Subscribe to RSS
![](/products/assets/desktop/img/oa-logo.png)
DOI: 10.1055/a-2231-7393
Can single-use versus standard duodenoscope improve ergonomics in ERCP? A comparative, simulation-based pilot study
![](https://www.thieme-connect.de/media/10.1055-s-00025476/202403/lookinside/thumbnails/10-1055-a-2231-7393-1.jpg)
Abstract
Background and study aims Musculoskeletal disorders (MSDs) and injuries (MSIs) are frequent in gastrointestinal endoscopy. The aim of this study was to assess potential ergonomic advantages of a lighter single-use duodenoscope compared with a standard reusable one for endoscopists performing endoscopic retrograde cholangiopancreatography (ERCP).
Methods Three experienced endoscopists performed an ergonomic, preclinical, comparative protocol-guided simulation study of a single-use and a standard reusable duodenoscope using an anatomic bench model. Surface EMG signals from left forearm and arm muscles were recorded. A commercial inertial sensor-based motion capture system was applied to record body posture as well.
Results A significant lowering of root mean square amplitude and amplitude distribution of biceps brachii signal (ranging from 13% to 42%) was recorded in all the participants when using a single-use duodenoscope compared with a reusable one. An overall reduction of muscle activation amplitude and duration was also associated with the single-use duodenoscope for forearm muscles, with different behaviors among subjects. Participants spent most of the time in wrist extension (> 80%) and ulnar deviation (> 65%). A consistent pattern of functional range of motion employed for completing all procedures was observed.
Conclusions Our study showed that a lighter scope has a promising effect in reducing upper arm muscle activity during ERCP with potential benefit on musculoskeletal health in the ERCP setting.
Keywords
ERC topics - Pancreatobiliary (ERCP/PTCD) - Diagnostic ERC - Quality and logistical aspects - Quality managementPublication History
Received: 14 September 2023
Accepted after revision: 12 December 2023
Accepted Manuscript online:
18 December 2023
Article published online:
18 March 2024
© 2024. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).
Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany
-
References
- 1 Shergill AK, Asundi KR, Barr A. et al. Pinch force and forearm-muscle load during routine colonoscopy: a pilot study. Gastrointest Endosc 2009; 69: 142-146
- 2 Campbell 3rd EV, Muniraj T, Aslanian HR. et al. Musculoskeletal pain symptoms and injuries among endoscopists who perform ERCP. Dig Dis Sci 2021; 66: 56-62
- 3 O'Sullivan S, Bridge G, Ponich T. Musculoskeletal injuries among ERCP endoscopists in Canada. Can J Gastroenterol 2002; 16: 369-374 DOI: 10.1155/2002/523125. (PMID: 12096300)
- 4 ASGE Technology Committee, Pedrosa MC, Farraye FA. et al. Minimizing occupational hazards in endoscopy: personal protective equipment, radiation safety, and ergonomics. Gastrointest Endosc 2010; 72: 227-235
- 5 Shergill AK, McQuaid KR, Rempel D. Ergonomics and GI endoscopy. Gastrointest Endosc 2009; 70: 145-153 DOI: 10.1016/j.gie.2008.12.235. (PMID: 19559836)
- 6 Muthusamy VR, Bruno MJ, Kozarek RA. et al. Clinical evaluation of a single-use duodenoscope for endoscopic retrograde cholangiopancreatography. Clin Gastroenterol Hepatol 2020; 18: 2108-2117.e3
- 7 Gobba F, Ghersi R, Martinelli S. et al. Traduzione in lingua italiana e validazione del questionario standardizzato Nordic IRSST per la rilevazione di disturbi muscoloscheletrici [Italian translation and validation of the Nordic IRSST standardized questionnaire for the analysis of musculoskeletal symptoms]. Med Lav 2008; 99: 424-443
- 8 Ross AS, Bruno MJ, Kozarek RA. et al. Novel single-use duodenoscope compared with 3 models of reusable duodenoscopes for ERCP: a randomized bench-model comparison. Gastrointest Endosc 2020; 91: 396-403
- 9 Bassi M, Apolito P, Aspide R. et al. Workforce availability on the intraprocedural stage of endoscopy procedures: a single-center time and motion preliminary efficiency study. iGIE April 2023; DOI: 10.1016/j.igie.2023.03.002.
- 10 Merletti R, Cerone GL. Tutorial. Surface EMG detection, conditioning and pre-processing: Best practices. J Electromyogr Kinesiol 2020; 54: 102440 DOI: 10.1016/j.jelekin.2020.102440. (PMID: 32763743)
- 11 Kim D, Nicoletti C, Soedirdjo SDH. et al. Effect of Periodic Voluntary Interventions on Trapezius Activation and Fatigue During Light Upper Limb Activity. Hum Factors 2021; 65: 1491-1505 DOI: 10.1177/00187208211050723.
- 12 Shiang A, Wang JS, Cho DH. et al. Patient factors affect ergonomic strain of endoscopists during colonoscopy. Dig Dis Sci 2023; 68: 736-743
- 13 Lai K-H, Mo L-R, Wang H-P. Basic Technique of ERCP in Biliopancreatic Endoscopy: Practical Application. Singapore: Springer; 2018
- 14 Harvin G. Review of musculoskeletal injuries and prevention in the endoscopy practitioner. J Clin Gastroenterol 2014; 48: 590-594 DOI: 10.1097/MCG.0000000000000134. (PMID: 24798940)
- 15 O'Driscoll SW, Horii E, Ness R et. al. The relationship between wrist position, grasp size, and grip strength. J Hand Surg Am 1992; 17: 169-177
- 16 Putz-Anderson V. Cumulative Trauma Disorders: a manual for Musculoskeletal diseases of the Upper Limbs - CRC Press; 1st edition. 1988
- 17 Caumes M, Goislard de Monsabert B, Hauraix H et. al. Complex couplings between joints, muscles and performance: the role of the wrist in grasping. Sci Rep 2019; 9: 19357
- 18 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: 482-491 DOI: 10.1016/j.gie.2023.05.056. (PMID: 37245720)
- 19 Hori Y, Nagai T, Hayashi K. et al. Ability of ergonomic timeout to reduce musculoskeletal discomfort related to fluoroscopic endoscopy. Endosc Int Open 2021; 9: E1909-E1913 DOI: 10.1055/a-1594-2037. (PMID: 34917460)
- 20 Rothmore P. Lead aprons, radiographers, and discomfort: A pilot study. J Occupat Health Safety - Australia and New Zealand 2002; 18: 357-365
- 21 Nivatvongs S, Goldberg SM. Holder for the fiberoptic colonoscope. Dis Colon Rectum 1974; 17: 273-274 DOI: 10.1007/BF02588116. (PMID: 4819279)
- 22 Singla M, Kwok RM, Deriban G. et al. Training the endo-athlete: an update in ergonomics in endoscopy. Clin Gastroenterol Hepatol 2018; 16: 1003-1006 DOI: 10.1016/j.cgh.2018.04.019. (PMID: 29914638)
- 23 Shergill A. Ergonomics in endoscopy. Gastroenterol Hepatol (N Y) 2020; 16: 644-647 DOI: 10.1016/j.giec.2021.05.003. (PMID: 34538406)
- 24 Hislop J, Tirosh O, McCormick J. et al. Muscle activation during traditional laparoscopic surgery compared with robot-assisted laparoscopic surgery: a meta-analysis. Surg Endosc 2020; 34: 31-38
- 25 Korman LY, Egorov V, Tsuryupa S. et al. Characterization of forces applied by endoscopists during colonoscopy by using a wireless colonoscopy force monitor. Gastrointest Endosc 2010; 71: 327-334
- 26 Korman LY, Brandt LJ, Metz DC. et al. Segmental increases in force application during colonoscope insertion: quantitative analysis using force monitoring technology. Gastrointest Endosc 2012; 76: 867-872