Observational Study
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Endosc. Mar 16, 2022; 14(3): 142-152
Published online Mar 16, 2022. doi: 10.4253/wjge.v14.i3.142
Ergonomics of gastrointestinal endoscopies: Musculoskeletal injury among endoscopy physicians, nurses, and technicians
Samana Zainab Shah, Syed Tabish Rehman, Aysha Khan, Muhammad Muneeb Hussain, Mohsin Ali, Sonaila Sarwar, Shahab Abid
Samana Zainab Shah, Syed Tabish Rehman, Muhammad Muneeb Hussain, Mohsin Ali, Sonaila Sarwar, Shahab Abid, Department of Medicine, Aga Khan University Hospital, Karachi 74800, Sindh, Pakistan
Aysha Khan, Department of Internal Medicine, Baystate Medical Center, Springfield, MA 01199, United States
Author contributions: Shah SZ designed the study and methodology for the study and contributed to the finalized article writing; Abid S conceptualized the idea, edited and revised the manuscript and oversaw the entire project; Rehman ST and Hussain MM contributed to initial and finalized article writing and analysis alongside literature search; Ali M, Khan A and Sarwar S contributed in data collection and analysis.
Institutional review board statement: The study was reviewed and approved by the Ethics Review Committees (ERC) at the Aga Khan University (Karachi, Pakistan).
Informed consent statement: All study participants provided informed written consent prior to study enrollment.
Conflict-of-interest statement: There are no conflicts of interest to report.
Data sharing statement: No additional data are available.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Shahab Abid, MBBS, PhD, Professor, Department of Medicine, Aga Khan University Hospital, Stadium Road, P O Box 3500 , Karachi 74800, Sindh, Pakistan. shahab.abid@aku.edu
Received: April 21, 2021
Peer-review started: April 21, 2021
First decision: June 25, 2021
Revised: July 17, 2021
Accepted: February 11, 2022
Article in press: February 11, 2022
Published online: March 16, 2022

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.


To document the prevalence of MSI, and awareness and practices of ergonomics by endoscopists and ancillary staff.


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.


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 not certain whether endoscopy had caused their symptoms. Twenty-one point four percent of patients had to take time off their work, while 33.9% took medications for pain. Ergonomic modifications to prevent musculoskeletal injury, including placement of endoscopic monitor at eye level and the cardiac monitor in front, stopping the procedure to move patients, sitting while performing colonoscopy, and navigating height-adjustable bed were used by 21.4%. Nine out of 13 ergonomic facilities were not present in all five tertiary care hospitals. Conveniences, such as anti-fatigue mats, height-adjustable computer stations, and time out between patients were not present.


Three-fourth of our endoscopists reported MSI, of which more than half were not sure or attributed this problem to endoscopy. The prevalence of MSI warrants urgent attention.

Keywords: Endoscopy, Ergonomics, Injury, Musculoskeletal, Endoscopists, Gastroenterologist

Core Tip: Musculoskeletal injuries (MSI) have impacted gastroenterologists and ancillary staff involved in endoscopy. Maneuvers, time duration, and failure of ergonomic practices and provision of facilities have led to the prevalence of MSI. This has resulted in stress, chronic pain management, office leaves, and consumption of analgesics. We found three-fourth of our endoscopists reported MSI, of which more than half were not sure or attributed this problem to endoscopy. The high prevalence of MSI and lack of awareness among endoscopists and ancillary staff needs to be addressed urgently.