Improving Ergonomics in Endoscopy to Prevent Injury and Improve Quality

Over the past decade, there has been a significant focus on reducing burnout to improve physicians' quality of life and retain a strong healthcare workforce. However, for proceduralists and other surgical specialists, disability is one of the most significant factors in determining if they leave the workforce early. In a survey of physician members of the American College of Gastroenterology (ACG), 75 percent of respondents reported experiencing an injury related to endoscopy.

“Injury is often at the forefront of our minds,” said Gyanprakash Ketwaroo, MD, MSc, associate professor of medicine (digestive diseases) and chief of endoscopy at the West Haven VA. “We do repetitive tasks over and over again, which can cause pain and recurring injuries. It's a significant problem, especially during training and early in an endoscopist’s career.”

Ketwaroo says that much of endoscopy training typically focuses on achieving an outcome, such as removing a polyp or tissue. However, many training programs place little emphasis on the preventive measures that are important for reducing strain on the endoscopist.

Until recently, there was not much attention on the important role ergonomics plays in endoscopy; however, in 2023, the American Society for Gastrointestinal Endoscopy issued a clinical practice guideline recommending ergonomic education to reduce the risk of endoscopy-related injuries.

Ketwaroo, along with his colleagues Kalpesh Patel, MD, of Baylor College of Medicine, and Amandeep K. Shergill, MD, MS, of the University of California, San Francisco, recently edited a book, “Ergonomics for Endoscopy.” The book, which was launched at the American College of Gastroenterology conference in late 2024, focuses on changes that can be put into place at every level, from the individual to the office to the system level.

The book provides guidance on proper positioning during endoscopy and routine stretches and exercises to minimize injury and prolong careers.

“While some ergonomics for endoscopy is individualized in response to a person’s own injuries and predispositions, there are still some principles that apply to everyone,” said Ketwaroo.

For example, Ketwaroo says that building thoughtful schedules can allow for sufficient rest and recovery. Alternating procedures throughout the day can help endoscopists rest specific muscles and prevent some of the repetitive motions that can cause injury. Additional chapters cover topics such as the design of the endoscopy suite, ergonomics during pregnancy, and the business case for implementing ergonomic practices across the health system.

“If we can use good ergonomic practices, we can help endoscopists minimize injury and perform endoscopy more efficiently. Then, because endoscopists are less injured, more efficient, and more productive, they may be less likely to experience burnout,” he said.

Despite some of the field’s challenges, Ketwaroo says he remains inspired by his work.

“Endoscopy is an exciting field that is constantly innovating. You get to use your hands and see immediate results for the patient,” he said. “With a stronger focus on ergonomics, we’ll be able to keep more endoscopists healthy and in the field, continuing to care for patients.”

Since forming one of the nation’s first sections of hepatology more than 75 years ago and then gastroenterology nearly 70 years ago, Yale School of Medicine’s Section of Digestive Diseases has had an enduring impact on research and clinical care in gastrointestinal and liver disorders. To learn more about their work, visit Internal Medicine: Digestive Diseases.