ASGE Develops First Ergonomics Guideline to Help Reduce Injury Risk in Endoscopy

ASGE has released the first evidence-based guideline on ergonomics in endoscopy, recommending doctors receive work safety education and use properly positioned equipment to lower their injury risk.

The clinical practice guideline to be published in the October 2023 issue of Gastrointestinal Endoscopy (GIE), the society’s monthly, peer-reviewed research journal, also suggests endoscopists take breaks and use antifatigue mats.

“ASGE advocates for important research and provides recommendations for practicing endoscopists and trainees to reduce the risk of significant injury during the course of their professional careers,” ASGE President Jennifer Christie, MD, FASGE, said.

Reviewing 17 studies on more than 5,000 gastrointestinal endoscopists, who diagnose and treat conditions of the digestive system, researchers found that the work-related injury rate was 58 percent, and hands, fingers, back and neck were the most injured body parts.

“This guideline is a first of its kind and will pave the path for responsible endoscopic practice based on sound ergonomic principles for (endoscopy-related injury) ERI prevention,” first author Swati Pawa, MD, FASGE, said.

The injury rate was 62 percent in female endoscopists and 46 percent in male endoscopists. Other injury risk factors include higher procedure volume, small hands and age. Injuries ranging from pain to disability could result from performing repetitive actions in awkward positions, such as using the endoscope, an instrument with a lens for examination.

“ERIs affect many endoscopists,” said coauthor and ASGE Standards of Practice Committee Immediate Past Chair Bashar J. Qumseya, MD, MPH, FASGE. “This is the national guideline to systematically analyze the scope of this issue and make practical recommendations on how to prevent ERIs.”

Developed by the committee using Grading of Recommendations, Assessment, Development and Evaluation (GRADE) methodology, the guideline recommends endoscopists:

  • Seek education, which could include visiting a physical therapist and accessing informational materials. (ASGE provides videos and training.)
  • Take breaks.
    • Microbreaks – short breaks typically with movement – and macrobreaks – scheduled for 15 to 45 minutes – help lower pain and possibly prevent injury.
    • Resources about exercise are available on GI Leap.
  • Ensure monitors and beds are positioned so they enable a neutral posture. In an ergonomic stance, the neck, back and knees are not hyperextended, and weight is equally distributed between the legs.
    • Neck strain was lowest and task performance optimal when the monitor was in front of the physician.
  • Use antifatigue mats, which are associated with less pain.

“The new guideline is built upon a growing need for improving the lives of physicians and has the potential for real impact on adult and pediatric patients,” coauthor Douglas Fishman, MD, FASGE, said. “We want to stimulate an enthusiasm for education and research in the ergonomics of endoscopy.”

The guideline also advocates for:

  • Additional funding for developing devices to assist endoscopists with smaller hands and enhancing endoscope design to lower injury risk.
  • A program in all endoscopy units to recognize poorly operating endoscopes that could result in endoscopists using more force, raising injury risk.

“It is important for healthcare systems, industry and individual endoscopists to recognize the increasing prevalence of ERIs,” coauthor Richard Kwon, MD, FASGE, said.

Read all ASGE guidelines and GIE.

About Gastrointestinal Endoscopy
Gastrointestinal endoscopic procedures allow the gastroenterologist to visually inspect the upper gastrointestinal tract (esophagus, stomach and duodenum) and the lower bowel (colon and rectum) through an endoscope, a thin, flexible device with a lighted end and a powerful lens system. Endoscopy has been a major advance in the treatment of gastrointestinal diseases. For example, the use of endoscopes allows the detection of ulcers, cancers, polyps and sites of internal bleeding. Through endoscopy, tissue samples (biopsies) may be obtained, areas of blockage can be opened and active bleeding can be stopped. Polyps in the colon can be removed, which has been shown to prevent colon cancer.

About the American Society for Gastrointestinal Endoscopy
Since its founding in 1941, the American Society for Gastrointestinal Endoscopy (ASGE) has been dedicated to advancing patient care and digestive health by promoting excellence and innovation in gastrointestinal endoscopy. ASGE, with almost 16,000 members worldwide, promotes the highest standards for endoscopic training and practice, fosters endoscopic research, recognizes distinguished contributions to endoscopy, and is the foremost resource for endoscopic education. Visit and for more information and to find a qualified doctor in your area.


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