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

Has Audio

Presenting Author(s)

Azizullah Beran, MD

Indiana University
Indianapolis, IN

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

Outcomes	Total studies	Total number of endoscopists with MSI	Number of endoscopists with outcome of interest	% (95% CI)
Received ergonomic training	7	2,523	839	23.5% (14.1, 32.8)
Most common MSI types
Low back pain	18	3,234	1,318	37.7% (28.6, 46.8)
Neck pain	18	3,234	1,441	37.2% (28.4, 46.1)
Thumb pain	15	3,072	1,352	34.2% (23, 45.3)
Hand pain	13	2,821	1,081	32.2% (19.7, 44.6)
Shoulder pain	16	3,102	1,015	30.1% (20.3, 39.8)
De Quervain's tenosynovitis	3	326	42	10% (2.2, 17.8)
Carpal tunnel syndrome	9	2,384	352	9.9% (4.7, 15.1)
Treatment of MSIs
Pain medications	14	1,638	683	37.7% (26.6, 48.7)
Physical therapy	10	1,415	440	25% (14.1, 36)
Splinting	10	1,346	178	11% (6.2, 15.9)
Steroid injection	8	1,214	154	8.5% (2.9, 14.2)
Surgery	10	2,466	238	5.6% (2.4, 8.8)
Required time off work	16	2.921	509	13.2% (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.