Ergonomics in gastrointestinal endoscopy ‒ A position statement of the Spanish Society of Gastrointestinal Endoscopy.

Abstract

Endoscopy involves prolonged standing, static postures, repetitive hand and wrist movements, sustained force on the controls, manual torque of the insertion tube and, during fluoroscopic procedures, the additional load imposed by radiation protection equipment. In a survey conducted by the Spanish Society of Gastrointestinal Endoscopy (SEED), 69.1% of responding physicians reported discomfort or injury associated with endoscopic practice that had led to medication use, medical consultation or sick leave. The most frequently affected regions were the back/neck (50.8%), wrists/hands (35.0%) and shoulders (8.5%). The SEED Ergonomics Committee was established and developed eight statements, all of which reached Delphi consensus (agreement ranging from 80.9% to 100%): 1. SEED recommends incorporating structured education in ergonomics (before, during and after procedures) into endoscopy training programmes and continuing professional development. 2. SEED recommends taking microbreaks during procedures and scheduled breaks during endoscopy sessions. 3. Alternate endoscopic activity with other tasks and avoid concentrating prolonged or physically demanding procedures within a single working day, where organisational arrangements and staffing permit. 4. Position the monitor directly in front of the operator and approximately 15-30° below eye level to promote a neutral neck posture and avoid sustained flexion or hyperextension. 5. Adjust the height of the procedure bed or table to promote a neutral posture during endoscopy, with the working area approximately at or slightly below elbow level and the elbows flexed at approximately 90°. 6. Introduce an ergonomic check or checklist before each procedure to assess posture, bed and monitor height, pedal positioning and equipment accessibility. 7. Consider technological adaptations of the endoscope and ergonomic support devices for endoscopists with musculoskeletal symptoms or difficulty adapting to standard equipment, as part of an individualised approach to prevention or rehabilitation. 8. Apply comprehensive ergonomic principles during fluoroscopic procedures, including optimisation of posture and distance from the radiation emitter, appropriate use of radiation protection measures and balanced distribution of the load imposed by protective equipment.