Procedure-related musculoskeletal symptoms in gastrointestinal endoscopists in Korea

AIM: To determine the prevalence and risk factors of work-related musculoskeletal disorders in gastrointestinal endoscopists in Korea. METHODS: A survey of musculoskeletal symptoms, using a self-administered questionnaire, was conducted on 55 endoscopists practicing in general hospitals or health promotion centers. RESULTS: Forty-nine (89.1%) endoscopists reported musculoskeletal pain on at least one anatomic location and 37 (67.3%) endoscopists complained of pain at rest. Twenty-six (47.3%) endoscopists had severe musculoskeletal pain defined as a visual analogue score greater than 5.5. Factors related to the development of severe pain were (1) standing position during upper endoscopy, (2) specific posture/ habit during endoscopic procedures, and (3) multiple symptomatic areas. Finger pain was more common in beginners, whereas shoulder pain was more common in experienced endoscopists. Sixteen percent of symptomatic endoscopists have modified their practice or reduced the number of endoscopic examinations. Only a few symptomatic endoscopists had sought professional consultation with related specialists. CONCLUSION: The prevalence of musculoskeletal pain in endoscopists is very high. The location of pain was different between beginners and experienced endoscopists. Measures for the prevention and adequate management of endoscopy-related musculoskeletal symptoms are necessary.

Non-physician endoscopists: A systematic review

AIM:To examine the available evidence on safety, competency and cost-effectiveness of nursing staff providing gastrointestinal(GI) endoscopy services.METHODS:The literature was searched for publications reporting nurse endoscopy using several databases and specific search terms.Studies were screened against eligibility criteria and for relevance.Initial searches yielded 74 eligible and relevant articles; 26 of these studies were primary research articles using original datasets relating to the ability of nonphysician endoscopists.These publications included a total of 28883 procedures performed by non-physician endoscopists.RESULTS:The number of publications in the field of non-specialist gastrointestinal endoscopy reached a peak between 1999 and 2001 and has decreased thereafter.17/26 studies related to flexible sigmoidoscopies,5 to upper GI endoscopy and 6 to colonoscopy.All studies were from metropolitan centres with nurses working under strict supervision and guidance by specialist gastroenterologists.Geographic distribution of publications showed the majority of research was conducted in the United States(43%),the United Kingdom(39%)and the Netherlands(7%).Most studies conclude that after appropriate training nurseendoscopists safely perform procedures.However,in relation to endoscopic competency,safety or patient satisfaction,all studies had major methodological limitations.Patients were often not randomized(21/26studies)and not appropriately controlled.In relation to cost-efficiency,nurse endoscopists were less costeffective per procedure at year 1 when compared to services provided by physicians,due largely to the increased need for subsequent endoscopies,specialist follow-up and primary care consultations.CONCLUSION:Contrary to general beliefs,endoscopic services provided by nurse endoscopists are not more cost effective compared to standard service models and evidence suggests the opposite.Overall significant shortcomings and biases limit the validity and generalizability of studies that have explored safety and quality of services delivered by non-medical endoscopists.

Ergonomics of gastrointestinal endoscopies:Musculoskeletal injury among endoscopy physicians,nurses,and technicians

BACKGROUND Musculoskeletal injuries(MSI)have plagued endoscopists and ancillary staff for decades without any innovative and strong ergonomic guidelines.It has placed a physical and mental strain on our endoscopists and ancillary staff.We have very have limited data supporting this claim in our region and most data is supported by western literature.AIM To document the prevalence of MSI,and awareness and practices of ergonomics by endoscopists and ancillary staff.METHODS This is an observational cross-sectional study,conducted in Karachi,a city that boasts the maximum number of daily endoscopies in the country.An eleven-point self-administered questionnaire was distributed and used to evaluate MSI and ergonomic adjustments amongst three tertiary care setups in Karachi.An onsite survey via a 13-point checklist for endoscopy suite facilities was used to assess the ergonomically friendly conveniences at five tertiary care setups in Karachi.A total of 56 participants replied with a filled survey.RESULTS There were 56 participants in total with 39(69.6%)males.Pain and numbness were documented by 75%of the patients,with pain in the neck(41.1%),lower back(32.1%),shoulder(21.4%),thumb(12.5%),hand(23.2%),elbow(8.9%),and carpal tunnel syndrome(CTS)(7.1%).Of those,33.3%attributed their symptoms to endoscopy, 14.2% said that symptoms were not caused by endoscopy, and 52.4% were notcertain whether endoscopy had caused their symptoms. Twenty-one point four percent of patientshad to take time off their work, while 33.9% took medications for pain. Ergonomic modifications toprevent musculoskeletal injury, including placement of endoscopic monitor at eye level and thecardiac monitor in front, stopping the procedure to move patients, sitting while performingcolonoscopy, and navigating height-adjustable bed were used by 21.4%. Nine out of 13 ergonomicfacilities were not present in all five tertiary care hospitals. Conveniences, such as anti-fatiguemats, height-adjustable computer stations, and time out between patients were not present.CONCLUSIONThree-fourth of our endoscopists reported MSI, of which more than half were not sure orattributed this problem to endoscopy. The prevalence of MSI warrants urgent attention.

Endoscopy in inflammatory bowel disease when and why

Endoscopy plays an important role in the diagnosis and management of inflammatory bowel disease(IBD).It is useful to exclude other aetiologies,differentiate between ulcerative colitis(UC) and Crohn’s disease(CD),and define the extent and activity of inflammation.Ileocolonoscopy is used for monitoring of the disease,which in turn helps to optimize the management.It plays a key role in the surveillance of UC for dysplasia or neoplasia and assessment of post operative CD.Capsule endoscopy and double balloon enteroscopy are increasingly used in patients with CD.Therapeutic applications relate to stricture dilatation and dysplasia resection.The endoscopist’s role is vital in the overall management of IBD.

Acute distal common bile duct angle is risk factor for postendoscopic retrograde cholangiopancreatography pancreatitis in beginner endoscopist

BACKGROUND Post-endoscopic retrograde cholangiopancreatography(ERCP) pancreatitis(PEP)is a critical and poorly managed complication of ERCP. Endoscopists need to understand the risk factors for PEP. However, the majority of studies investigating ERCP-related risk factors have included well-trained endoscopists,with the issue of endoscopist experience on PEP incidence not having been systematically evaluated.AIM To explore the risk factors for PEP in beginner endoscopists without supervision.METHODS We performed a retrospective analysis of 293 patients, with na?ve papilla and no history of pancreatitis, treated using bile duct cannulation. Patients were classified according to the endoscopist’s experience(beginner vs expert). The angle of the distal common bile duct(CBD) was measured as the angle between the lower wall of the bile duct and a vertical line extending to the lower wall of the bile duct on coronal view computed tomography.RESULTS After propensity matching, there were no differences between patients treated by the expert and beginner endoscopist with regard to age, sex, mean bile duct dilatation, and ratio of benign disease. The distal CBD angle was classified as acute(> 30o) or obtuse(≤ 30o), based on the mean angle of 29.9o for the group. An acute distal CBD angle was a significant risk factor for PEP for beginner(P =0.049), but not expert.CONCLUSION For beginner endoscopists first performing unsupervised ERCP, cases with an obtuse distal CBD angle may be more appropriate to lower the risk of PEP.

Diagnostic pitfall of sebaceous gland metaplasia of the esophagus

We investigated the sebaceous gland metaplasia(SGM) of the esophagus and clarified the evidence of misdiagnosis and its diagnosis pitfall. Cases of pathologically proven SGM were enrolled in the clinical analysis and reviewed description of endoscope. In the current study, we demonstrated that SGM is very rare esophageal condition with an incidence around 0.00465% and an occurrence rate of 0.41 per year. There were 57.1% of senior endoscopists identified 8 episodes of SGM. In contrast, 7.7% of junior endoscopists identified SGM in only 2 episodes. Moreover, we investigated the difference in endoscopic biopsy attempt rate between the senior and junior endoscopist(P = 0.0001). The senior endoscopists had more motivation to look for SGM than did junior endoscopists(P = 0.01). We concluded that SGM of the esophagus is rare condition that is easily and not recognized in endoscopy studies omitting pathological review.

Endoscopic Methods in the Diagnosis and Treatment of Pancreatic Cancer

Endoscopic methods are widely used in the diagnosis and palliative treatment of pancreatic cancer. The most sensitive method in early diagnosis is endosonography (EUS) which can also provide histological diagnosis. Diagnostic ERCP became a rather rare procedure as a consequence of wide availability of Magnetic Resonance Cholangiopancreatography (MRCP) but ERCP assisted intraductal methods have gained importance (brush-cytology, intraductal ultrasound, optical coherence tomography) and finally, peroral pancreatoscopy has become technically feasible but available only in some specialized centers. Minimally invasive endoscopic methods play an important role in the palliative treatment of unresectable pancreatic cancer which represents the majority of cases. EUS-guided histological confirmation of adenocarcinoma is crucial in the election of chemotherapy. Celiac plexus blockade and endoscopic biliary and pancreatic stent placement contribute to pain reduction, drainage of obstructed bile duct and assure a better quality of life.