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Gastroenterologists are exposed daily to musculoskeletal (MSK) stress during upper and lower gastrointestinal endoscopy, both during routine endoscopies and during long, demanding therapeutic procedures. There is evidence that endoscopy-related MSK injuries are becoming more common, particularly in the back, neck, shoulders, elbows, and hands. The aims of this study were to identify the most stressed muscle groups during endoscopy; to measure their activity using surface electromyographical (EMG) sensors; to detect areas of muscle overload; and to identify the number of microbreaks taken in specific muscles. Furthermore, we measured differences in the loading of these muscle groups with and without the use of special support systems such as a belt-like holder. Measurements were performed on 15 subjects (7 experienced endoscopists and 8 non-endoscopists). Due to this small sample size, inside each group, we achieved inconclusive results regarding statistically significant differences in different muscle groups. We increased the sample size by comparing all participants with and without the belt support system, disregarding their endoscopic background. There was a statistically significant difference (p < 0.05) in muscle tension and in levels of microbreaks in the muscles of the left forearm, biceps, and trapezius muscles. No statistically significant difference was observed in the muscle tension and level of microbreaks in the left deltoid muscle (p > 0.05). We hypothesize that the increased level of muscle loading and decreased level of microbreaks in the deltoid muscle are due to different muscle activity and different shoulder movements. Additionally, the deltoid muscle is not connected to the kinetic chain of body posture and stabilization. It is our belief that MSK injuries in gastrointestinal (GI) endoscopy can be prevented with the use of a belt-like support system.

GI endoscopy forms an important part in the daily practice of a gastroenterologist. Musculoskeletal injuries related to GI endoscopy are on the rise. Observational studies and surveys depict the importance of a proper ergonomic environment when performing GI endoscopy. Our aim is to describe the pathophysiology, risk factors and possible preventive measures to reduce the risk of musculoskeletal injuries during gastrointestinal (GI) endoscopy. We review the most relevant studies that outline the gravity of the problem. A detailed analysis of proposed ergonomic recommendations is performed, outlining crucial steps in injury prevention. Proper ergonomic education is a key step in preventing occupational injury. Robotics and other mechanical solutions offer a variety of approaches to tackling the ergonomic challenge. Implementing proper ergonomic education and mechanical solutions lowers the possibility of occupational injury. The strategies and appliances presented are beneficial to all GI endoscopy practitioners.