Disposable Instruments Used During Endoscopic Procedures Produce Large Amounts of Waste Annually in US

Interior treatment room with digital endoscope for diagnosis of hollow organs, colonoscopy, gastroscopy in multidisciplinary Clinic.
Researchers estimated the average disposable waste produced from endoscopic procedures performed in the United States.

An endoscopic procedure generates about 2 kg of disposable waste from periprocedural, single-use disposable materials and supplies, according to a study in Gut.

These findings are based on an audit of waste generated during endoscopic procedures at 1 low- and 1 high-endoscopy volume academic medical center during 5 workdays from January to February 2020.

Researchers calculated the average disposable waste, excluding waste from reprocessing, produced in 1 endoscopic procedure in order to estimate the waste from all endoscopic procedures (18 million performed during 2013 in the United States). They then estimated the effect of changing from reusable endoscopes to single-use endoscopes.

A total of 278 endoscopies were conducted in 243 patients at the hospitals during the 5-day period. The total waste produced for these procedures filled 190 20-gallon waste bins and weighed 619 kg.

About 64% of the waste was sent to a landfill, 28% was biohazard waste, and 9% was recycled. At the high-volume hospital, 29% of waste volume (16% of waste mass) was recycled, and the low-volume hospital did not recycle any waste.

Each endoscopy generated, on average, 2.1 kg of waste mass, filling 0.6 waste bins, and 2.4 kg when waste from reprocessing was included (0.7 waste bins). Waste varied between the hospitals more in volume (relative difference [RD], 1.37) compared with mass (RD, 1.15).

The total waste produced from disposable single-use supplies would fill more than 11 million waste bins and weigh 42,000 US tons, when the average waste estimates were applied from the low-volume and high-volume centers to all endoscopic procedures performed annually in the United States, noted the investigators.

If colonoscopies and endoscopic retrograde cholangiopancreatography were conducted with FDA-approved single-use instead of reusable endoscopes, the waste mass related to reprocessing endoscopes would decrease by 62%, although the net waste mass per endoscopic procedure would increase by 25%, according to the study authors. If all endoscopies used single-use endoscopes, the total net waste mass would increase by 40%, even after the lack of waste from reprocessing was accounted for.

The overall waste from only reprocessing a reusable endoscope in its lifetime (minimum of 2000 procedures) would be 610 kg. Single-use endoscopes, however, would generate 2520 kg of waste to attain the same number of procedures; this represents a 4.1-fold increase in waste and net of 1.0 kg per single-use endoscope when only waste from reprocessing and endoscope disposal are considered.

The researchers noted that their waste estimates may not represent all endoscopy units and disposition of waste may vary. Additionally, measuring waste mass and volume is imprecise, and cost was not considered.

“We need to better quantify the environmental impact of performing endoscopies and identify ways to minimi[z]e this impact,” stated the study authors. “Any cost-benefit analyses of endoscopy should also consider potential environmental harms.”

Reference

Namburar S, von Renteln D, Damianos J, et al. Estimating the environmental impact of disposable endoscopic equipment and endoscopes. Gut. Published online December 1, 2021. doi: 10.1136/gutjnl-2021-324729