Characterization of biomechanical risk factors during endoscopic submucosal dissection: Ergonomic pilot study

Musculoskeletal disorders (MSDs) are prevalent among endoscopists. The aim of this study was to evaluate biomechanical risk factors for MSDs in gastroenterologists performing ESD.

An observational study was performed among interventional endoscopists performing ESD in three French centers. Physical constraints were assessed using an analog scale of perceived physical effort intensity and physiological sensors to measure joint angulation kinematics and muscle activity levels (flexor and extensor carpi radialis muscles) during diagnostic colonoscopy and ESD. High muscle strain was defined as any muscle activation exceeding 10% of maximum voluntary contraction (MVC). Two distinct sub-tasks of ESD were identified: lesion marking and circumferential incision phase (ESD-1) and dissection phase (ESD-2).

Six interventional gastroenterologists participated in the study. Perceived physical effort was significantly greater for ESD compared with colonoscopy ( P = 0.03). Time spent at more than 10% MVC for the right extensor carpi radialis was significantly higher during ESD-1 than during colonoscopy (+15%, P = 0.04). The greatest strain was observed in the left extensor carpi radialis. This muscle was particularly exposed because more than 50% of the time was spent at more than 10% of MVC during colonoscopy and up to more than 80% during ESD-1 and -2. Time spent in the neck flexion risk zone was significantly higher during ESD-2 than during colonoscopy (+42%, P = 0.046).

ESD increased the risk of musculoskeletal strain. It is crucial to develop prevention programs to reduce risk of MSD in the population of gastroenterologists.