The carbon footprint of ambulatory gastrointestinal endoscopy

Abstract

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.

28 kg of carbon dioxide per endoscopic procedure. Time to make green endoscopy a professional priority

“…One of the striking findings is that patient and staff transport accounted for 45 % of the carbon footprint [9], above previously reported healthcare data. This percentage would likely be lower if the study were conducted in a better-connected hospital.…”

“…In this issue of Endoscopy, Lacroute et al [9] present the results of a retrospective study conducted in 2021 in an ambulatory GI endoscopy center. A total of 8524 procedures were performed.…”

Pan-intestinal capsule endoscopy as first-line procedure in patients with suspected mid or lower gastrointestinal bleeding

“…Another aspect, recently addressed in a position paper from the British Society of Gastroenterology on the topic of green endoscopy, is the potential role of capsule endoscopy as a more sustainable alternative to conventional diagnostic endoscopy [22]. However, PCE requires further evaluation regarding cost-effectiveness and its environmental impact versus the alternative endoscopic procedures [23].…”

Materials Science Toolkit for Carbon Footprint Assessment: A Case Study for Endoscopic Accessories of Common Use

“…In the context of testing our toolkit on single-use endoscopic accessories, two main aspects arose. On one side, the carbon footprint of all devices studied is relatively high (0.48−0.80 kg CO 2 eq•accessory −1 ), representing ∼40% of the total consumables footprint for a single endoscopy 23 and especially considering that all of them are single-use and that they require an endoscope to be used, i.e., 2.1 kg additional CO 2 eq• device −1 . 48 Moreover, not only differences between types of accessories were significant but also between models for the same application, depending on the brand.…”

“…The environmental impact of gastrointestinal endoscopy is widely recognized. − An endoscopy unit that performs 40 endoscopies daily generates approximately 241.4 tons of CO 2 eq annually, which is 7% of total emissions due to consumables, that is, around 16 tons of CO 2 eq In the U.S., the GHG production related to endoscopic procedures was estimated to be 85,768 t of CO 2 eq annually . Interventions to make endoscopy more sustainable are urgent to minimize our carbon footprint and avoid the worst consequences of climate change.…”