Do you have the keys to endoscopic fitness? Given musculoskeletal injuries affect up to two thirds of endoscopists, it’s probably high time you reviewed the basics to protect your posture while maintaining great patient care.

A group of Portuguese gastroenterologists have laid out the basic habits needed for reducing the long-term risk of injury, particularly as procedures become longer and more complex.

“Proposed key preventive measures include maintaining a neutral posture, optimising monitor and bed height, using strain-reducing techniques, taking regular breaks and supporting physical health through proper equipment maintenance and overall conditioning,” they wrote in Gut [link here].

Here are their key principles for proper endoscopy ergonomics:

Get balanced 

Performing a complex procedure in a cramped examination room is a recipe for awkward positions and poor posture, the authors said.

“However, a neutral posture allows efficient force generation with less energy expenditure,” gastroenterology resident at University Hospital Centre of the Algarve, Dr Raquel Oliveira, and colleagues wrote.

Clinicians should focus on adopting a balanced stance, neutral back and neck and have their feet oriented towards the monitor.

There’s also the chance for colleagues to keep an eye on your position.

“Because visual attention is focused on the screen, postural awareness may be limited. Team-based feedback may therefore help identify and correct maladaptive positions.”

Optimise the setup… and your technique 

Just as an office worker needs their desk chair at the right height, endoscopy suites should be set up to match the clinician using them.

Dr Raquel Oliveira.

“Monitor height should be adjustable and positioned directly in front of the endoscopist, just below eye level and at an appropriate viewing distance, to reduce eye strain and neck discomfort,” the authors said.

The bed height should also be adjusted to between elbow height or slightly below to encourage neutral joint positions.

The quality of a clinician’s individual technique also played a role in prevention, with good technique linked to efficiency.

“Several strategies may help distribute workload and reduce physical strain,”, and colleagues wrote.

“Passing the umbilical cord along the inside of the left forearm can stabilise the control body and reduce excessive rotation.”

Take care of the equipment 

“Poorly maintained endoscopes require greater force to manipulate, increasing physical strain,” the authors argued.

General physical fitness was also important for endoscopists to prevent injuries while working.

Overall, preventing injury involved a series of largely low-cost measures, like being aware of posture and technique. Taking a quick “ergonomic timeout” before starting the day in an endoscopy suite could also help clinicians to make sure they’re moving safely throughout the day’s procedures.

“Ergonomics should be integrated in training curricula, reflected in workplace design and reinforced in daily practice.”