How Can Health Care Systems Reduce the Carbon Footprint in Endoscopic Practice?

Footprints made out of fresh green grass, say on a dry cracked earth base.
Researchers discuss alternatives to endoscopy procedures as a way to help reduce health care systems’ carbon footprint.

Providing quality triage, rationalizing histopathology requests, and streamlining waste management are among the ways health care systems can help reduce the carbon footprint of gastrointestinal (GI) endoscopy, according to a commentary published in Gastroenterology.

GI endoscopy requires significant resources, which collectively contribute to carbon emissions. Some of the contributors include single-use consumables, repeated patient and family travel, multiple nonrenewable waste streams, and resource-heavy decontamination processes. The authors of the commentary, Robin Baddeley et al, offered suggestions for how health care systems can work toward decarbonization in endoscopic practice.

The researchers emphasized that the most effective way to mitigate the carbon footprint of endoscopy is to reduce the number of unnecessary endoscopic procedures performed. Researchers also recommended alternatives to endoscopy, such as home-based noninvasive tests like fecal calprotectin and fecal immunochemical test.

Operational inefficiencies in an endoscopy department present another opportunity for decarbonization, the researchers noted, citing oversurveillance and inappropriate endoscopy referrals among the challenges in an administrative setting. Other recommendations for environmental friendly practices included opting for digitalization of items vs paper use, using recycled paper when possible, and installing low-energy LED lighting in the facility to minimize electricity use.

Among procedural adjustments, researchers recommend that clinicians consider alternatives to nitrous oxide, which contains 300 times the global warming potential of carbon dioxide, according to the commentary. Reusable bottles and water from potable water filtration systems were recommended for intraprocedural water use. The water could be installed on taps, ultimately with the goal of reducing the significant quantities of sterile bottled water that are used in colonoscopies.

The authors also highlighted that the processing of GI biopsies is an added energy expenditure, generates hazardous waste, and incurs a significant carbon footprint. Thus, ensuring appropriate biopsies are undertaken, or avoided altogether if they would not alter therapeutic management, should be considered.

“Perhaps the challenge for our generation of endoscopists is not so much technical as it is structural: to bend the shape of endoscopy’s wasteful linear economy into something altogether more restorative and circular,” the commentary authors wrote.


Baddeley R, Aabakken L, Veitch A, Hayee B. Green endoscopy: counting the carbon cost of our practice. Gastroenterology. Published online February 17, 2022. doi: 10.1053/j.gastro.2022.01.057