Self-Care Advice from Experienced Gastroenterologists

Gastroenterologists and their staff face the physical toll of colonoscopy procedures each day, and now they are acutely feeling the strain of a nationwide endoscopy personnel shortage. Now more than ever, it’s imperative to prioritize self-care strategies, safe patient handling, and optimal ergonomics to navigate this anticipated surge in procedures. 

We had the opportunity to speak with three experienced gastroenterologists*, exploring the valuable insights they’ve learned throughout their extensive careers and the proactive measures they wish they’d taken earlier to prevent injury and safeguard their overall health. In this article, we sought self-care advice from experienced gastroenterologists, in hopes of passing along that wisdom to younger generations of GI professionals.

*Note: The insights shared by the three gastroenterologists in this interview are provided anonymously to ensure confidentiality and professional discretion.

The Looming Shortage of Gastroenterologists

Each year, it's estimated that the United States sees over 15 million colonoscopies performed, a number driven by increasing rates of colorectal cancer diagnoses and a growing emphasis on early screening. This escalating need not only strains the healthcare system as a whole, but also coincides with a concerning forecast: a looming shortage of gastroenterologists. According to the U.S. Health Resources and Services Administration (HRSA), the country is expected to face a national deficit of over 1,600 full-time practitioners by 2025. 

This alarming situation is further compounded by rising rates of physician burnout and staff absenteeism—sometimes attributed to musculoskeletal injuries—which frequently occur due to the repeated application of manual abdominal pressure and patient repositioning used to manage looping during procedures.

Looping: The Phenomenon Behind the Pain

Looping, a frequent challenge affecting up to 90% of colonoscopies, occurs when the colonoscope stretches and distends the colon as the physician tries to advance through the colon. It is a leading cause of patient discomfort, procedural complications, and poor outcomes. Counteracting looping typically involves physically demanding, high-risk activities such as the application of direct pressure to the patient’s abdomen or repositioning the patient entirely.

Self-Care Discussion

ColoWrap: Have you ever experienced pain or injury while performing a colonoscopy? 

Expert 1: It is an occupational hazard. There are few parts of my body by the end of the day that are not hurting. It's been that way for 30 years—it’s a physically demanding job, there’s no getting around that. 

Expert 2: Oh, you should see the state of my fingers on my left hand! They’re practically deformed after years of holding the scope and twisting the knobs. I don’t have the numbers off the top of my head but I’d guess that the vast majority of gastros practicing for over 25 years are suffering from some sort of ailment due to scoping. It might not be 100% of gastros, but I’d bet it’s close. 

Expert 3: I’ve had so many injuries and procedures at this point in my life. As a trainee, there was one educator who taught me how to hold the scope with my left hand to minimize the risk of carpal tunnel and wrist injuries, and that’s just about the only joint left in my body that hasn’t caused me pain. 

ColoWrap: That actually brings me to my next question. When you were going through your training and education, was self-care or safe ergonomics ever a topic you were exposed to? 

Expert 2: No, we learned by experience. There wasn’t a training program to go and learn how to apply pressure or how to torque safely—it was something we had to figure out on our own. 

Expert 3: When I started my training I got a lot of people telling me about what to expect. It was all very, “you do this long enough, and you’ll have a patient complication. You’ll have a bad outcome,” but nobody ever warned me that I’d be injured. If I had known at the time, it wouldn’t have stopped me but it would’ve been nice to know. 

ColoWrap: In your experience, what is the cause of all these injuries? 

Expert 1: For me, it’s in the right hand and shoulder because of all the torquing of the scope. And then there’s the issue of the dial, I’m reaching around to be able to hold it and there’s just constant muscle strain.

Expert 3: In my experience, female physicians attract a lot of female patients, and those colonoscopies tend to be more complicated than the ones in males. There’s more wear and tear involved and that’s before you even consider women being more prone to musculoskeletal injury. Once you have these injuries, the main recommendation is to rest and let things heal. But gastros don’t want to rest, so we go back and perpetuate the injury with little thought to the long-term consequences. 

Expert 2: It’s an issue of sheer volume. Back in the 1990s, I was doing 20 procedures a week but now it’s closer to 50. There’s no question that we’re better trained today, the technology has improved. The procedure is getting easier, but the volume is astronomical. You get up to a certain number of procedures and your body just starts tearing, making the likelihood of injury higher and higher. 

ColoWrap: Are there certain techniques or protocols you’ve put in place to help protect yourself and your staff against these injuries? 

Expert 1:  I think I’ve done everything I can at this point. I’ve got the dial extenders. I use more flexible scopes. I spend an awful lot of time with loop prevention to avoid advancing the scope against resistance. 

Expert 2: I try to use as much targeted pressure as possible. I’m very specific about where I’m moving the scope so I can cut down on how long my staff has to apply the pressure. It’s exhausting if you’re pressing intensely on a wide area for 20 minutes so I try to use almost a pulse technique - 5 or 10 seconds and then we stop and move on to a new area. 

Expert 3: Because I’ve had so many injuries myself, I’ve made it a point to address this with fellows and trainees. I let them know about the risk of injury and I show them things to decrease the risk. You know, Stand like this, hold the scope like this. 

ColoWrap: Do you have any advice for new gastroenterologists? Anything you’d do differently if you could turn back time to the start of your career?

Expert 1: You’ve got to get a sense of loop management. Figuring out how to divorce what your hands are feeling from what your eyes are seeing. It’s hard and mostly comes with experience, but I think understanding loop management is probably the intervention that will have the biggest impact on preventing injury. 

Expert 2: Talking about the dangers. They’re real, they’re happening—you’re probably going to get hurt, so the next thing to do is try to prevent it. Convincing hospitals to understand that staff are at risk and that interventions are needed to protect them. 

Expert 3: Our medical societies are finally talking about this more. Ergonomics is getting airplay. I think having more journals, video tutorials, scientific evidence, etc. is a good way to expose fellows to best practices. Way better than the whole,  “The guy who taught me did this so I do this,” strategy too many of us are guilty of. It’s imperative we teach fellows about ergonomics from the start and show them the best ways to protect themselves in the long term.

ColoWrap Prioritizes Ergonomics in Endoscopy

These expert insights underscore that while there’s no substitute for experience, there are actionable techniques and interventions that can be used to safeguard endoscopists and prevent endoscopy staff injury. 

One such intervention is ColoWrap—the first device specifically designed to mitigate looping. In clinical trials, ColoWrap use was associated with up to a 90% reduction in the need for manual pressure and an 80% reduction in patient repositioning. 

Colonoscopy can pose significant physical challenges so it’s essential to take active measures in ensuring the safety of endoscopy staff. ColoWrap plays a vital role in eliminating the most strenuous and risky aspect of colonoscopy. 

Presentation by Gastroenterologist, Dr. Marybeth Spanarkel: Endo Staff Under Pressure: Understanding Colonoscopy-Related Ergonomic Hazards

In March of 2024, at the AORN Global Surgical Conference & Expo, Dr. Marybeth Spanarkel presented on the topic of ergonomic hazards in colonoscopy today.