Background and study aims Endoscopy is considered the third highest generator of waste within healthcare. This is of public importance as approximately 18 million endoscopy procedures are performed yearly in the United States and 2 million in France. However, a precise measure of the carbon footprint of gastrointestinal endoscopy (GIE) is lacking. Methods This retrospective study for 2021 was conducted in an ambulatory GIE center in France where 8’524 procedures were performed on 6’070 patients. The annual carbon footprint (CF) of GIE was calculated using “Bilan Carbone” of the French Environmental and Energy Management Agency. This multi-criteria method accounts for direct and indirect greenhouse gas (GHG) emissions from energy consumption (gas and electricity), medical gases, medical and non-medical equipment, consumables, freight, travel and waste. Results Greenhouse gas emissions in 2021 are estimated at 241 tonnes CO2 equivalents (CO2e) at the center, giving a carbon footprint for one GIE procedure at 28·4 kg CO2e. The main greenhouse gas emission, 45 % of total, is from travel by patients and professionals at the center. Other emission sources, in rank order, are medical and non-medical equipment (32%), energy consumption (12%), consumables (7%), waste (3%), freight (0·4%) and medical gases (0·005%). Conclusions This is the first multi-criteria analysis assessing carbon footprint of gastrointestinal endoscopy. It highlights that travel, medical equipment and energy are major sources of this footprint, waste being a minor contributor. This study provides an opportunity to raise awareness among gastroenterologists of the carbon footprint of GIE procedures.

Endoscopic submucosal dissection (ESD) was developed in Japan but has now also become permanently established in various centers in Europe. ESD is an endoscopic en bloc mucosal resection technique for the treatment of early cancers with a diameter >1 cm and also superficial precancerous lesions, which could only be removed unsatisfactorily in several fragments or with uncertain lateral safety margins using previous loop excision procedures. Using ESD a lesion is excised after circular marking and generous submucosal injection with a safety margin of approximately 5 mm and subsequently resected at the level of the submucosa with a 1-3 mm short diathermic knife. ESD requires high technical skills in interventional endoscopy and is more time-consuming than snare resection techniques. However, numerous studies have shown a clear superiority for ESD with respect to the R0 resection rate and the local recurrence rate. The present article gives a current review of the use of ESD in the upper and lower gastrointestinal tract and demonstrates perspectives of the procedure.

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