The Customer Is Always Right: A Survey to Determine Endoscopists Preferences for More Ergonomically-Designed Colonoscopes

Introduction: Survey based studies show a high prevalence of endoscopy related injury (ERI), with 75% of respondents reporting pain and injury in a recent survey of almost 1700 endoscopists. A biomechanical study identified high risk exposures during endoscopy due to holding and manipulating the control section and insertion tube, providing strong evidence that the current design of the endoscope contributes to ERI. Eliminating and substituting these high-risk exposures are the most effective mitigation measures in the hierarchy of controls, and require industry solutions. Methods: The ACG Ergonomics task force (ETF) conducted a 26-item anonymous, electronic , multiple-choice survey to evaluate the preferences of ACG members in redesigning a more ergonomic colonoscope. Information obtained included demographic data (age, gender), workload parameters (current practice type, years practicing, time spent performing endoscopy), questions related to endoscope maneuvers and design (hand size, ease of use of tip angulation controls, impact of shaft parameters, use of right-hand torque, use of dial extenders, future desired design changes) and injury prevention strategies. There were 455 respondents (4.7% response rate). Data analysis was performed using SAS Enterprise Guide 7.0 (SAS Institute, Cary, NC). Outcomes with P ≤ 0.05 were considered statistically significant. Results: The survey respondents were broadly representative of ACG’s membership with 55.33% in private practice, 31.4% women, and 51.54% having > 10 years in practice. 85.68% favored a pro-ergonomic colonoscope redesign, with customizability for hand size of the control knobs (85%) and decreased force required for “up/down” knob manipulation (78%) being the most desired features. Women were statistically more likely to desire such changes ( P < 0.001). While 70.3% of respondents would prefer that the shaft require less torque during insertion, there was no consensus on which design they preferred to achieve that end. Greater than 95% deemed ergonomics as “very” or “extremely” important. Conclusion: Given the known high prevalence of ERI among endoscopist, it is not surprising that the vast majority of survey respondents desire modifications in the current colonoscope, particularly as regards customizable and more easily manipulated control surfaces. Professional societies and industry should work together to design scopes more aligned with best ergonomic principles.