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Sunday Poster Session

Category: General Endoscopy

P0565 - Prevalence of Musculoskeletal Injuries in Gastrointestinal Endoscopy: A Systematic Review and Meta-Analysis

Sunday, October 22, 2023
3:30 PM - 7:00 PM PT
Location: Exhibit Hall
ACG Award Winner ACG Outstanding Poster Presenter
Award: ACG Auxiliary Award (Trainee)

Award: Presidential Poster Award

Azizullah Beran, MD1, Mouhand FH. Mohamed, MD2, John Guardiola, MD1, Tarek Aboursheid, MD3, Alejandra Vargas, MD4, Khaled Elfert, MD5, Hala Fatima, MD1, Jeffrey Easler, MD1, Mohammad Al-Haddad, MD1, Nabil Fayad, MD1, Patrick E. Young, MD6, Samir A. Shah, MD7, Douglas K. Rex, MD8
1Indiana University, Indianapolis, IN; 2Brown University, Providence, RI; 3Ascension Saint Francis Hospital, Chicago, IL; 4Eastern Virginia Medical School, Norfolk, VA; 5SBH Health System, Bronx, NY; 6Uniformed Services University, Gaithersburg, MD; 7Gastroenterology Associates, Inc., Providence, RI; 8Indiana University School of Medicine, Indianapolis, IN

Introduction: Musculoskeletal injuries (MSI) reportedly vary among gastrointestinal (GI) endoscopists. This comprehensive systematic review and meta-analysis assessed the prevalence, characteristics, and impact of MSI in GI endoscopy.

Methods: We performed a comprehensive search of PubMed, Embase, and Web of Science databases from inception through March 2023 for studies reporting the MSI prevalence among GI endoscopists. The primary outcome was the prevalence of MSI injuries. Secondary outcomes included characteristics and impact of MSI. The pooled rates were generated using a proportion meta-analysis with the random-effects model. Odds ratios (OR) were used for between-groups comparisons.

Results: Our analysis incorporated 21 studies encompassing 5,407 endoscopists. The overall MSI prevalence was 62% (95% CI: 53.4-70.5) (Figure 1A). MSI prevalence in GI fellows was 47.9% (235/527) (95% CI: 32.1-63.8), and it was 75.9% (291/362) (95% CI: 57.6-94.3) in interventional endoscopists. MSI prevalence was higher in female endoscopists compared to their male counterparts (73% vs. 63.2%; OR 1.84, 95% CI 1.32-2.56, P=0.0003) (Figure 1B). MSI prevalence was numerically lower in academic centers compared to non-academic settings but without a statistically significant difference (48.5% vs. 59.5%; OR 0.76, 95% CI 0.51-1.14, P=0.18) (Figure 1C). Interestingly, only 23.5% of endoscopists reported ergonomic training. Pooled prevalence estimates for common MSI types included low back pain (37.7%), neck pain (37.2%), thumb pain (34.2%), hand pain (32.2%), and shoulder pain (30.1%). Incidences of carpal tunnel syndrome and De Quervain's tenosynovitis were reported at 9.9% and 10%, respectively. Those afflicted with MSI reported various treatments: pain medications (37.7%), physical therapy (25%), splinting (11%), steroid injections (8.5%), and surgery (5.6%). Finally, 13.2% of those with MSI required time off work. All prevalence estimates of common MSI types with common treatments used are summarized in Table 1.

Discussion: Given MSI’s high prevalence and significant health burden among GI endoscopists, ergonomic endoscopic instrument redesign is critical. Implementing standardized ergonomic curricula in endoscopy training institutions and suites is essential. Further research to inform such an evidence-based ergonomic curriculum is paramount to mitigate MSI risk, especially considering the imminent shortage of gastroenterologists and increasing procedure volume.

Figure: Figure 1
OutcomesTotal studiesTotal number of endoscopists with MSINumber of endoscopists with outcome of interest% (95% CI)
Received ergonomic training72,52383923.5% (14.1, 32.8)
Most common MSI types
  • Low back pain
183,2341,31837.7% (28.6, 46.8)
  • Neck pain
183,2341,44137.2% (28.4, 46.1)
  • Thumb pain
153,0721,35234.2% (23, 45.3)
  • Hand pain
132,8211,08132.2% (19.7, 44.6)
  • Shoulder pain
163,1021,01530.1% (20.3, 39.8)
  • De Quervain's tenosynovitis
33264210% (2.2, 17.8)
  • Carpal tunnel syndrome
9 2,3843529.9% (4.7, 15.1)
Treatment of MSIs
  • Pain medications
141,63868337.7% (26.6, 48.7)
  • Physical therapy 
101,41544025% (14.1, 36)
  • Splinting
101,34617811% (6.2, 15.9)
  • Steroid injection
81,2141548.5% (2.9, 14.2)
  • Surgery
102,4662385.6% (2.4, 8.8)
Required time off work162.92150913.2% (7.9, 18.5)

Table: Table 1
abbreviations:
CI: confidence interval
MSI: musculoskeletal injury


Disclosures:
Azizullah Beran indicated no relevant financial relationships.
Mouhand Mohamed indicated no relevant financial relationships.
John Guardiola indicated no relevant financial relationships.
Tarek Aboursheid indicated no relevant financial relationships.
Alejandra Vargas indicated no relevant financial relationships.
Khaled Elfert indicated no relevant financial relationships.
Hala Fatima indicated no relevant financial relationships.
Jeffrey Easler: Boston Scientific – Consultant.
Mohammad Al-Haddad: Amplified Sciences – Grant/Research Support. Creatics, LLC – Grant/Research Support. Interpace diagnostics – Consultant.
Nabil Fayad indicated no relevant financial relationships.
Patrick Young: Elements Endoscopy – Consultant.
Samir Shah indicated no relevant financial relationships.
Douglas Rex: Acacia – Consultant. Boston Scientific – Consultant, Speakers Bureau. Braintree – Consultant, Grant/Research Support. ERBE – Grant/Research Support. Medtronic – Consultant, Speakers Bureau. Norgine – Consultant. Olympus Corporation – Consultant, Grant/Research Support. Satisfai Health – Owner/Ownership Interest.


Azizullah Beran, MD1, Mouhand FH. Mohamed, MD2, John Guardiola, MD1, Tarek Aboursheid, MD3, Alejandra Vargas, MD4, Khaled Elfert, MD5, Hala Fatima, MD1, Jeffrey Easler, MD1, Mohammad Al-Haddad, MD1, Nabil Fayad, MD1, Patrick E. Young, MD6, Samir A. Shah, MD7, Douglas K. Rex, MD8. P0565 - Prevalence of Musculoskeletal Injuries in Gastrointestinal Endoscopy: A Systematic Review and Meta-Analysis, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.