1192 Evaluating Ergonomics in Endoscopy Through Surveying Faculty and Trainee Gastroenterologists in Academic Centers

Abstract

Background & Aims: In the esophagogastroduodenoscopy (EGD) to diagnose upper gastrointestinal disorders, there is a difference in the detection rate of the lesion because of differences in proficiency of the endoscopists and anatomical blind spots. The aim of this study is to identify gaze pattern and blind spot by analyzing the gaze of endoscopist during real-time EGD according to endoscopic proficiency by applying eye-tracking technique. Methods: In this study, 5 endoscopists consist of 3 experts and 2 novices performed 37 EGDs. The measured gaze across the endoscopy monitor acquired by performing EGD while wearing eye-tracker was matched with medical photos taken during EGD. Interval where the analysis was performed among the observation ranges includes from Z-line to 2 nd portion of duodenum during insertion, stomach and to Z-line during withdrawal of the scope, not including the esophagus. The frequency and observation time of the gaze are visualized as heatmaps, and gaze movements as gaze plots. The observation time (OT), duration of fixation (FD), FD to OT ratio, gaze pattern and blind spot were analyzed. Results: In five endoscopists, the mean of OT from Z-line to Z-line was 2.38 AE 0.53 min, FD was 1.80 AE 0.51min, and fixation to observation time ratio was 74.8%. The 34.3% of the time was spent to observe antrum. Although the total OT and FD were longer in novice (9.7AE8.3 vs 12.58AE13.31, P Z 0.006, 7.2AE6.3 vs 9.6AE10.9, P Z 0.004), the FD to OT ratio showed no difference between experts and novices (73.0% vs 72.0%, P Z 0.360). When comparing the gaze pattern observed at the same time for the same area, experts observe linearly while the gaze of novice was scattered (Figure 1). When observing the body in the retroflexion view, experts observed the overall well without blind spot, but the novice showed a limited observation in the posterior wall of body (Figure 2). Conclusion: It is necessary to minimize the distraction of gaze and to pay attention to the observation of the posterior wall with the retroflexion view in novice. Also, the eye-tracking technique may be useful for endoscopic training in the future.