Introduction
Interventional gastrointestinal endoscopy (IE), characterized by high technical complexity, significant cognitive load, and real-time decision-making, particularly exposes operators to acute stress. However, the relationship between baseline general stress, stress experienced during interventional procedures, and the influence of personal and professional characteristics is insufficiently documented.
Aims & Methods
Our aim was to assess the impact of acute stress on the activity and performance of interventional gastrointestinal endoscopists (IGE). Secondary objectives included evaluating perceived stress levels among IGE, comparing general stress with procedure-related stress in IE and analyzing their relationship, as well as identifying factors associated with procedural stress.
We conducted an international cross-sectional study using an anonymous online questionnaire targeting practicing IGE. Demographic and professional data included age, sex, marital status, country of practice, type of institution, professional status, primary and secondary interventional specialization, and average volume of interventional procedures performed. Stress was assessed using the 10-item Perceived Stress Scale (PSS-10) for general stress, and an adapted version of the PSS-10 for interventional endoscopy-related stress. Scores were calculated according to standard methodology (0–4 coding with reverse scoring of positive items). Descriptive, paired comparative, and intergroup analyses were performed. Statistical significance was set at p < 0.05.
Results
126 IGE responded to the survey. Twe noted a male predominance (84%), with a median age in the 30–40-year range, mostly married (77%), and nearly half practicing in academic settings (44%) with broad international representation, particularly from Italy, Egypt, Saudi Arabia, France, and the United States.
Procedural stress related to IE was significantly higher than general stress (15.5 ± 3.9 vs 14.3 ± 5.7; p = 0.005). We noted a significant association between general and procedural stress (p < 0.001), although concordance was not perfect.
Procedural stress was not significantly associated with age, sex, marital status, type of institution, or years of experience. However, we noted higher stress scores in younger, less experienced practitioners and those working inprivate settings. In contrast, an inverse relationship was found between interventional activity volume and procedural stress: low-volume endoscopists had the highest stress levels, whereas those performing more than 40 procedures per week reported the lowest scores (p = 0.017).
The procedures deemed the most stressful were ERCP, endoscopic submucosal dissection, interventional EUS, and POEM. Stress was reported to impair concentration and procedural performance, in terms of efficiency and procedure duration, rather than the occurrence of immediate complications.
Half of the endoscopists reported having attributed certain procedural failures to stress, and 39% reported procedure delays related to stress during the past month. Complications were mostly considered independent of stress (60%), although about 14% acknowledged occasional contribution. 74% believed that stress management techniques could improve their performance, 64% expressed interest in dedicated training, and 78% supported the integration of simulation-based training under controlled stress conditions.
Conclusion
Half of IGEs in our study attributed procedural failures, and about 40% attributed procedural delays, to procedural stress, illustrating the detrimental impact of acute stress on interventional performance.
References
(1) Keswani et al. Increased Levels of Stress and Burnout Are Related to Decreased Physician Experience and to Interventional Gastroenterology Career Choice: Findings From a US Survey of Endoscopists. American Journal of Gastroenterology, October 2011.
(2) Taft et al. Increased Levels of Job-Related Stress and Burnout in Interventional Gastroenterologists (IGEs): Findings From a U.S. Survey, Gastrointestinal Endoscopy.
(3) Tam, et al. The effects of stress on surgical performance: a systematic review. Surg Endosc 39, 77–98 (2025)
