The Young Endoscopist's Back: Practical Ergonomics to Prevent Career-Long Injury

Vol. 31, Issue 3 (September 2026)

Radu-Alexandru Fărcaș, MD, PhD
Department of Internal Medicine
Maimonides Medical Center
Brooklyn, New York, USA
 

Georgiana Gîlcă-Blanariu, MD, PhD
Grigore T. Popa University of Medicine and Pharmacy
Gastroenterology Department
Sf Spiridon Country Clinical Emergency Hospital
Iasi, Romania

 

Key Message

Ergonomics should be regarded not as an optional wellness consideration, but as a core competency in endoscopic practice. A ten-second room check, a lighter grip, and early use of team-assisted maneuvers can prevent thousands of repeated high-risk movements over a career.

Why this matters

Endoscopy is taught as a cognitive and technical discipline: recognize pathology, reach the caecum, inspect carefully, resect safely, and manage complications. Yet every procedure is also a prolonged physical task involving sustained standing, repetitive thumb and wrist motion, pinch force, shoulder elevation, trunk rotation, and intense visual concentration. These exposures accumulate quietly. By the time pain changes an endoscopist’s practice, the injurious pattern may have been repeated for years.

The scale of the problem is substantial. An earlier systematic review found endoscopy-related musculoskeletal pain or injury in 39%–89% of surveyed endoscopists, including back pain in 15%–57% and neck pain in 9%–46%.¹ A 2025 meta-analysis of 30 studies and 7,646 endoscopists estimated a pooled career-long prevalence of 62.5%; the hand, lower back, thumb, and neck were the most frequently affected sites.^{1, 2} The consequences extend beyond discomfort: treatment, physiotherapy, sick leave, reduced procedural volume. and impaired leisure activity are all reported.^{2, 3}

Young gastroenterologists should not assume that injury is a late-career problem. In a national survey of 168 gastroenterology fellows, 54.8% reported an endoscopy-related injury, most often involving the thumb, hand or fingers, and wrist.⁴ The practical implication is clear: prevention should begin during the first months of training, before speed, force, and non-neutral posture become automatic.

Treat ergonomics as part of the procedure

The 2023 American Society for Gastrointestinal Endoscopy (ASGE) guideline supports formal ergonomics education, neutral monitor and table positioning, microbreaks and macrobreaks, antifatigue mats, and selected ancillary devices.⁵ The certainty of evidence is limited because many studies are observational and rely on self-report. However, these interventions are inexpensive, low risk, and biologically plausible. More importantly, ergonomics is teachable: simulation-based training has improved measured posture and reduced injury-risk scores during clinical colonoscopy, while systematic review evidence suggests that educational interventions improve ergonomic knowledge and behavior.^{6, 7}

Ergonomic Practices to Implement

1. Set the room before touching the scope.
   The monitor should come to the endoscopist, not the endoscopist’s neck to the monitor. Place the primary screen directly in front of you, with the center of the image slightly below eye level. ASGE guidance cites a preferred viewing angle approximately 15–25° below the horizontal line of sight.⁵ A monitor positioned laterally or too high encourages repeated cervical rotation, chin elevation, and trunk twisting.
   
   Make this a non-negotiable pre-procedure habit. Before insertion, stand where you intend to work and look naturally ahead. If you must rotate your neck, extend your chin, or lean around another team member, move the screen. The anesthesia workspace, nursing access, and monitor position should be planned together; a well-designed room should not force one professional to work safely at another’s expense.
    
2. Adjust the bed for your body.
   Bed height influences the shoulders, elbows, wrists, and lumbar spine. A useful starting point is to keep the endoscope control body around elbow height or up to 10 cm below it.^{5, 8} A bed that is too high elevates the shoulders and abducts the arms; one that is too low promotes forward flexion and leaning. Do not accept the height inherited from the previous case or previous endoscopist. Re-adjust before every procedure and after major patient repositioning.
    
3. Move your feet and do not torque your back.
   Colonoscopy easily creates an asymmetric posture: the left hand is fixed on the control head, the right hand torques the shaft, and the trunk drifts towards the bed. Stand close enough to avoid reaching, maintain a balanced stance, and reposition your feet as the direction of force changes. Pivot from the hips and feet rather than rotating through a fixed lumbar spine.
   
   Most importantly, do not treat every loop as a personal strength test. Use withdrawal and reduction, change the patient’s position, ask for targeted abdominal pressure, and consider water-assisted or other low-force techniques according to local practice. Good colonoscopy is not defined by how much torque the operator can generate. It is defined by effective, controlled force applied through the safest available strategy.
    
4. Protect the hands and thumbs.
   The endoscope control head was not designed around the biomechanics of every hand. Repeated dial manipulation, sustained pinch, non-neutral wrist posture, and high grip force contribute to thumb, wrist, forearm, and nerve injury.^{8, 9} Use the lightest grip that preserves control. Relax the left thumb and fingers whenever a maneuver ends; avoid keeping the control dials clamped between actions. Keep the wrists as neutral as possible, bring the instrument towards the body rather than reaching, and use the right hand to support and steer the shaft rather than relying on a prolonged static pinch.
   
   Trainees often tighten their grip during difficult passages because anxiety is translated into muscle force. A useful self-check is: ‘Can I soften my hands without losing control?’ If the answer is yes, do so immediately. Precision usually improves when unnecessary tension falls.
    
5. Use microbreaks as procedural maintenance.
   Microbreaks are not lost productivity. They are brief interruptions of sustained loading. Between cases, or during a safe pause in a prolonged therapeutic procedure, 30–60 seconds can be used for cervical retraction, scapular setting, wrist and thumb mobility, lumbar extension, and calf activation. Longer lists should also include scheduled microbreaks when feasible.⁵ The aim is not an elaborate workout in the endoscopy unit; it is to prevent one posture from becoming continuous exposure.
   
   Supportive, stable footwear and an appropriately cleaned antifatigue mat may reduce lower-limb and back discomfort during long standing lists.⁵ Mats should have bevelled edges and be positioned so that they do not create a trip or infection-control problem.
    
6. Make ergonomics a team behavior.
   The individual endoscopist cannot compensate indefinitely for a poorly designed unit. Teams should normalize adjustment of monitors and beds, early patient repositioning, effective abdominal pressure, and brief recovery pauses. Procedure rooms should accommodate operators of different heights, including trainees who may be substantially shorter or taller than their supervisors. Equipment purchasing should consider handle size, shaft forces, monitor mobility, and room layout, not only image quality.
   
   Supervisors also shape behavior. When a trainer praises rapid completion but ignores a fellow’s elevated shoulder, twisted neck, or white-knuckle grip, the hidden curriculum favors injury. A better teaching language is specific and immediate: ‘Lower the bed,’ ‘square your hips to the monitor,’ ‘step rather than twist,’ or ‘release your thumb between dial movements.’

When pain appears, respond early

Pain should not be accepted as proof of commitment or procedural volume. Persistent symptoms, nocturnal pain, weakness, numbness, loss of dexterity, or reduced range of motion deserve early occupational-health, physiotherapy, or medical assessment. In a small real-world intervention, physical-therapist observation of endoscopists followed by an individualized wellness plan led to improvement or resolution at 63% of reported pain sites.¹⁰ The study was small and uncontrolled, but it illustrates an important principle: generic advice may miss the specific posture, mobility restriction, or room constraint driving an individual’s symptoms.

Early reporting also allows the unit to identify system problems. Several clinicians developing similar neck pain may indicate a monitor-placement issue; recurrent thumb symptoms may reflect instrument-hand mismatch or excessive list intensity. Ergonomic injury is therefore both an individual health concern and a quality-improvement signal.

Conclusion

Endoscopy-related injury is not an unavoidable badge of honor. It usually develops through small, repeated mismatches between the operator, the instrument, the room, and the workload. Young gastroenterologists have a unique opportunity to build safer motor patterns before harmful habits become efficient habits. Small, cost-free changes can make a big difference: adjust the monitor and bed every time; stand close, move the feet, and use the team; hold the scope lightly; take brief recovery pauses. Last but not least, seek help when symptoms begin, not when they threaten procedural ability. Safe endoscopy means both safe for the patient and safe for the endoscopist. Protecting the operator’s body is not separate from quality; it is what makes a lifetime of high-quality endoscopy possible.

References

1. Yung DE, Banfi T, Ciuti G, Arezzo A, Dario P, Koulaouzidis A. Musculoskeletal injuries in gastrointestinal endoscopists: a systematic review. Expert Rev Gastroenterol Hepatol. 2017;11(10):939–947. doi:10.1080/17474124.2017.1356225.
2. Oliveira R, Roseira J, Estevinho MM, et al. Endoscopy-related musculoskeletal injuries: a systematic review and meta-analysis on prevalence, risk factors and prevention. United European Gastroenterol J. 2025;13(6):1012–1030. doi:10.1002/ueg2.70042.
3. Sturm N, Leukert J, Perkhofer L, et al. The impact of endoscopic activity on musculoskeletal disorders of high-volume endoscopists in Germany. Sci Rep. 2022;12(1):8538. doi:10.1038/s41598-022-12400-4.
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5. Pawa S, Kwon RS, Fishman DS, et al. American Society for Gastrointestinal Endoscopy guideline on the role of ergonomics for prevention of endoscopy-related injury: summary and recommendations. Gastrointest Endosc. 2023;98(4):482–491. doi:10.1016/j.gie.2023.05.056.
6. Khan R, Scaffidi MA, Satchwell J, et al. Impact of a simulation-based ergonomics training curriculum on work-related musculoskeletal injury risk in colonoscopy. Gastrointest Endosc. 2020;92(5):1070–1080.e3. doi:10.1016/j.gie.2020.03.3754.
7. Scaffidi MA, Gimpaya N, Fecso AB, et al. Educational interventions to improve ergonomics in gastrointestinal endoscopy: a systematic review. Endosc Int Open. 2022;10(9):E1322–E1327. doi:10.1055/a-1897-4835.
8. Shergill AK, McQuaid KR, Rempel D. Ergonomics and GI endoscopy. Gastrointest Endosc. 2009;70(1):145–153. doi:10.1016/j.gie.2008.12.235.
9. Ridtitid W, Coté GA, Leung W, et al. Prevalence and risk factors for musculoskeletal injuries related to endoscopy. Gastrointest Endosc. 2015;81(2):294–302.e4. doi:10.1016/j.gie.2014.06.036.
10. Markwell SA, Garman KS, Vance IL, Patel A, Teitelman M. Individualized ergonomic wellness approach for the practicing gastroenterologist (with video). Gastrointest Endosc. 2021;94(2):248–259.e2. doi:10.1016/j.gie.2021.01.045.