Indexed In : Science Citation Index Expanded(SCIE), MEDLINE,
Pubmed/Pubmed Central, Elsevier Bibliographic, Google Scholar,
Databases(Scopus & Embase), KCI, KoreaMed, DOAJ
Gut and Liver is an international journal of gastroenterology, focusing on the gastrointestinal tract, liver, biliary tree, pancreas, motility, and neurogastroenterology. Gut atnd Liver delivers up-to-date, authoritative papers on both clinical and research-based topics in gastroenterology. The Journal publishes original articles, case reports, brief communications, letters to the editor and invited review articles in the field of gastroenterology. The Journal is operated by internationally renowned editorial boards and designed to provide a global opportunity to promote academic developments in the field of gastroenterology and hepatology. +MORE
| Yong Chan Lee |
Professor of Medicine Director, Gastrointestinal Research Laboratory Veterans Affairs Medical Center, Univ. California San Francisco San Francisco, USA |
| Jong Pil Im | Seoul National University College of Medicine, Seoul, Korea |
| Robert S. Bresalier | University of Texas M. D. Anderson Cancer Center, Houston, USA |
| Steven H. Itzkowitz | Mount Sinai Medical Center, NY, USA |
All papers submitted to Gut and Liver are reviewed by the editorial team before being sent out for an external peer review to rule out papers that have low priority, insufficient originality, scientific flaws, or the absence of a message of importance to the readers of the Journal. A decision about these papers will usually be made within two or three weeks.
The remaining articles are usually sent to two reviewers. It would be very helpful if you could suggest a selection of reviewers and include their contact details. We may not always use the reviewers you recommend, but suggesting reviewers will make our reviewer database much richer; in the end, everyone will benefit. We reserve the right to return manuscripts in which no reviewers are suggested.
The final responsibility for the decision to accept or reject lies with the editors. In many cases, papers may be rejected despite favorable reviews because of editorial policy or a lack of space. The editor retains the right to determine publication priorities, the style of the paper, and to request, if necessary, that the material submitted be shortened for publication.
Split Viewer
Sun-Hye Ko1 
, Myong Ki Baeg2
Correspondence to: Myong Ki Baeg
ORCID https://orcid.org/0000-0002-4807-2447
E-mail baegmk@gmail.com
See “Rehabilitation Program for Improved Musculoskeletal Pain in Gastrointestinal Endoscopists: Multicenter Prospective Cohort Study” by Su Youn Nam, et al. on page 853, Vol. 17, No. 6, 2023
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Gut Liver 2023;17(6):829-830. https://doi.org/10.5009/gnl230439
Published online November 15, 2023, Published date November 15, 2023
Copyright © Gut and Liver.
The incidence of cancer is increasing worldwide, including gastrointestinal cancers such as colorectal, stomach, and esophageal cancers.1 This puts an added burden on gastroenterologists, as the major diagnostic modality of gastrointestinal cancers is the flexible endoscope. This has exponentially increased the number of endoscopy procedures performed worldwide, including those in cancer screening programs.2 The increase in more complex and technically challenging endoscopic procedures such as endoscopic submucosal dissection, endoscopic ultrasonography, and endoscopic retrograde cholangiopancreatography (ERCP) have also resulted in longer endoscopy times.2
This has led to an increase in the risk of musculoskeletal injuries (MI) to gastrointestinal endoscopists.3 Gastrointestinal endoscopy requires repetitive thumb, hand, and wrist motions in often awkward body positions, which may lead to pain and injury.3,4 Indeed, a systemic review estimated that about 40% to 90% of endoscopists develop MI.3 However, there are few studies on the incidence, prevention, and treatment of MI in gastrointestinal endoscopists.5,6
In this issue, Nam et al.7 developed a prospective rehabilitation program for musculoskeletal pain experienced by gastrointestinal endoscopists and verified its usefulness. They reported that 94% of the participating endoscopists complained of musculoskeletal pain at baseline. The baseline pain was positively correlated with the number of endoscopy procedures performed and negatively with the outpatient clinic time.
The program consisted of education on equipment/posture correction and stretching exercises and was developed in collaboration between gastroenterologists and a physiatrist. Four recommendations were made in regard to equipment and eight for good posture. The stretching program consisted of 12 exercises for the neck, shoulder, elbow, wrist, finger, back, leg, and ankle/foot. A figure and video were created and distributed to all participants (https://www.youtube.com/watch?v=6h7f0WMMcAo).7 A satisfaction survey was conducted at the end of the 6th and 8th week after stretching commencement.
The endoscopists who participated in this study expressed general satisfaction with the program. Fewer upper endoscopies, better scope and table posture and a decrease in admitted patients was correlated with improved pain. An increase in colonoscopies was associated with aggravation of musculoskeletal pain. This confirms that endoscopy burden is a risk for MI which is similar to previous reports.5,6 There were no statistical differences in symptom improvement in regard to therapeutic endoscopy or ERCP. However, a study which investigated MI in endoscopists who performed ERCPs reported that two-thirds of the endoscopists had musculoskeletal complaints with those performing over 150 ERCPs per year statistically significant.8 A possible but unknown aggravation factor may be the wearing of lead aprons during ERCP, which lighter aprons may help alleviate.
Interestingly, female endoscopists complained of more neck and shoulder pain compared to men. This may be due to several factors. First, women have smaller hands which may not fit as well as men. Second, the muscle mass of women are lower, possibly putting women at higher risk of endoscopy-related MIs.9 Third, women may be at higher risk of MIs due to childcare and household activities which are more predominantly performed by women.
Study participants voiced satisfaction with the equipment correction done. This study and other recommendations suggest that monitors be placed directly in front of the endoscopists at eye level to reduce neck and shoulder strain.7,10 The distance between the monitor and the endoscopist should be between 52 to 182 cm, but may be further, depending on monitor size and image quality. Optimal bed height should be between the elbow and 10 cm below elbow, or 85 to 120 cm.7,10 Endoscopy suites should be equipped with adjustable monitors and beds to satisfy these criteria.
Exercises, equipment changes, and posture correction may not be enough. Current endoscopy designs are at least 40 years old and not ergonomic. Developing a more refined, human-friendly design would go a great way in protecting endoscopists. Other advancements, such as designing remote control mechanisms to reduce load and torque may also help prevent MI. Finally, robots and magnet-controlled endoscopies such as capsules may exclude human control altogether, putting this discussion into moot.
In conclusion, gastrointestinal endoscopists are at high risk of MI. Stretching and resting between endoscopy procedures, proper equipment and posture position, and a reduced workload would help reduce MI and protect our endoscopists. Proper ergonomic education should be done during endoscopic training and the relevant institutions and societies should ensure that such practices are adhered to.
No potential conflict of interest relevant to this article was reported.
Gut and Liver 2023; 17(6): 829-830
Published online November 15, 2023 https://doi.org/10.5009/gnl230439
Copyright © Gut and Liver.
Sun-Hye Ko1 , Myong Ki Baeg2
1Department of Internal Medicine, International St. Mary’s Hospital, Catholic Kwandong University College of Medicine, Incheon, and 2Department of Internal Medicine, Jeju National University Hospital, Jeju, Korea
Correspondence to:Myong Ki Baeg
ORCID https://orcid.org/0000-0002-4807-2447
E-mail baegmk@gmail.com
See “Rehabilitation Program for Improved Musculoskeletal Pain in Gastrointestinal Endoscopists: Multicenter Prospective Cohort Study” by Su Youn Nam, et al. on page 853, Vol. 17, No. 6, 2023
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
The incidence of cancer is increasing worldwide, including gastrointestinal cancers such as colorectal, stomach, and esophageal cancers.1 This puts an added burden on gastroenterologists, as the major diagnostic modality of gastrointestinal cancers is the flexible endoscope. This has exponentially increased the number of endoscopy procedures performed worldwide, including those in cancer screening programs.2 The increase in more complex and technically challenging endoscopic procedures such as endoscopic submucosal dissection, endoscopic ultrasonography, and endoscopic retrograde cholangiopancreatography (ERCP) have also resulted in longer endoscopy times.2
This has led to an increase in the risk of musculoskeletal injuries (MI) to gastrointestinal endoscopists.3 Gastrointestinal endoscopy requires repetitive thumb, hand, and wrist motions in often awkward body positions, which may lead to pain and injury.3,4 Indeed, a systemic review estimated that about 40% to 90% of endoscopists develop MI.3 However, there are few studies on the incidence, prevention, and treatment of MI in gastrointestinal endoscopists.5,6
In this issue, Nam et al.7 developed a prospective rehabilitation program for musculoskeletal pain experienced by gastrointestinal endoscopists and verified its usefulness. They reported that 94% of the participating endoscopists complained of musculoskeletal pain at baseline. The baseline pain was positively correlated with the number of endoscopy procedures performed and negatively with the outpatient clinic time.
The program consisted of education on equipment/posture correction and stretching exercises and was developed in collaboration between gastroenterologists and a physiatrist. Four recommendations were made in regard to equipment and eight for good posture. The stretching program consisted of 12 exercises for the neck, shoulder, elbow, wrist, finger, back, leg, and ankle/foot. A figure and video were created and distributed to all participants (https://www.youtube.com/watch?v=6h7f0WMMcAo).7 A satisfaction survey was conducted at the end of the 6th and 8th week after stretching commencement.
The endoscopists who participated in this study expressed general satisfaction with the program. Fewer upper endoscopies, better scope and table posture and a decrease in admitted patients was correlated with improved pain. An increase in colonoscopies was associated with aggravation of musculoskeletal pain. This confirms that endoscopy burden is a risk for MI which is similar to previous reports.5,6 There were no statistical differences in symptom improvement in regard to therapeutic endoscopy or ERCP. However, a study which investigated MI in endoscopists who performed ERCPs reported that two-thirds of the endoscopists had musculoskeletal complaints with those performing over 150 ERCPs per year statistically significant.8 A possible but unknown aggravation factor may be the wearing of lead aprons during ERCP, which lighter aprons may help alleviate.
Interestingly, female endoscopists complained of more neck and shoulder pain compared to men. This may be due to several factors. First, women have smaller hands which may not fit as well as men. Second, the muscle mass of women are lower, possibly putting women at higher risk of endoscopy-related MIs.9 Third, women may be at higher risk of MIs due to childcare and household activities which are more predominantly performed by women.
Study participants voiced satisfaction with the equipment correction done. This study and other recommendations suggest that monitors be placed directly in front of the endoscopists at eye level to reduce neck and shoulder strain.7,10 The distance between the monitor and the endoscopist should be between 52 to 182 cm, but may be further, depending on monitor size and image quality. Optimal bed height should be between the elbow and 10 cm below elbow, or 85 to 120 cm.7,10 Endoscopy suites should be equipped with adjustable monitors and beds to satisfy these criteria.
Exercises, equipment changes, and posture correction may not be enough. Current endoscopy designs are at least 40 years old and not ergonomic. Developing a more refined, human-friendly design would go a great way in protecting endoscopists. Other advancements, such as designing remote control mechanisms to reduce load and torque may also help prevent MI. Finally, robots and magnet-controlled endoscopies such as capsules may exclude human control altogether, putting this discussion into moot.
In conclusion, gastrointestinal endoscopists are at high risk of MI. Stretching and resting between endoscopy procedures, proper equipment and posture position, and a reduced workload would help reduce MI and protect our endoscopists. Proper ergonomic education should be done during endoscopic training and the relevant institutions and societies should ensure that such practices are adhered to.
No potential conflict of interest relevant to this article was reported.
pISSN 1976-2283
eISSN 2005-1212
Gut and Liver is an international journal of gastroenterology, focusing on the gastrointestinal tract, liver, biliary tree, pancreas, motility, and neurogastroenterology. Gut atnd Liver delivers up-to-date, authoritative papers on both clinical and research-based topics in gastroenterology. The Journal publishes original articles, case reports, brief communications, letters to the editor and invited review articles in the field of gastroenterology. The Journal is operated by internationally renowned editorial boards and designed to provide a global opportunity to promote academic developments in the field of gastroenterology and hepatology. +MORE
| Yong Chan Lee |
Professor of Medicine Director, Gastrointestinal Research Laboratory Veterans Affairs Medical Center, Univ. California San Francisco San Francisco, USA |
| Jong Pil Im | Seoul National University College of Medicine, Seoul, Korea |
| Robert S. Bresalier | University of Texas M. D. Anderson Cancer Center, Houston, USA |
| Steven H. Itzkowitz | Mount Sinai Medical Center, NY, USA |
All papers submitted to Gut and Liver are reviewed by the editorial team before being sent out for an external peer review to rule out papers that have low priority, insufficient originality, scientific flaws, or the absence of a message of importance to the readers of the Journal. A decision about these papers will usually be made within two or three weeks.
The remaining articles are usually sent to two reviewers. It would be very helpful if you could suggest a selection of reviewers and include their contact details. We may not always use the reviewers you recommend, but suggesting reviewers will make our reviewer database much richer; in the end, everyone will benefit. We reserve the right to return manuscripts in which no reviewers are suggested.
The final responsibility for the decision to accept or reject lies with the editors. In many cases, papers may be rejected despite favorable reviews because of editorial policy or a lack of space. The editor retains the right to determine publication priorities, the style of the paper, and to request, if necessary, that the material submitted be shortened for publication.
PDF
Standard view
Export citation
Share 
