Interventional gastroenterology

‘Colonoscopists thumb’ shows need for better health & safety protection for endoscopists


Musculoskeletal injuries are an occupational hazard for endoscopists, with most experiencing painful symptoms as a result of their work, new research suggests.

A review on occupational health hazards for endoscopists, published in the Annals of Gastroenterology, cites surveys which put the prevalence of MSK symptoms at between 37% and 89%. Pain in the thumb, hands, neck and back were the most common musculoskeletal symptoms.

The figures highlight a need to emphasise occupational health and safety messages and the role of ergonomics in all endoscopy workplaces, starting with training, according to gastroenterologist who spoke to the limbic.

Surveys by the American Society of Gastrointestinal Endoscopy found 57% of participants had musculoskeletal injuries in 1994 rising to  78% in 2006 and this figure “is expected to increase still further”, write the authors of the review.

Repetitive work and prolonged awkward postures put proceduralists at risk for overuse injuries such as carpal tunnel syndrome, De Quervain’s tenosynovitis and lateral epicondylitis while “colonoscopists thumb” – an issue caused by repetitive abduction and extension of the left thumb in the manipulation of colonoscope dials – is also common.

“Reported factors associated with a higher rate of endoscopy-related injury included a higher procedure volume (>20 cases a week), a greater number of hours spent on procedures (>16 hours per week) and the total number of years performing endoscopy,” say the authors of the review.

Endoscopic-related musculoskeletal injuries result in lost working days and restricted work days, yet the problem is not gaining the attention of the profession and ergonomics is “a neglected area of gastro-endoscopic training and practice,” they write.

The research should be a call to action for the gastroenterology speciality in Australia which does not place enough emphasis on the importance of occupational health and safety or the role of ergonomics, said Clinical Associate Professor Payal Saxena, a Sydney-based gastroenterologist specialising in endoscopy and member of GESA’s Australian Gastrointestinal Endoscopy Association.

“As doctors we are just taught to do the procedures, we are not taught about the ergonomics for longevity of our procedures,” Professor Saxena told the limbic, adding that she had often witnessed examples of poor ergonomic set-ups and their effects on her endoscopist colleagues.

“I see monitors that are not appropriately positioned, often I see people wearing lead gowns that are one piece, or don’t have elastic waist bands, and I know lots of colleagues who have complained about their thumb being sore after many years of scope handling.”

Simple interventions – such setting monitors and beds at appropriate heights and ensuring lighting does not cause eye strain – could be introduced, she suggested.

Individuals could opt for comfortable shoes and have lead aprons retrofitted to provide back and neck support.

“You can be labelled as picky if you ask for too many things but it is important for your health and safety in the future but you have to be insistent,” she said.

However to really make a shift, the role of ergonomics in practice should be embedded into workplace culture.

“I think as part of your colonoscopy training there should be a process on teaching trainees the right ergonomics on endoscopy so having your shoulders  relaxed your bed should be at a height where your elbows are 90 degrees to your wrist, insist the monitor is at the right height and the supervisors need to make a point of correcting the trainees.”

The review also highlighted the transmission of infection, and radiation exposure, as occupational hazards associated with the job, exacerbated by many proceduralists’ failure to wear adequate personal protective equipment including face masks, lead aprons and lead glasses.

The authors cited one study that estimated endoscopists were exposed to 3.35 and 5.87 mSv whole-body effective dose equivalent of ionizing radiation each year, higher than what is considered acceptable for the public.

Professor Saxena said while many practitioners were lax about wearing face masks,“I think there has been a lot of awareness about radiation and I would say most people are wearing appropriate lead gowns and thyroid (protection).

“I don’t think everyone is wearing lead glasses but we should be encouraging that and hospitals should be providing them.”

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