survey data, 37 to 89% of endoscopists will develop work-related injuries. Suspected risk factors include repetitive hand motion, high hand forces, and awkward wrist, shoulder, and neck postures. The number of procedures performed by endoscopists is ever-increasing, and surveys suggest that the majority of individuals have had an injury definitely or possibly related to endoscopy. Ergonomics plays a very important role in injury prevention for endoscopists and raising awareness and enhancing ergonomics in endoscopy may prevent endoscopic-related injuries. In this video, we review proper attire and equipment prior to endoscopy, ergonomic room setup prior to endoscopy, including bed position, monitor position, as well as appropriate processor and scope positioning. The use of proper shoes is very important in order to make sure that your weight is evenly distributed amongst your feet. The use of insoles and having shoes with appropriate arch support is important. You may also consider using a padded mat to help more evenly distribute your weight. For those endoscopists who use fluoroscopy, the weight of lead can also lead to ergonomic injury. One should limit the use of lead only to the procedure as needed or use a two-piece or belted lead to more evenly distribute the weight. One should always have their ears above their shoulders, back straight, your back should not be arched, your hips should be in line with your spine. You should also make sure that your hips are not tilted, your head is not tilted, as these may lead to sustained injuries. Your weight should be evenly distributed between your two feet. You should not have your weight on one side or the other for prolonged periods of time. You can shift your weight throughout a procedure to help evenly distribute, but if you find yourself leaning to one side you may get hip and foot injuries as well as low back injuries. You don't want your feet too close together, shoulder width apart is an appropriate distance, and having your knees slightly bent is also important. If your knees are locked out, you're putting excessive stress on your low back and your hips as well as your knees, and these can lead to injury when you're doing endoscopy day after day. You also want to make sure your hands and elbows are in a neutral position, and most of your power is when your hands are in a neutral position rather than hyper-flexed or hyper-extended. You want to make sure that you maintain your hands and wrists and arms in a power position to prevent injury. Also, when we begin endoscopy, the bed is usually low to accommodate the patient, and we tend all to raise the bed slightly. However, in the speed of endoscopy, the bed may not be high enough, and you may find yourself throughout the procedure bending and becoming kyphotic. In order to maintain good posture, the bed should be raised up in the patient position such that your elbows are in a 90 degree or slightly larger angle, and your wrists are in a neutral position. This way, throughout the procedure, your tendency is to maintain good posture. One of the other things to focus on is appropriate monitor position. One may find that if the monitor is too low or too high, you will become bent in either direction. So bringing the monitor in line to the height of your eye level is the most ergonomically appropriate position. This way, you will maintain good posture throughout the procedure. You may also find that if the patient is in left lateral position, the monitor directly across from the bed is appropriate. But if the patient is supine, you may find yourself with your body turned away from the patient and the monitor to the left. In these situations, the monitor should be repositioned so that your head is not turned and that the monitor is directly in front of your body. Particularly those endoscopists who perform endoscopic ultrasound and ERCP, they may find themselves, if the patient is supine, turned almost 180 degrees away from the patient. In these situations, the monitor should also be repositioned in order to keep it in front of your body. For every 90 degrees that the patient turns from left lateral to supine, you will have to move your monitor approximately 90 degrees as well to maintain appropriate ergonomic position and to prevent prolonged neck stress, which may predispose to injury. You want to make sure that the processor is directly behind you and that the scope umbilicus is in a neutral position without any excessive torque or strain. When the umbilicus is loose, the scope is loose and allows you the most ergonomically powerful position. If the processor is directly to your left, you may find excessive strain in the scope umbilicus. If the processor is to your right and the scope behind you, there will be too much tension. Even if the scope is in front of you, you may find that throughout the procedure, there will be excessive torque on the scope and preventing you from full range of motion. So again, to have no loop in the umbilicus is important and making sure that if possible, the processor is behind you, which allows you the most degrees of freedom and would prevent any excessive strain on your wrists and arms. If you find that the processor is to your right, this is also an appropriate position so long as the umbilicus is loose and allows you the appropriate amount of freedom to move your wrists, arms, and body and not create excessive tension. In summary, heightened awareness for room and patient setup prior to endoscopy is important and it may prevent endoscopic injury through enhanced ergonomics. We encourage viewers to assess their own units and practices to limit injury.

endoscopists

ergonomics

work-related injuries

proper posture

ergonomic practices