Prevalence and sex differences in endoscopy-related injuries: comprehensive systematic review and meta-analysis

Background and Aims: Gastroenterologists are at risk for endoscopy-related injury (ERI). The aim of this meta-analysis was to assess the prevalence, characteristics, and burden of ERI. Methods: We searched PubMed, EMBASE, and Web of Science databases for studies reporting ERI prevalence among GI endoscopists. The primary outcome was the pooled ERI prevalence. We also assessed ERI types and treatments. We compared ERI based on sex. Finally, we compared musculoskeletal injury (MSI) prevalence between GI endoscopists and nonendoscopists. The pooled rates were generated using a proportion meta-analysis with the random-effects model. Prevalence ratios (PRs) with the corresponding confidence intervals (CIs) were used for comparative data. Results: We included 26 studies with 6246 endoscopists. Overall, ERI prevalence was 67.9% (95% CI, 60.7-74.4). ERI prevalence in advanced endoscopists was 77.8% (95% CI, 55.1-90.9). A higher trend of ERI prevalence was observed in more recent studies (after 2015) (71.7%; 95% CI, 63.3-78.9). Neck pain (36.7%) was the most common ERI, followed by low back pain (35.6%) and thumb pain (33.1%). Although women reported higher incidences of De Quervain tenosynovitis and carpal tunnel syndrome and wrist, thumb, shoulder, and neck pain, men reported higher incidences of elbow pain. GI endoscopists had a higher MSI prevalence than nonendoscopists (PR, 1.56; 95% CI, 1.01-2.41). Female endoscopists reported higher ERIs (PR, 1.21; 95% CI, 1.10-1.32). Only 19.1% of endoscopists reported receiving prior ergonomic training. Conclusions: ERI is increasingly prevalent in gastroenterology, particularly in female gastroenterologists with significant sex disparities in ERI types noted. These findings underscore the significance of incorporating ergonomic principles into gastroenterology practices to mitigate ERI risks, particularly considering the shortage of gastroenterologists.