Introduction

Up to 80% of practicing GI endoscopists are affected by musculoskeletal health disorder with significant influence on personal health, absence from work and reduction of endoscopic workload (1). It is estimated that overuse injury is a main mechanism of health impairment, but methods to prevent musculoskeletal disorder in GI endoscopists are elusive. Since hand grip strength measurement has been identified as an important indicator of musculoskeletal health and physical fitness (2), the further evaluation of hand grip strength in working endoscopists in comparison to non-endoscopists might bring further evidence to prevent musculoskeletal health disorder in GI endoscopists.

Aims & Methods

In this prospective single-center pilot study, measurement of hand grip strength was conducted on 20 workdays by a high-volume GI endoscopist and a gastroenterologist who did not perform endoscopic procedures before and after work at University Hospital Ulm. For hand grip strength measurement, JAMAR© Plus Hand Dynamometer was used according to the Southampton protocol (3). Three serial measurements were performed with each hand to obtain an average grip strength at each measurement point. Statistical analysis was performed using SPSS Statistics 29 (IBM, USA). Mann-Whitney U test, students t-test, univariate analysis of variation (ANOVA) and Kruskal-Wallis test were performed whenever applicable.

Results

Average hand grip strength of the high-volume endoscopist was not significant higher than the hand grip strength of the non-endoscopic working gastroenterologist (left hand: 102.2 lbs vs. 93.3 lbs, p=0.26; right hand: 114.0 lbs vs. 108.2 lbs, p=0.44). In comparison, hand grip strength was significant higher after work in non-endoscopist subject for both hands (left: 89.2 lbs vs. 95.4 lbs, p=0.025; right: 95.9 lbs vs. 101.4 lbs, p=0.035) while the participating endoscopist had a significant lower grip strength after work (left: 107.4 lbs vs. 95.2 lbs, p<0.001; right: 106.8 lbs vs. 95.6 lbs, p<0.001). In both subjects, the day of the week (beginning vs. end of the week) had no effect on hand grip strength.

Conclusion

As hand grip strength is associated with health performance status, significant difference can be observed between endoscopists and non-endoscopists in the impairment of hand grip strength within a workday. To prevent musculoskeletal health issues in endoscopists, timing and effect of health interventions could be implemented by evidence from hand grip strength measurement. Therefore, further observation studies are mandatory to develop methods to prevent musculoskeletal health disorder especially for high-volume endoscopists.

References

1.Sturm, N., Leukert, J., Perkhofer, L. et al. The impact of endoscopic activity on musculoskeletal disorders of high-volume endoscopists in Germany. Sci Rep 12, 8538 (2022). https://doi.org/10.1038/s41598-022-12400-4
2.Kim, S.H., Kim, T., Park, JC. et al. Usefulness of hand grip strength to estimate other physical fitness parameters in older adults. Sci Rep 12, 17496 (2022). https://doi.org/10.1038/s41598-022-22477-6
3.Helen C. Roberts, Hayley J. Denison, Helen J. Martin, Harnish P. Patel, Holly Syddall, Cyrus Cooper, Avan Aihie Sayer, A review of the measurement of grip strength in clinical and epidemiological studies: towards a standardised approach, Age and Ageing, Volume 40, Issue 4, July 2011, Pages 423–429, https://doi.org/10.1093/ageing/afr051

Introduction

Treatment of complex fistula and residual anastomotic insufficiencies remain a challenge even in an interdisciplinary setting. Endoscopic standard techniques for closure like clips, OTSC or SEMS are limited to special indications. Endoscopic suturing may offer an approach to close complex fistula orifices.

Aims & Methods

Endoscopic suturing was used for interventional closure of complex insufficiencies in the lower GI-tract. 5 consecutive patients were treated using standard Endosuturing (SutuArt, Olympus) or modified suture strategy using an additional working channel (ACEES). In three patients residual insufficiencies in the rectum were visible after complex vacuum therapy. In one patient a recto-vaginal fistula was clinical apparent. In one patient an iatrogenic perforation was occurred within dilation therapy for anastomotic stenosis. Due to size or location of the defects a standard closure technique was either not applicable or failed in a prior attempt.

Results

Technical success, defined as macroscopic defect closure, was achievable in 5 of 5 patients. Mean time for intervention was 57(±14)min. For 3 patients bimanual work using additional working channel enhanced endoscopic suturing (ACEES) was performed. In endoscopic surveillance permanent closure was achieved in 4 of 5 patients.

Conclusion

Endoscopic suturing is a newly available technique. Beyond its basic indication for defect closure after ESD this procedure, also in combination with bimanual suturing (ACEES), may offer an excellent opportunity for treatment of complex fistula.

Disclosure

nothing to disclose

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

As for any hand tool, the weight of the endoscope influences user comfort and the risk of developing musculoskeletal injuries, frequently occurring among gastrointestinal endoscopists [1; 2]. As a result, the endoscope weight reduction has been recommended to optimize the ergonomics of the endoscopes [3]. Because of the constituent material, single-use endoscopes are lighter than reusable ones, with a possible reduction of the muscle activation needed to hold and operate the endoscope.

Aims & Methods

The aim of the study was to compare the muscle activation while holding and operating two different gastroscopes with different weights. The activation of the forearm muscles using a single-use and a reusable gastroscope was measured using wearable superficial electromyogram (sEMG) sensors while holding the endoscopes and performing a set of standardized manoeuvres. 14 subjects (six females; median age 34 years; range 25-65 years) participated. The gastroscopes were a single-use (aScope Gastro, Ambu A/S, Denmark; weight: 0.6 kg) and a reusable gastroscope (GIF-1TH190, Olympus, Japan; 1.4 kg). The set of exercises included an initial 30-second rest position holding the endoscope statically; followed by two left-hand wheel rotations reaching a 90° tip up and down bend, respectively, and maintaining these positions for 10 seconds. Finally, the valves were pressed for 10 seconds each. The exercises were repeated three times with a 30-second rest position in between. The two gastroscopes were used in randomized order. A sleeve with embedded sEMG electrodes (ErgoSleeve, Myontec Ltd., Finland) was worn by the participants on the left arm to detect activation of the wrist flexor and extensor muscles. Before starting, the maximal voluntary contraction (MVC) was measured. sEMG data were processed using the connected software (Ergolink, Myontec Ltd., Finland), reported as muscle load (%MVC) i.e., the percentage of sEMG data normalized to MVC and displayed as average and standard deviation of the muscle load. Data were compared with paired t-test with statistical significance set at p<0.05 and calculated using Excel (Microsoft Corporation, USA).

Results

The muscle load was higher with the reusable gastroscope in the rest positions and during all manoeuvres (flexors [%MVC]: 6±2 vs. 5±2; extensors [%MVC]: 7±3 vs. 6±3; all p<0.001). We deduced that the gastroscopes’ weight difference played a major role. In fact, also during the rest position during which no manipulation of wheels or valves was required, the muscle load was higher when the reusable gastroscope was used (flexors [%MVC]: 4±2 vs. 3±2; extensors [%MVC]: 3±1 vs. 2±1; all p<0.001). In a previous study regarding hand tool weight and its relationship with the development of postural tremor [4], the authors demonstrated that the heavier the tool, the shorter the time before detecting postural tremor (as example, 9 minutes for tools weighing 0.8 kg, 12 min for 0.4 kg). Considering that the majority of diagnostic gastroscopies last a minimum of 10 min [1], tremor is assumed to be inevitable when using reusable endoscopes. In fact, despite the weight is partially distributed on the insertion tube and the connection cord, the total weight of reusable gastroscopes is higher than 1.2 kg, while the one of single-use gastroscopes less than 0.6 kg.

Conclusion

Holding and operating a single-use gastroscope reduces the load on the left wrist muscles compared to a heavier reusable gastroscope. This benefits the user ergonomics, and may prevent or delay the development of tremor, fatigue, and musculoskeletal injuries.

References

1. Bessone V, Adamsen S. Gastrointestinal endoscopy and work-related injuries: an international survey. Endosc Int Open 2022; 10(5): E562-E569
2. El Bacha H, Mariam K, Nadia B, Errabih I. Prevalence of musculoskeletal disorders among digestive endoscopy physicians. Endoscopy 2023; 55(S2): S85
3. Khanicheh A, Shergill AK. Endoscope design for the future. Tech Gastrointest Endosc 2019; 21(3): 167-173
4. Kim JY, Song HY, Yun MH, Yun MW. Effect of tool weight and hand posture on the postural tremor of the upper extremity. J Erg Society of Korea 1996; 15(2): 177-184

Disclosure

At the time of abstract submission, Dr. Veronica Bessone declares to be employed by Ambu Innovation GmbH, while Dr. Sven Adamsen to be medical advisor for Ambu A/S.

Introduction

Recently, much attention has been given to the well-being of health care workers, but endoscopists are no exception. Endoscopy examinations require complex and repetitive maneuvers that can put a strain on the musculoskeletal system. Female endoscopists are greatly disadvantaged in muscle strength and hand size compared to male endoscopists when operating a one-size-fits-all endoscope. Altough there have been some reports, especially from Western countries, on endoscopy-related injuries (ERI),there have been a few reports on ERI from Japan.^1-3 A survey was conducted to examine ERI with a focus on hand disorders and operability of endoscope handles for Japanese female endoscopists.

Aims & Methods

Our aim was to examine ERI with a focus on hand disorders and operability of endoscope handles for Japanese female endoscopists from a survey.
A survey was designed in the Hokkaido chapter of the Women Endoscopists Career Support Committee in the Japan Gastroenterological Endoscopy Society (JGES). An anonymous electronic questionnaire was distributed to endoscopists who have been performing endoscopy in Japan. Participants accessed the Google form web site during the period from July to December in 2023.
A 25-item survey with multiple choice answers was created. Twelve items were dedicated to obtaining non-identifiable demographic data and practice-related information such as the number of endoscopies performed per week performed by each participant. Six-items focused on ERI including current and past injuries and the duration and severity of injuries. The other 7-items were about the usability of the current endoscope handle and practice of ergonomic endoscopy. ERI were defined as past or present endoscopy-related muscle and joint disorders including pain, discomfort, movement restriction and numbness.

Results

Data for 352 endoscopists were analyzed. The incidences of ERI were 55.6% (150/270) in men and 61.0% (50/82) in women and the most common site of ERI was the hands including fingers, thumbs and wrists followed by the lower back and then the neck (incidence of 28.1% in hands, 26.4% in lower back and 24.1% in neck). ERI in hands occurred in 35.4% of the women and increased with age. There were significant differences in age and endoscopy career between female endoscopists with and those without ERI in the hands, and there were no relations to glove size, number of endoscopy procedures and usability of the endoscopy handle. Regardless of the presence or absence of hand injuries, many female endoscopists were not satisfied with the shape and usability of endoscopes (75.6%).Especially for female with small hands (gloves size 6 or smaller), the current endoscope handle is so large and they cannot reach the left and right angle knobs with their fingers.

Conclusion

In conclusion, ERI in hands were related to long endoscopy career and aging in female endoscopists. Improved usability of endoscopes and ergonomic endoscopy are important for female endoscopists to continue clinical practice.

References

1. Diana Y, Tommaso B, Gastone C et al. Musculoskeletal injuries in gastrointestinal endoscopists: a systematic review. Expert Rev Gastroenterol Hepatol 2017; 11: 939–947.
2. 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.
3. 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: E674–1E683.