Introduction
Serious adverse events (SAEs) are frequent occurrences in endoscopy and especially for those performing complex endoscopic interventions. These events may be life altering for the patient (the first victim); however, it is unclear how impactful they are to the endoscopist (the second victim). While the psychological impact on surgeons of complications has been well studied, that for endoscopists has not. We aimed to assess the psychological impacts of SAEs on interventional endoscopists and subsequent coping mechanisms.

Methods
An IRB-approved survey, incorporating demographic information and questions from DSM-5 certified Post-Traumatic Stress Disorder screening questionnaires, was created using the Harvard Qualtrics software. This anonymous survey was posted on the platform “X”, formerly known as “Twitter”, to allow those globally to voluntarily participate during the months of July 2023 to October 2023. Those who were not interventional endoscopists or who practiced in the European Union (lack of research agreement between these countries and primary institution) were excluded. T-test and one-way ANOVA were used for statistical analysis.

Results
There were 195 participants in the survey, with 131 completed surveys. 154 (78.97%) experienced SAEs during endoscopy and 142 (72.82%) felt psychologically impacted by them. Perforation was the most frequent impactful SAE (46.47%), followed by death (26.76%). Age of the endoscopist was an independent factor of nervousness after SAEs and the older the endoscopist, the less likely they were to be nervous [F=2.88, p=0.03]. The more years of practice one had, the less likely they were to be significantly nervous after experiencing a SAE. More years of practice correlated to higher likelihood of developing anger/frustration after SAEs [F=3.36, p=0.02]. Endoscopists who performed 500-1000 procedures/year were more likely to develop physical reactions [F=2.98, p=0.03] and nightmares [F=2.76, p=0.04] after SAEs, yet those who were over 1000 procedures/year were less likely to be as affected. Race [t=6.94, p=0] and ethnicity [t=-2.08, p=0.03] were independent factors in speaking with colleagues/mentors in an effort to cope with the SAE. Those who were older had more benefit in coping from meditation [F=3.60, p=0.01]. 1 endoscopist sought help from a therapist and 3 increased their visit frequency after the SAE. 7 centers had a program to support physicians following SAEs and 120 did not.

Discussion
SAEs take a significant physical and mental toll on the endoscopist, more than currently recognized. Impact and coping strategies vary by endoscopist age, experience, race and other characteristics. Lack of programmatic support for physicians appears universal and institutions need to prioritize developing these in the future to ensure the mental health and wellbeing of these physicians.

Turki Abdullah Alarmi

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