BACKGROUND: Endoscopy-related musculoskeletal injuries (ERIs) are a major occupational hazard, impacting career longevity and personal well-being. OBJECTIVE: This systematic review and meta-analysis aimed to update and expand on previous findings by assessing prevalence, risk factors and management of ERIs among endoscopists. METHODS: Following PRISMA guidelines, we systematically searched MEDLINE, Web of Science and Scopus for relevant studies published since the last comprehensive review. A manual search of the references of relevant manuscripts was also performed. Outcomes of interest included the prevalence of ERIs, common pain syndromes, risk factors, and preventive or treatment strategies. Studies' quality was assessed using the National Institutes of Health (NIH) Quality Assessment Tool. RESULTS: Thirty studies were included, incorporating data from 7646 gastrointestinal endoscopists. The pooled career-long prevalence of overall ERI was 62.5% (CI 52.6-71.8, I CONCLUSION: ERIs are highly prevalent among international gastrointestinal endoscopists, and are linked to procedural volume, years in practice, and gender. Ergonomic training and workplace adaptations are essential to mitigate risks and support career sustainability. TRIAL REGISTRATION: PROSPERO Registration: CRD42024534349.