Burke, Carol A

INTRODUCTION: Endoscopy-related injury (ERI) is common in gastroenterologists (GI). The study aim was to assess the prevalence of self-reported ERI, patterns of injury, and endoscopist knowledge of preventative strategies in a nationally representative sample. METHODS: A 38-item electronic survey was sent to 15,868 American College of Gastroenterology physician members. The survey was completed by 1,698 members and was included in analyses. Descriptive, univariate, and multivariate analyses were conducted to evaluate the likelihood of ERI based on workload parameters and gender. RESULTS: ERI was reported by 75% of respondents. ERI was most common in the thumb (63.3%), neck (59%), hand/finger (56.5%), lower back (52.6%), shoulder (47%), and wrist (45%). There was no significant difference in the prevalence of ERI between men and women GI. However, women GI were significantly more likely to report upper extremity ERI while men were more likely to report lower-back pain-related ERI. Significant gender differences were noted in the reported mechanisms attributed to ERI. Most respondents did not discuss ergonomic strategies in their current practice (63%). ERI was less likely to be reported in GI who took breaks during endoscopy ( P = 0.002). DISCUSSION: ERI is highly prevalent in GI physicians. Significant gender differences regarding specific sites affected by ERI and the contributing mechanisms were observed. Results strongly support institution of training in ergonomics for all GI as a strategy to prevent its impact on providers of endoscopy. JOURNAL/ajgast/04.03/00000434-202103000-00021/inline-graphic1/v/2026-07-10T100418Z/r/image-tiff

INTRODUCTION: Endoscopy- related injury (ERI) is common in gastroenterologists. This study aimed to evaluate the prevalence of self-reported ERI, patterns of injury and knowledge of ergonomic strategies in endoscopists who are ACG physician members. METHODS: A 38-item survey was developed and initially piloted at three academic medical centers. Through the ACG Women in GI Committee and ACG Governing Board sponsorship, the survey was administered to ACG physician members. Statistical analysis was performed using SAS Enterprise Guide 7.0 (SAS Institute Inc., Cary, NC); chi-square tests and descriptive analysis evaluating associations between multiple variables and ERI. RESULTS: Of the 14759 total surveys sent, 5940 were opened, and only completed surveys were included (n = 1133). ERI was reported by 71% of the respondents including 49% of trainees. More than half of the respondents reported pain in the thumbs (64%), hand/fingers (59%), neck (57%), and lower back (54 %). The most common causes of ERI reported were torqueing with the right hand (64%), adjusting tip angulation with left hand (53%), standing for prolonged periods of time (59%), and standing in awkward positions while supporting an endoscope (58 %). While no differences were noted in characteristics associated with overall ERI, including sex ( P = 0.77), performance of interventional endoscopy or a focus in another GI domain ( P = 0.55) women were more likely to have upper extremity pain and upper back pain (see Table 2). There were statistically significant differences between genders in the mechanisms of ERI (see Table 3). Most respondents did not receive training during fellowship (68%), or discuss ergonomic strategies in their current practice (63%). Those without training in ergonomics were more likely to report ERI ( P = 0.02). 81 % of respondents noted a desire for more training in ergonomic strategies to reduce ERI. CONCLUSION: The results of this study show an overwhelming occurrence of ERI in all GI physicians and in nearly half of the trainee respondents. Preliminary analysis shows a significant difference between men and women with regards to specific areas of ERI and contributing mechanisms. Results strongly support training and a desire for continued education in ergonomic strategies as a preventative strategy. Education and prevention of ERI represent rich opportunities for improving key aspects of clinical practice, reducing burden on physicians, and decreasing interruptions to clinical care.

Background and aim Although Non-steroidal anti-inflammatory drugs reduce colorectal adenoma burden in familial adenomatous polyposis (FAP), the utility of combining chemopreventive agents in FAP is not known. We conducted a randomised trial of celecoxib (CXB) versus CXB+diflouromethylornithine (DFMO) to determine the synergistic effect, if any. Methods The primary endpoint was % change in adenoma count in a defined field. Secondary endpoints were adenoma burden (weighted by adenoma diameter) and video review of entire colon/rectal segments. Adverse event (AEs) were monitored by National Cancer Institution toxicity criteria. Results 112 subjects were randomised: 60 men and 52 women at a mean age of 38 years. For the 89 patients who had landmark-matched polyp counts available at baseline and 6 months, the mean % change in adenoma count over the 6 months of trial was −13.0% for CXB+DFMO and −1.0% for CXB (p=0.69). Mean % change in adenoma burden was −40% (CXB+DFMO) vs −27% (CXB) (p=0.13). Video-based global polyp change was −0.80 for CXB+DFMO vs −0.33 for CXB (p=0.03). Fatigue was the only significant AE, worse on the CXB arm (p=0.02). Conclusions CXB combined with DFMO yielded moderate synergy according to a video-based global assessment. No significant difference in adenoma count, the primary endpoint, was seen between the two study arms. No evidence of DFMO-related ototoxicity was seen. There were no adverse cardiovascular outcomes in either trial arm and no significant increase in AEs in the CXB+DFMO arm of the trial. Differences in outcomes between primary and secondary endpoints may relate to sensitivity of the endpoint measures themselves. Trial registration number ClinicalTrials.gov number N01-CN95040.

Abstract Background: Individuals with a strong family history of colorectal cancer have significant risk for colorectal cancer, although adherence to colonoscopy screening in these groups remains low. This study assessed whether a tailored telephone counseling intervention can increase adherence to colonoscopy in members of high-risk families in a randomized, controlled trial. Methods: Eligible participants were recruited from two national cancer registries if they had a first-degree relative with colorectal cancer under age 60 or multiple affected family members, which included families that met the Amsterdam criteria for hereditary non-polyposis colon cancer (HNPCC), and if they were due for colonoscopy within 24 months. Participants were randomized to receive a tailored telephone intervention grounded in behavioral theory or a mailed packet with general information about screening. Colonoscopy status was assessed through follow-up surveys and endoscopy reports. Cox proportional hazards models were used to assess intervention effect. Results: Of the 632 participants (ages 25–80), 60% were female, the majority were White, non-Hispanic, educated, and had health insurance. Colonoscopy adherence increased 11 percentage points in the tailored telephone intervention group, compared with no significant change in the mailed group. The telephone intervention was associated with a 32% increase in screening adherence compared with the mailed intervention (HR, 1.32; P = 0.01). Conclusions: A tailored telephone intervention can effectively increase colonoscopy adherence in high-risk persons. This intervention has the potential for broad dissemination to healthcare organizations or other high-risk populations. Impact: Increasing adherence to colonoscopy among persons with increased colorectal cancer risk could effectively reduce incidence and mortality from this disease. Cancer Epidemiol Biomarkers Prev; 23(4); 601–10. ©2014 AACR.