Background and study aims: The SARS-CoV-2 pandemic has strongly affected medical activity around the world. We sought to measure the impact of the COVID-19 pandemic on the gastrointestinal endoscopic activity in France. Methods: We performed a web-based survey, including 35 questions on the responders and their endoscopic practice, from March 23rd to March 27th 2020, sent to the 3300 French gastroenterologists practicing endoscopy. Results: 694 (21%) gastrointestinal endoscopists provided analyzable data. 29.4% (204/694) were involved in the management of COVID-19 patients outside the endoscopy departments, and 98.7% (685/694) of the endoscopic procedures were canceled. 12.8% (89/694) of the gastroenterologists reported symptoms compatible with COVID-19 infection, and a positive PCR was recorded in 12/197 (6.1%) vs. 3/497 (0.6%) patients in the high vs. low prevalence areas, p<0.0001. Conclusions: The COVID-19 pandemic led to a major reduction in the volume of gastrointestinal endoscopies performed in France in March 2020. The prolonged limited access to gastrointestinal endoscopy could lead to a delay in the management of patients with gastrointestinal cancers.

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.

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