Carbon footprint of routine endoscopic procedures – a comprehensive assessment in three US endoscopy units

Aims GI endoscopy is a procedure intensive specialty with high utilization of single use instruments and supplies. However, there has been a lack of carbon footprint analyses that encompass all aspects of GI endoscopy care. Our goal was to perform a comprehensive assessment of the carbon footprint of routine colonoscopies and upper endoscopies (EGD). Methods We conducted a prospective review of endoscopic procedures performed during a one-week audit at three diverse United States (US) endoscopy units. Cradle-to-grave life cycle assessment (LCA) was applied to measure the global warming potential expressed as kgCO2e following ISO-1404 standards. We considered all aspects of pre, intra, and postprocedural care and established a detailed life cycle inventory of all instruments, supplies, and medications used (referred to as supplies). We further included emissions related to patient travel, endoscope reprocessing, energy needs, and heating ventilation and air conditioning (HVAC); the latter using a mathematical model that considered unit space, building specifications, temperature variations, and geographic location (New England with predominant fossil fuel energy source). Based on prior surgical LCAs we planned to audit a minimum of 10 colonoscopies and 10 EGDs at each unit. Environmental impact assessment was performed using the Ecoinvent database and the TRACI method. Our primary outcome of interest was the carbon footprint of performing a routine endoscopy. We further examined contribution of emission sources and compared colonoscopy and upper endoscopy emissions. Results A total of 131 routine endoscopies were audited (71 colonoscopies, 36 EGDs, and 24 colonoscopies/EGDs). 45.5% were performed with moderate sedation and 54.5% with monitored anesthesia care. The polyp detection rate was 60.2%, and 81.7% of the procedures used any ancillary equipment (snare, forceps, or hemoclip). The carbon footprint for performing any routine procedure was 47.8 kgCO2e (range 36.7-58.8), for a colonoscopy it was 48.8 kgCO2e (range 37.2-59.4), and for an EGD it was 48.1 kgCO2e (range 37.2-59.4). Among all routine procedures, 48.6% of the carbon footprint (23.3 kgCO2e) was related to energy and HVAC use, while patient travel (predominantly in rural locations) made up 24.4% (11.7 kgCO2e). Supplies represented only 21.0% (10.0 kgCO2e) and reprocessing 6.0% (2.9 kgCO2e). The most pronounced variation between endoscopy units was seen for energy and HVAC emissions ranging from 12.3 to 34.2 kgCO2e. Performing EGD and colonoscopy for a patient on the same day reduced the carbon footprint by 7.9%. Conclusions This comprehensive analysis examined the carbon footprint for performing routine endoscopies in US practice. Energy and HVAC use (scope 1 and 2 emissions) were the major contributor (49%), and supplies (scope 3 emissions) made up only 21%. While emissions related to supplies confirm findings of a recent French study (10.0 vs 9.0 kgCO2e), travel and energy/HVAC emissions will vary based on location. Detected variations between endoscopy units will serve to identify alternative endoscopy practices to lower emissions. Publication History Article published online: 27 March 2025 © 2025. European Society of Gastrointestinal Endoscopy. All rights reserved. Georg Thieme Verlag KG Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany

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