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AGA survey shows endoscopists at high risk for musculoskeletal injuries

A new survey of AGA members indicates that 89 percent of endoscopists are at risk for musculoskeletal injuries. The study also revealed gender-based differences in the types of injuries sustained when performing endoscopy.

The three most common sites of injury were the neck, left thumb and lower back, according to Katherine Garman, MD, assistant professor of medicine at Duke University of Medicine, Durham, NC, who reported the survey results on Saturday at DDW®. The survey was sponsored by the AGA Institute Women’s Committee.

Katherine Garman, MD

“Because we set out to determine gender-related issues in endoscopic injury, we wanted to compare rates of injury between men and women,” Dr. Garman explained. “While rates of overall injury were quite high in both men and women, rates of upper body injury were more common in women endoscopists than men, including injuries to the right thumb, right wrist, both right and left shoulders, and upper back.” The mean time to injury among women was nine years after starting endoscopy, with a median of five years, according to the survey. For men, the mean time to injury was 12 years with a median of seven years.

Dr. Garman said scope size was among the reasons that women are at higher risk for injury when performing endoscopy.

“Scopes are designed for larger hands, dating to a time when most endoscopists were men,” she said. “Room setup may be for taller people, with screen height higher than is comfortable for a woman.”

The survey was sent to more than 10,500 endoscopists. The height of respondents ranged from 52 inches to 81 inches and the age of the respondents ranged from 28 to 82 years. Sixty-nine percent of the respondents were general endoscopists. The procedures surveyed included colonoscopy and esophagogastroduodenoscopy.

Thirty-six percent of respondents reported neck injuries, 34 percent reported injuries to the left thumb and 35 percent reported injuries to the lower back. For both men and women, a prior injury to the neck, thumb or back increased the risk of a subsequent injury to those body parts. Older age was also a risk factor for injury associated with endoscopy.

The risk of injury was highly correlated with the number of procedures performed per week, with greater numbers associated with higher risk. When respondents were asked if they felt pressure to perform more procedures, 45.6 percent said yes. Of those feeling pressure, 57 percent were women and 37 percent were men.

Dr. Garman said the survey responses showed a general lack of awareness of strategies to reduce the risk of injuries during endoscopy, including taking microbreaks and ergonomic time out.

“A microbreak is a quick, one- to three-minute chance to relieve tension, and this should be done every 45 minutes or so,” Dr. Garman said. “You can think of microbreaks as periods of active movement sprinkled throughout the day. One definition describes them as regular, small, biologically meaningful breaks using movement to counter the static or tense positions one may assume during endoscopy. You can use your cell phone or Fitbit to remind you to take these breaks.”

Survey participants were also asked about the ergonomic training they received during fellowship.

“In general, until 2010, it was very rare for anyone to receive training in ergonomics during fellowship,” Dr. Garman said. “Between 2010 and 2015, 11 percent reported receiving ergonomics training.”

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