Failure of an engineered system: The gastrointestinal endoscope

Advances in endoscopic technology continue to expand the field of gastrointestinal endoscopy. However, there have been no parallel advances in general endoscope design, and gastroenterologists are at risk for musculoskeletal repetitive strain injury due to the repetition, high forces and prolonged, awkward postures required to perform endoscopy. The current endoscope design lacks a consideration of human factors, and due to the high risk of injury, represents a failure of an engineered system. This review will focus on a risk assessment and management strategy for the gastrointestinal endoscope. Risk assessment is the identification of potential flaws in the system. Risk management describes the steps taken to mitigate these flaws. Three different approaches to risk assessment and management, proactive, reactive, and interactive risk assessment and management, will be reviewed as they apply to the performance of gastrointestinal endoscopy.