felt they were supported by the OH team.
10.9% of participants have been diagnosed with osteoarthritis or an inflammatory arthropathy, unrelated to work.

Conclusion

This study provides a valuable insight into the relationship between endoscopic procedures and the occurrence of MSK injuries among endoscopists, offering opportunities for prevention to safeguard the health of endoscopists and to encourage them to seek help for such injuries.

Disclosure

The authors declare they have no conflict of interest.

Introduction

Digestive hemorrhage is a frequent complication in advanced chronic kidney disease. Patients with end-stage renal disease (ESRD) are more likely to have gastrointestinal (GI) problems, including digestive bleeding of high or low origin.

Aims & Methods

The aim of our work is to study the particularities of HD in CKD patients.
This is a monocentric prospective analytical study over a period of 28 months: April 2020 to August 2022, including patients with HD with CKD at the dialysis stage or not, including renal transplant patients.
In order to be able to compare patients with ESRD with patients without ESRD, a control group of patients admitted for HD who had a GI endoscopy during the study period and with normal renal function were identified and grouped. In this group of patients, we took into account age, sex, indications, GI endoscopy results and ICU stay.
We also assessed all-cause mortality between the groups of CKD patients with HD versus the control group.

Results

A total of 378 patients underwent digestive exploration for HD. In this population, 46 (12.16%) patients with CKD were compared with 332 patients without RI.
70% (n=32) of the patients with RI were on chronic hemodialysis, 26% (n=12) had a GFR<60ml/min/1.73m2 but were managed without the aid of dialysis or transplantation, and 4% (n=2) patients were renal transplant recipients.
The most common etiologies in CKD patients were ulcer disease 65.2% (n=30); vascular ectasia 28.2% (n=13), gastritis 26% (n=12), esophagitis 10.8% (n=5); and tumors in 8.6% (n=4).
After statistical analysis patients with CKD had:
A higher risk of hemodynamic instability 69.5% (n=32) compared to the control group 11.14% (n=37) with p=0.002,
A higher rate of recurrence 26% (n=12) CKD patients compared to 9.6% (n=32) of the control group with a p=0.00.
A higher mortality rate 4.34% (n=2) in CKD patients compared to the control group 1.2% (n=4) with p=0.00.

Conclusion

GI bleeding in advanced chronic kidney disease is more severe it is accompanied by a higher risk of recurrence of ICU stay and mortality, hence the interest of prompt management and close monitoring. The main causes are peptic ulcer and vascular ectasia.

Introduction

Anal fistulas are the most common clinical forms of ano-perineal suppurations. They are defined by the initial infection of an anal gland of Hermann and Desfosses opening in the middle part of the anal canal. A specific origin is possible. The treatment is surgical and has two objectives: to treat the suppuration definitively and to preserve fecal continence, but also to have histological evidence for specific fistulas.

Aims & Methods

The aim of our work is to collect epidemiological, clinical, paraclinical, therapeutic and evolutionary data of this condition.
This is a retrospective, descriptive study over a period of 6 years: January 2015-December 2021, including 640 patients with anal fistula collected at the proctology unit, all patients with anal fistula and who received surgical treatment or biopsy for diagnostic purposes were included in our study. This work allowed to collect epidemiological, clinical, paraclinical, therapeutic and evolutionary data of this condition.

Results

640 patients were included presenting with anal fistula. The average age was 39 years [25-59], with a male predominance of 570 patients (89%). Clinically, the predominant symptomatology was chronic purulent discharge in 416 cases (65%), 128 cases (20%) had an inaugural anal abscess, 77 cases (12%) had proctalgia, 19 cases (3%) had anal pruritus and 13 cases (2%) had diarrhea.
The proctological examination revealed: simple anal fistula in 575 patients (90%) and 65 patients had complex anal fistula (10%).
Out of 640 patients recruited for anal fistula, 45 patients (7%) had specific anal fistula and 595 patients (93%) had cryptoglandular anal fistula.
After a digestive, phtysiological and radiological assessment we concluded :
- 26 cases (58%) anal fistula occurring in patients followed for Crohn's disease or inaugural ano-perineal Crohn's disease having benefited from a seton drainage and put under combotherapy.
- 16 cases (36%) in favour of anal tuberculosis put on anti bacillary treatment.
- 2 cases (4%) of neoplastic fistulas that benefited from oncological management.
- 1 case (2%) in favor of anal sarcoidosis treated with corticotherapy.

Conclusion

Anal fistulas are a fairly common pathology. The diagnosis of anal fistulas is clinical. Cryptoglandular anal fistula remains the most frequent entity, requiring surgical treatment, while the management of specific anal fistula depends on the etiology.

Disclosure

No conflict of interest

Introduction

Hemorrhoidal disease (HD) is the most common pathology in proctology, with an estimated prevalence of between 4.4% and 39%. It can be managed in a variety of ways: hygienic-dietary measures, medical, instrumental or surgical treatment. The latter is considered especially after failure of medical and instrumental treatment.

Aims & Methods

Aims : The aim of our study is to report our experience with Milligan and Morgan technique in the management of hemorrhoidal disease.

Materials and methods: This was a monocentric retrospective descriptive-analytical study conducted over a 12-year period: from January 2011 to January 2023. The data studied were age, sex, clinical manifestations, stage of HD on proctological examination and therapeutic data. All patients who underwent Milligan and Morgan hemorrhoidectomy (MMH) and presented with stage IV and III hemorrhoids (after failure of instrumental treatment) were included in our study. Excluded were asymptomatic patients, patients with surgical contraindications and other stages treated by non-surgical means. The statistical study was carried out using IBM-SPSS 20.0 software. The chi-2 test was used to compare categorical variables.

Results

468 patients were enrolled during the study period. The mean age of this population was 41 years (22-71). The sex ratio M/F was 2,1. Clinical expression was dominated by rectal discharge in 246 patients (74%), proctalgia in 132 patients (28%), anal pruritus in 119 patients (25%) and anal oozing in 56 patients (12%). Proctological examination revealed stage IV haemorrhoids in 201 patients (43%) and stage III haemorrhoids in 267 patients (57%). 25 patients (5.3%) had an associated anal fissure. Anemia was present in 341 patients (72.8%), with a mean hemoglobin value of 7.8 g/dl. Transfusion was required in 65 patients (14%) who presented with severe anemia of less than 7g/dl. Colonoscopy was indicated in 87 patients (18.5%) over the age of 45 with rectal bleeding, and in 42 patients (9%) with a history of digestive cancer. Milligan and Morgan's indication was stage III hemorrhoids with severe anemia in 65 patients (14%), after failure of infrared photocoagulation in 194 patients (41.4%); after failure of HAL-RAR treatment n=8 (1.7%) and stage IV hemorrhoids in 201 patients (43%). The procedure performed was a hemorrhoidectomy.An open pedicle MMH type was performed. Patients with an associated anal fissure (5.3%) underwent the Bellan procedure in addition to hemorrhoidectomy. Immediate post-operative complications included post-operative pain in all our patients, urinary retention in 31 patients (6.6%), significant post-operative bleeding in 2 patients (0.5%) treated by electrocoagulation in the OR, and minimal post-operative bleeding in 117 patients (25%) treated by compression bandaging. The latter was reported in 43 patients (36.7%) with stage III hemorrhoids and 74 patients (63.2%) with stage IV hemorrhoids. This difference was statistically significant (p<0.001). Late complications included delayed healing in 9 patients (1.9%), 4 of whom were diabetic, anal stenosis in 5 patients (1%), requiring sphincterotomy combined with anoplasty in 3 patients, and finger dilatation in 2 patients. Anal stenosis was reported in 4 patients who did not undergo postoperative digital rectal examination and 1 patient who did. This difference is statistically significant p=0.03.

Conclusion

MMH remains the gold standard for the treatment of hemorrhoidal disease. The results are satisfactory, especially in the long term. Post-hemorrhoidectomy anal stenosis remains the most serious complication.